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Duration of first-line antiretroviral therapy with tenofovir and emtricitabine combined with atazanavir/ritonavir, efavirenz or lopinavir/ritonavir in the Italian ARCA cohort.
- Source :
-
The Journal of antimicrobial chemotherapy [J Antimicrob Chemother] 2013 Jan; Vol. 68 (1), pp. 200-5. Date of Electronic Publication: 2012 Aug 21. - Publication Year :
- 2013
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Abstract
- Objectives: To explore the durability of three first-line tenofovir/emtricitabine-based regimens in combination with atazanavir/ritonavir, efavirenz or lopinavir/ritonavir in HIV-1-infected patients.<br />Patients and Methods: A retrospective, longitudinal, multicentre analysis of adult patients enrolled in the Antiretroviral Resistance Cohort Analysis (ARCA), a national prospective observational cohort of HIV-1-infected patients followed up at more than 100 clinical and laboratory units in Italy. Patients eligible were those starting first-line antiretroviral therapy between 1 June 2004 and 15 April 2011 and who were followed up for at least 6 months. The primary endpoint was durability, defined as the time from antiretroviral therapy initiation to first treatment modification. Time-dependent events were analysed by the Kaplan-Meier approach and the Cox proportional hazard model.<br />Results: There are 26,000 HIV-infected patients in the ARCA database, of whom 1654 met study inclusion criteria. Six hundred and thirty-nine (38.6%) received efavirenz, 321 (19.4%) received atazanavir/ritonavir and 694 (41.9%) received lopinavir/ritonavir as a first-line regimen. Over a total observation period of 88 months, equivalent to more than 2805 person-years of follow-up, 618 patients underwent treatment modification. Lopinavir/ritonavir, given twice daily, was associated with a higher discontinuation rate than efavirenz- and atazanavir-based regimens [hazard ratio (HR) 1.83, 95% confidence interval (CI) 1.56-2.15, P = 0.001]. Comparing the once-daily regimens, the rate of discontinuation of efavirenz was higher than that of atazanavir/ritonavir (HR 1.39, 95% CI 1.06-1.83, P = 0.016).<br />Conclusions: Significant differences in treatment duration were observed among the three studied regimens. Once-daily regimens exhibited greater durability than the twice-daily regimen. Among the specific regimens examined, tenofovir/emtricitabine plus atazanavir/ritonavir showed the greatest durability.
- Subjects :
- Adenine administration & dosage
Alkynes
Anti-Retroviral Agents administration & dosage
Atazanavir Sulfate
Cohort Studies
Cyclopropanes
Deoxycytidine administration & dosage
Drug Resistance, Viral drug effects
Drug Resistance, Viral physiology
Drug Therapy, Combination
Emtricitabine
HIV Infections drug therapy
HIV Infections epidemiology
HIV-1 drug effects
Humans
Italy epidemiology
Longitudinal Studies
Prospective Studies
Retrospective Studies
Tenofovir
Time Factors
Adenine analogs & derivatives
Benzoxazines administration & dosage
Deoxycytidine analogs & derivatives
Lopinavir administration & dosage
Oligopeptides administration & dosage
Organophosphonates administration & dosage
Pyridines administration & dosage
Ritonavir administration & dosage
Subjects
Details
- Language :
- English
- ISSN :
- 1460-2091
- Volume :
- 68
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- The Journal of antimicrobial chemotherapy
- Publication Type :
- Academic Journal
- Accession number :
- 22915463
- Full Text :
- https://doi.org/10.1093/jac/dks339