Predictors of virological rebound in HIV-1-infected patients initiating a protease inhibitor-containing regimen
| Autor: | Françoise Brun-Vézinet, François Raffi, Lionel Piroth, Le Moing, J P Cassuto, Ahmadou Alioum, Geneviève Chêne, Jean-Paul Moatti, M P Carrieri, Catherine Leport |
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| Rok vydání: | 2002 |
| Předmět: |
Adult
Male medicine.medical_specialty Anti-HIV Agents medicine.medical_treatment Immunology HIV Infections Gastroenterology Cohort Studies Pharmacotherapy Predictive Value of Tests Surveys and Questionnaires Internal medicine medicine Humans Immunology and Allergy Risk factor Sida Chemotherapy biology Proportional hazards model business.industry Hazard ratio HIV Protease Inhibitors Viral Load biology.organism_classification Regimen Infectious Diseases HIV-1 Patient Compliance RNA Viral Reverse Transcriptase Inhibitors Drug Therapy Combination Female business Viral load |
| Zdroj: | AIDS. 16:21-29 |
| ISSN: | 0269-9370 |
| Popis: | OBJECTIVE To study the predictors of virological rebound in patients having early virological response to protease inhibitor (PI)-containing regimen. DESIGN AND METHODS APROCO cohort study prospectively enrolled 1283 HIV-infected patients starting a PI-containing regimen in 1997-1999. Adherence to therapy was measured with self-administered questionnaires after 4 months of therapy (M4). Virological rebound was defined as a viral load (VL) > 500 copies/ml in patients having early virological response, defined as a VL < 500 copies/ml at M4. Predictors of time to virological rebound were studied with multivariate proportional hazards model. RESULTS During a median follow-up of 20 months, virological rebound was observed in 32% of the 830 patients with early virological response. Virological rebound was more frequent when patients had received previous antiretroviral treatment [adjusted hazards ratio (HR) = 2.4; P < 0.0001], were younger (HR = 1.4 per each 10 years younger; P < 0.0001), had baseline CD4 cell count < 500 x 106/l (HR = 2.3; P < 0.001), had higher baseline VL (HR = 1.4 per each log10 copies/ml higher; P < 0.001), reported low adherence to therapy at M4 (HR = 2.1; P < 0.001) or had stopped PI at M4 (HR = 1.7; P = 0.04). CONCLUSION Initiation of treatment at a stage of preserved immunity is associated with a more durable virological response under protease inhibitor. Every effort should be made to monitor and strengthen adherence to therapy, even in patients having early virological response. |
| Databáze: | OpenAIRE |
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