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HIV Med. 2018 May;19(5):324-338. doi: 10.1111/hiv.12581. Epub 2018 Feb 1.

Long-term effectiveness of recommended boosted protease inhibitor-based antiretroviral therapy in Europe.

Collaborators (158)

Losso M, Kundro M, Schmied B, Zangerle R, Karpov I, Vassilenko A, Mitsura VM, Paduto D, Clumeck N, Delforge M, Florence E, Vandekerckhove L, Begovac J, Machala L, Jilich D, Kronborg G, Benfield T, Gerstoft J, Katzenstein T, Møller NF, Ostergaard L, Wiese L, Nielsen LN, Zilmer K, Smidt J, Ristola M, Aho I, Viard JP, Girard PM, Pradier C, Fontas E, Rockstroh J, Schmidt R, Degen O, Stellbrink HJ, Stefan C, Fätkenheuer G, Chkhartishvili N, Gargalianos P, Xylomenos G, Lourida P, Sambatakou H, Szlávik J, Gottfredsson M, Mulcahy F, Yust I, Turner D, Burke M, Shahar E, Elinav H, Haouzi M, Elbirt D, Sthoeger ZM, D'Arminio Monforte A, Esposito R, Mazeu I, Mussini C, Mazzotta F, Gabbuti A, Vullo V, Lichtner M, Zaccarelli M, Antinori A, Acinapura R, Plazzi M, Castagna A, Gianotti N, Galli M, Ridolfo A, Rozentale B, Uzdaviniene V, Matulionyte R, Staub T, Hemmer R, Ormaasen V, Maeland A, Bruun J, Knysz B, Gasiorowski J, Inglot M, Horban A, Bakowska E, Flisiak R, Grzeszczuk A, Parczewski M, Pynka M, Maciejewska K, Mularska E, Smiatacz T, Gensing M, Jablonowska E, Malolepsza E, Wojcik K, Mozer-Lisewska I, Caldeira L, Mansinho K, Maltez F, Radoi R, Panteleev A, Panteleev O, Yakovlev A, Trofimora T, Kuzovatova E, Borodulina E, Vdoushkina E, Jevtovic D, Tomazic J, Gatell JM, Miró JM, Moreno S, Rodriguez JM, Clotet B, Jou A, Tural C, Puig J, Bravo I, Domingo P, Gutierrez M, Mateo G, Sambeat MA, Laporte JM, Falconer K, Thalme A, Sonnerborg A, Flamholc L, Scherrer A, Weber R, Cavassini M, Calmy A, Furrer H, Battegay M, Kuznetsova A, Kyselyova G, Gazzard B, Johnson AM, Simons E, Edwards S, Johnson MA, Mocroft A, Weber J, Scullard G, Clarke A, Leen C, Gatell J, Ledergerber B, Lundgren J, Kirk O, Peters L, Matthews C, Fischer AH, Bojesen A, Raben D, Kristensen D, Podlekareva D, Shepherd L, Schultze A, Thiebaut R, Burger D.

Author information

1
Fight Against AIDS Foundation, Germans Trias i Pujol University Hospital, Barcelona, Spain.
2
Royal Free and University College, London, UK.
3
Centre Hospitalier Universitaire Saint-Pierre, Brussels, Belgium.
4
Odense University Hospital, Odense, Denmark.
5
Academic Medical Center, Amsterdam, the Netherlands.
6
Karolinska Institute, Venhälsan, Stockholm, Sweden.
7
San Raffaele Scientific Institute, Milan, Italy.
8
Lviv Regional HIV/AIDS Prevention and Control Centre, Kiev, Ukraine.
9
Royal London Hospital, London, UK.
10
Hôpital Necker-Enfants Malades, Paris, France.
11
Medizinische Poliklinik, Munchen, Germany.
12
The General Hospital of Athens "G. Gennimatas", Athens, Greece.
13
Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
14
Rambam Health Care Campus, Haifa, Israel.
15
Centre for HIV/AIDS and Infectious Diseases, Moscow, Russia.
16
Szpital Specjalistyczny, Chorzow, Poland.
17
Klinicki Centar Univerziteta Sarajevo (KCUS), Sarajevo, Bosnia & Herzegovina.
18
Charles University Hospital, Plzen, Czech Republic.
19
IrsiCaixa AIDS Research Institute, Barcelona, Spain.
20
Universitat de Vic-Universitat Central de Catalunya, Barcelona, Spain.
21
Rigshospitalet and University of Copenhagen, Copenhagen, Denmark.

Abstract

OBJECTIVES:

The aim of the study was to evaluate the long-term response to antiretroviral treatment (ART) based on atazanavir/ritonavir (ATZ/r)-, darunavir/ritonavir (DRV/r)-, and lopinavir/ritonavir (LPV/r)-containing regimens.

METHODS:

Data were analysed for 5678 EuroSIDA-enrolled patients starting a DRV/r-, ATZ/r- or LPV/r-containing regimen between 1 January 2000 and 30 June 2013. Separate analyses were performed for the following subgroups of patients: (1) ART-naïve subjects (8%) at ritonavir-boosted protease inhibitor (PI/r) initiation; (2) ART-experienced individuals (44%) initiating the new PI/r with a viral load (VL) ≤500 HIV-1 RNA copies/mL; and (3) ART-experienced patients (48%) initiating the new PI/r with a VL >500 copies/mL. Virological failure (VF) was defined as two consecutive VL measurements >200 copies/mL ≥24 weeks after PI/r initiation. Kaplan-Meier and multivariable Cox models were used to compare risks of failure by PI/r-based regimen. The main analysis was performed with intention-to-treat (ITT) ignoring treatment switches.

RESULTS:

The time to VF favoured DRV/r over ATZ/r, and both were superior to LPV/r (log-rank test; P < 0.02) in all analyses. Nevertheless, the risk of VF in ART-naïve patients was similar regardless of the PI/r initiated after controlling for potential confounders. The risk of VF in both treatment-experienced groups was lower for DRV/r than for ATZ/r, which, in turn, was lower than for LPV/r-based ART.

CONCLUSIONS:

Although confounding by indication and calendar year cannot be completely ruled out, in ART-experienced subjects the long-term effectiveness of DRV/r-containing regimens appears to be greater than that of ATZ/r and LPV/r.

KEYWORDS:

antiretroviral therapy-experienced patients; antiretroviral therapy-naïve patients; atazanavir/ritonavir; darunavir/ritonavir; lopinavir/ritonavir

PMID:
29388732
DOI:
10.1111/hiv.12581

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