Heavy antiretroviral exposure and exhausted/limited antiretroviral options: Predictors and clinical outcomes
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Heavy antiretroviral exposure and exhausted/limited antiretroviral options : Predictors and clinical outcomes. / Mocroft, Amanda; Pelchen-Matthews, Annegret; Hoy, Jennifer; Llibre, Josep M.; Neesgaard, Bastian; Jaschinski, Nadine; Domingo, Pere; Rasmussen, Line Dahlerup; Günthard, Huldrych F.; Surial, Bernard; Öllinger, Angela; Knappik, Michael; De Wit, Stephane; Wit, Ferdinand; Mussini, Cristina; Vehreschild, Joerg; Monforte, Antonella D.Arminio; Sonnerborg, Anders; Castagna, Antonella; Anne, Alain Volny; Vannappagari, Vani; Cohen, Cal; Greaves, Wayne; Wasmuth, Jan C.; Spagnuolo, Vincenzo; Ryom, Lene; RESPOND Cohort Collaboration.
I: AIDS, Bind 38, Nr. 4, 2024, s. 497-508.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Heavy antiretroviral exposure and exhausted/limited antiretroviral options
T2 - Predictors and clinical outcomes
AU - Mocroft, Amanda
AU - Pelchen-Matthews, Annegret
AU - Hoy, Jennifer
AU - Llibre, Josep M.
AU - Neesgaard, Bastian
AU - Jaschinski, Nadine
AU - Domingo, Pere
AU - Rasmussen, Line Dahlerup
AU - Günthard, Huldrych F.
AU - Surial, Bernard
AU - Öllinger, Angela
AU - Knappik, Michael
AU - De Wit, Stephane
AU - Wit, Ferdinand
AU - Mussini, Cristina
AU - Vehreschild, Joerg
AU - Monforte, Antonella D.Arminio
AU - Sonnerborg, Anders
AU - Castagna, Antonella
AU - Anne, Alain Volny
AU - Vannappagari, Vani
AU - Cohen, Cal
AU - Greaves, Wayne
AU - Wasmuth, Jan C.
AU - Spagnuolo, Vincenzo
AU - Ryom, Lene
AU - RESPOND Cohort Collaboration
N1 - Publisher Copyright: © 2024 Lippincott Williams and Wilkins. All rights reserved.
PY - 2024
Y1 - 2024
N2 - Objectives:People with HIV and extensive antiretroviral exposure may have limited/exhausted treatment options (LExTO) due to resistance, comorbidities, or antiretroviral-related toxicity. Predictors of LExTO were investigated in the RESPOND cohort.Methods:Participants on ART for at least 5 years were defined as having LExTO when switched to at least two anchor agents and one third antiretroviral (any class), a two-drug regimen of two anchor agents (excluding rilpivirine with dolutegravir/cabotegravir), or at least three nucleoside reverse transcriptase inhibitors. Baseline was the latest of January 1, 2012, cohort enrolment or 5 years after starting antiretrovirals. Poisson regression modeled LExTO rates and clinical events (all-cause mortality, non-AIDS malignancy, cardiovascular disease [CVD], and chronic kidney disease [CKD]).Results:Of 23 827 participants, 2164 progressed to LExTO (9.1%) during 130 061 person-years follow-up (PYFU); incidence 1.66/100 PYFU (95% CI 1.59-1.73). Predictors of LExTO were HIV duration more than 15 years (vs. 7.5-15; adjusted incidence rate ratio [aIRR] 1.32; 95% CI 1.19-1.46), development of CKD (1.84; 1.59-2.13), CVD (1.64; 1.38-1.94), AIDS (1.18; 1.07-1.30), and current CD4+cell count of 350 cells/μl or less (vs. 351-500 cells/μl, 1.51; 1.32-1.74). Those followed between 2018 and 2021 had lower rates of LExTO (vs. 2015-2017; 0.52; 0.47-0.59), as did those with baseline viral load of 200 cp/ml or less (0.46; 0.40-0.53) and individuals under 40. Development of LExTO was not significantly associated with clinical events after adjustment for age and current CD4, except CKD (1.74; 1.48-2.05).Conclusion:Despite an aging and increasingly comorbid population, we found declining LExTO rates by 2018-2021, reflecting recent developments in contemporary ART options and clinical management. Reassuringly, LExTO was not associated with a significantly increased incidence of serious clinical events apart from CKD.
AB - Objectives:People with HIV and extensive antiretroviral exposure may have limited/exhausted treatment options (LExTO) due to resistance, comorbidities, or antiretroviral-related toxicity. Predictors of LExTO were investigated in the RESPOND cohort.Methods:Participants on ART for at least 5 years were defined as having LExTO when switched to at least two anchor agents and one third antiretroviral (any class), a two-drug regimen of two anchor agents (excluding rilpivirine with dolutegravir/cabotegravir), or at least three nucleoside reverse transcriptase inhibitors. Baseline was the latest of January 1, 2012, cohort enrolment or 5 years after starting antiretrovirals. Poisson regression modeled LExTO rates and clinical events (all-cause mortality, non-AIDS malignancy, cardiovascular disease [CVD], and chronic kidney disease [CKD]).Results:Of 23 827 participants, 2164 progressed to LExTO (9.1%) during 130 061 person-years follow-up (PYFU); incidence 1.66/100 PYFU (95% CI 1.59-1.73). Predictors of LExTO were HIV duration more than 15 years (vs. 7.5-15; adjusted incidence rate ratio [aIRR] 1.32; 95% CI 1.19-1.46), development of CKD (1.84; 1.59-2.13), CVD (1.64; 1.38-1.94), AIDS (1.18; 1.07-1.30), and current CD4+cell count of 350 cells/μl or less (vs. 351-500 cells/μl, 1.51; 1.32-1.74). Those followed between 2018 and 2021 had lower rates of LExTO (vs. 2015-2017; 0.52; 0.47-0.59), as did those with baseline viral load of 200 cp/ml or less (0.46; 0.40-0.53) and individuals under 40. Development of LExTO was not significantly associated with clinical events after adjustment for age and current CD4, except CKD (1.74; 1.48-2.05).Conclusion:Despite an aging and increasingly comorbid population, we found declining LExTO rates by 2018-2021, reflecting recent developments in contemporary ART options and clinical management. Reassuringly, LExTO was not associated with a significantly increased incidence of serious clinical events apart from CKD.
KW - clinical events
KW - heavily treatment experienced
KW - limited treatment options
U2 - 10.1097/QAD.0000000000003798
DO - 10.1097/QAD.0000000000003798
M3 - Journal article
C2 - 38079588
AN - SCOPUS:85186492663
VL - 38
SP - 497
EP - 508
JO - AIDS
JF - AIDS
SN - 1350-2840
IS - 4
ER -
ID: 386563160