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Clinical outcome of HIV-infected patients with sustained virologic response to antiretroviral therapy: long-term follow-up of a multicenter cohort.
PLoS One 2006; 1:e89Plos

Abstract

BACKGROUND

Limited information exists on long-term prognosis of patients with sustained virologic response to antiretroviral therapy. We aimed to assess predictors of unfavorable clinical outcome in patients who maintain viral suppression with HAART.

METHODS

Using data collected from ten clinic-based cohorts in Spain, we selected all antiretroviral-naive adults who initiated HAART and maintained plasma HIV-1 RNA levels <500 copies/mL throughout follow-up. Factors associated with disease progression were determined by Cox proportional-hazards models.

RESULTS

Of 2,613 patients who started HAART, 757 fulfilled the inclusion criteria. 61% of them initiated a protease inhibitor-based HAART regimen, 29.7% a nonnucleoside reverse-transcriptase inhibitor-based regimen, and 7.8% a triple-nucleoside regimen. During 2,556 person-years of follow-up, 22 (2.9%) patients died (mortality rate 0.86 per 100 person-years), and 40 (5.3%) died or developed a new AIDS-defining event. The most common causes of death were neoplasias and liver failure. Mortality was independently associated with a CD4-T cell response <50 cells/L after 12 months of HAART (adjusted hazard ratio [AHR], 4.26 [95% confidence interval {CI}, 1.68-10.83]; P = .002), and age at initiation of HAART (AHR, 1.06 per year; 95% CI, 1.02-1.09; P = .001). Initial antiretroviral regimen chosen was not associated with different risk of clinical progression.

CONCLUSIONS

Patients with sustained virologic response on HAART have a low mortality rate over time. Long-term outcome of these patients is driven by immunologic response at the end of the first year of therapy and age at the time of HAART initiation, but not by the initial antiretroviral regimen selected.

Authors+Show Affiliations

Unidad de Enfermedades Infecciosas, Hospital General Universitario de Elche, Universidad Miguel Hernández, Alicante, Spain. gutierrez_fel@gva.esNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17183720

Citation

Gutierrez, Félix, et al. "Clinical Outcome of HIV-infected Patients With Sustained Virologic Response to Antiretroviral Therapy: Long-term Follow-up of a Multicenter Cohort." PloS One, vol. 1, 2006, pp. e89.
Gutierrez F, Padilla S, Masiá M, et al. Clinical outcome of HIV-infected patients with sustained virologic response to antiretroviral therapy: long-term follow-up of a multicenter cohort. PLoS ONE. 2006;1:e89.
Gutierrez, F., Padilla, S., Masiá, M., Iribarren, J. A., Moreno, S., Viciana, P., ... Perez Hoyos, S. (2006). Clinical outcome of HIV-infected patients with sustained virologic response to antiretroviral therapy: long-term follow-up of a multicenter cohort. PloS One, 1, pp. e89.
Gutierrez F, et al. Clinical Outcome of HIV-infected Patients With Sustained Virologic Response to Antiretroviral Therapy: Long-term Follow-up of a Multicenter Cohort. PLoS ONE. 2006 Dec 20;1:e89. PubMed PMID: 17183720.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical outcome of HIV-infected patients with sustained virologic response to antiretroviral therapy: long-term follow-up of a multicenter cohort. AU - Gutierrez,Félix, AU - Padilla,Sergio, AU - Masiá,Mar, AU - Iribarren,José A, AU - Moreno,Santiago, AU - Viciana,Pompeyo, AU - Muñoz,Leopoldo, AU - Gómez Sirvent,José L, AU - Vidal,Francesc, AU - López-Aldeguer,José, AU - Blanco,José R, AU - Leal,Manuel, AU - Rodríguez-Arenas,María Angeles, AU - Perez Hoyos,Santiago, AU - ,, Y1 - 2006/12/20/ PY - 2006/10/11/received PY - 2006/11/09/accepted PY - 2006/12/22/pubmed PY - 2006/12/22/medline PY - 2006/12/22/entrez SP - e89 EP - e89 JF - PloS one JO - PLoS ONE VL - 1 N2 - BACKGROUND: Limited information exists on long-term prognosis of patients with sustained virologic response to antiretroviral therapy. We aimed to assess predictors of unfavorable clinical outcome in patients who maintain viral suppression with HAART. METHODS: Using data collected from ten clinic-based cohorts in Spain, we selected all antiretroviral-naive adults who initiated HAART and maintained plasma HIV-1 RNA levels <500 copies/mL throughout follow-up. Factors associated with disease progression were determined by Cox proportional-hazards models. RESULTS: Of 2,613 patients who started HAART, 757 fulfilled the inclusion criteria. 61% of them initiated a protease inhibitor-based HAART regimen, 29.7% a nonnucleoside reverse-transcriptase inhibitor-based regimen, and 7.8% a triple-nucleoside regimen. During 2,556 person-years of follow-up, 22 (2.9%) patients died (mortality rate 0.86 per 100 person-years), and 40 (5.3%) died or developed a new AIDS-defining event. The most common causes of death were neoplasias and liver failure. Mortality was independently associated with a CD4-T cell response <50 cells/L after 12 months of HAART (adjusted hazard ratio [AHR], 4.26 [95% confidence interval {CI}, 1.68-10.83]; P = .002), and age at initiation of HAART (AHR, 1.06 per year; 95% CI, 1.02-1.09; P = .001). Initial antiretroviral regimen chosen was not associated with different risk of clinical progression. CONCLUSIONS: Patients with sustained virologic response on HAART have a low mortality rate over time. Long-term outcome of these patients is driven by immunologic response at the end of the first year of therapy and age at the time of HAART initiation, but not by the initial antiretroviral regimen selected. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/17183720/Clinical_outcome_of_HIV_infected_patients_with_sustained_virologic_response_to_antiretroviral_therapy:_long_term_follow_up_of_a_multicenter_cohort_ L2 - http://dx.plos.org/10.1371/journal.pone.0000089 DB - PRIME DP - Unbound Medicine ER -