Impact of baseline plasma HIV-1 RNA and time to virological suppression on virological rebound according to first-line antiretroviral regimen.
Résumé
Objectives: We investigated the risk of virological rebound in HIV-1-infected patients achieving virological suppression
on first-line combined ART (cART) according to baseline HIV-1 RNA, time to virological suppression and
type of regimen.
Patients and methods: Subjects were 10836 adults who initiated first-line cART (two nucleoside or nucleotide
reverse transcriptase inhibitors!efavirenz, a ritonavir-boosted protease inhibitor or an integrase inhibitor) from
1 January 2007 to 31 December 2014. Cox proportional hazards models with multiple adjustment and propensity
score matching were used to investigate the effect of baseline HIV-1 RNA and time to virological suppression
on the occurrence of virological rebound.
Results: During 411436 patient-months of follow-up, risk of virological rebound was higher in patients with
baseline HIV-1 RNA 100000 copies/mL versus ,100000 copies/mL, in those achieving virological suppression
in.6months versus ,6months, and lower with efavirenz or integrase inhibitors than with ritonavir-boosted protease inhibitors. Baseline HIV-1 RNA .100000 copies/mL was associated with virological rebound for
ritonavir-boosted protease inhibitors but not for efavirenz or integrase inhibitors. Time to virological suppression
.6months was strongly associated with virological rebound for all regimens.
Conclusions: In HIV-1-infected patients starting cART, risk of virological rebound was lower with efavirenz or
integrase inhibitors than with ritonavir-boosted protease inhibitors. These data, from a very large observational
cohort, in addition to the more rapid initial virological suppression obtained with integrase inhibitors, reinforce
the positioning of this class as the preferred one for first-line therapy.
Domaines
Santé publique et épidémiologie
Loading...