Τίτλος:
Effectiveness of Transmitted Drug Resistance Testing before Initiation of Antiretroviral Therapy in HIV-Positive Individuals
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Background:For people living with HIV, major guidelines in high-income countries recommend testing for transmitted drug resistance (TDR) to guide the choice of first-line antiretroviral therapy (ART). However, individuals who fail a first-line regimen can now be switched to one of several effective regimens. Therefore, the virological and clinical benefit of TDR testing needs to be evaluated.Methods:We included individuals from the HIV-CAUSAL Collaboration who enrolled <6 months of HIV diagnosis between 2006 and 2015, were ART-naive, and had measured CD4 count and HIV-RNA. Follow-up started at the date when all inclusion criteria were first met (baseline). We compared 2 strategies: (1) TDR testing within 3 months of baseline versus (2) no TDR testing. We used inverse probability weighting to estimate the 5-year proportion and hazard ratios (HRs) of virological suppression (confirmed HIV-RNA <50 copies/mL), and of AIDS or death under both strategies.Results:Of 25,672 eligible individuals (82% males, 52% diagnosed in 2010 or later), 17,189 (67%) were tested for TDR within 3 months of baseline. Of these, 6% had intermediate- or high-level TDR to any antiretroviral drug. The estimated 5-year proportion virologically suppressed was 77% under TDR testing and 74% under no TDR testing; HR 1.06 (95% confidence interval: 1.03 to 1.19). The estimated 5-year risk of AIDS or death was 6% under both strategies; HR 1.03 (95% confidence interval: 0.95 to 1.12).Conclusions:TDR prevalence was low. Although TDR testing improved virological response, we found no evidence that it reduced the incidence of AIDS or death in first 5 years after diagnosis. © 2019 Wolters Kluwer Health, Inc. All rights reserved.
Συγγραφείς:
Lodi, S.
Günthard, H.F.
Gill, J.
Phillips, A.N.
Dunn, D.
Vu, Q.
Siemieniuk, R.
Garcia, F.
Logan, R.
Jose, S.
Bucher, H.C.
Scherrer, A.U.
Reiss, P.
Van Sighem, A.
Boender, T.S.
Porter, K.
Gilson, R.
Paraskevis, D.
Simeon, M.
Vourli, G.
Moreno, S.
Jarrin, I.
Sabin, C.
Hernán, M.A.
Περιοδικό:
JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES
Εκδότης:
Lippincott Williams and Wilkins
Λέξεις-κλειδιά:
efavirenz; nevirapine; nonnucleoside reverse transcriptase inhibitor; RNA directed DNA polymerase inhibitor; stavudine; anti human immunodeficiency virus agent; antiretrovirus agent, acquired immune deficiency syndrome; adult; antiretroviral therapy; Article; CD4 lymphocyte count; clinical outcome; clinical practice; cohort analysis; female; human; Human immunodeficiency virus infected patient; Human immunodeficiency virus infection; major clinical study; male; nonparametric test; prevalence; priority journal; RNA virus; sensitivity analysis; transmitted drug resistance; antiviral resistance; combination drug therapy; drug effect; Human immunodeficiency virus 1; Human immunodeficiency virus infection; middle aged; virology, Adult; Anti-HIV Agents; Anti-Retroviral Agents; CD4 Lymphocyte Count; Drug Resistance, Viral; Drug Therapy, Combination; Female; HIV Infections; HIV-1; Humans; Male; Middle Aged
DOI:
10.1097/QAI.0000000000002135
