Predictors of virologic failure in HIV-1-infected patients starting highly active antiretroviral therapy in Porto Alegre, Brazil.

Abstract

OBJECTIVE:

To assess predictors of virologic response 6 months after initiation of highly active antiretroviral therapy (HAART) in a cohort of HIV-infected patients in Brazil.

METHODS:

Treatment-naive patients who started HAART between 1996 and 2004 and had information on viral load at 3-9 months were included. Information was collected on demographic characteristics, antiretroviral regimen, adherence, AIDS diagnosis, baseline CD4 cell count, and viral load. Virologic failure (VF) was defined as viral load > or =400 copies/mL at 6 months or death before completion of 6 months of therapy.

RESULTS:

Among 454 patients who met the inclusion criteria, VF occurred in 127 (28.0%). In univariate analysis, VF was associated with younger age (median 34 vs. 37 years, P = 0.003), AIDS diagnosis (relative risk [RR] 1.18, P = 0.009), higher baseline viral load (5.34 vs. 5.00, P = 0.0002), lower baseline CD4 cell count (86 vs. 182, P = 0.006), nonadherence (RR 1.39, P < 0.0001), regimen containing 1 single protease inhibitor, as compared with ritonavir-boosted regimens (odds ratio [OR] 8.5, P < 0.0001), and year therapy initiated before 1999 (P < 0.0001). To minimize the systematic effect of therapy indication, we analyzed the subset of 158 patients with CD4 count < or =200 cells/microL who started therapy after 1999. After adjusting for age, education, adherence, regimen, and baseline viral load, nonadherence (OR 8.78, P = 0.02), and fewer years of education (OR 6.05, P = 0.05) remained associated with VF.

CONCLUSIONS:

A significant improvement was found in virologic suppression over time, consistent with the introduction of nonnucleoside reverse transcriptase inhibitors and ritonavir-boosted regimens into clinical practice. With currently available therapies, compliance and education were shown to be predictors of virologic response, particularly in more immunocompromised patients.

• Authors: Suely H Tuboi, Lee H Harrison, Eduardo Sprinz, Ricardo K M Albernaz, Mauro Schechter
• Journal: Journal of acquired immune deficiency syndromes (1999) (J Acquir Immune Defic Syndr) Vol. 40 Issue 3 Pg. 324-8 (Nov 01 2005) ISSN: 1525-4135 [Print] United States
• PMID: 16249707 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-HIV Agents

Topics

• Acquired Immunodeficiency Syndrome (immunology)
• Adult
• Anti-HIV Agents (therapeutic use)
• Antiretroviral Therapy, Highly Active
• Brazil
• Cohort Studies
• Disease Progression
• Female
• HIV Infections (drug therapy, virology)
• HIV-1 (isolation & purification)
• Humans
• Immunocompromised Host
• Male
• Patient Compliance
• Patient Education as Topic
• Risk Factors
• Viral Load