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Patterns, predictors, and consequences of initial regimen type among HIV-infected women receiving highly active antiretroviral therapy.
Clin Infect Dis. 2008 Jan 15; 46(2):305-12.CI

Abstract

BACKGROUND

It is important to elucidate differences among initial highly active antiretroviral therapy (HAART) regimen types in comparative studies of therapy effectiveness. We aimed to identify predictors of initiation with different HAART regimen types and the effect of initial regimen type on switching and immunologic response to therapy--controlling for those predictors--among human immunodeficiency virus (HIV)-infected women in the United States.

METHODS

Participants in the Women's Interagency HIV Study underwent semiannual interview, venipuncture, and clinical examination. Those beginning with protease inhibitor-based, nonnucleoside reverse-transcriptase inhibitor (NNRTI)-based, or triple-nucleoside reverse-transcriptase inhibitor (NRTI)-based HAART during April 1996-March 2005 were eligible for analysis. Predictors of initial regimen type were assessed with polytomous logistic regression. Correlates of switching were assessed with discrete-time proportional hazards models, and immunologic response to therapy was assessed with linear regression.

RESULTS

Among 1555 HAART initiators, CD4(+) lymphocyte count and HIV load were significant predictors of initial regimen type during 1996-2002; only sociodemographic predictors were significant during 2002-2005. Initial regimen type was not a significant predictor of subsequent regimen switching. Compared with those whose initial treatment was protease inhibitor-based HAART, those who began with triple-NRTI-based regimens had significantly lower CD4(+) cell counts at 1 year (P=.006) and 2 years (P=.004) after initiation; NNRTI initiators had lower CD4(+) cell counts after 2 years (P=.05).

CONCLUSIONS

We demonstrate that predictors of initial regimen type among women in the United States have been changing over time. Protease inhibitor initiators had significantly higher CD4(+) cell counts than did NNRTI or triple-NRTI initiators up to 2 years after HAART initiation. Adjustment for biological predictors of initial regimen is important to avoid confounding in the study of treatment effectiveness.

Authors+Show Affiliations

Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, Maryland 21205, USA. egolub@jhsph.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

18171267

Citation

Golub, Elizabeth T., et al. "Patterns, Predictors, and Consequences of Initial Regimen Type Among HIV-infected Women Receiving Highly Active Antiretroviral Therapy." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, vol. 46, no. 2, 2008, pp. 305-12.
Golub ET, Benning L, Sharma A, et al. Patterns, predictors, and consequences of initial regimen type among HIV-infected women receiving highly active antiretroviral therapy. Clin Infect Dis. 2008;46(2):305-12.
Golub, E. T., Benning, L., Sharma, A., Gandhi, M., Cohen, M. H., Young, M., & Gange, S. J. (2008). Patterns, predictors, and consequences of initial regimen type among HIV-infected women receiving highly active antiretroviral therapy. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 46(2), 305-12. https://doi.org/10.1086/524752
Golub ET, et al. Patterns, Predictors, and Consequences of Initial Regimen Type Among HIV-infected Women Receiving Highly Active Antiretroviral Therapy. Clin Infect Dis. 2008 Jan 15;46(2):305-12. PubMed PMID: 18171267.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Patterns, predictors, and consequences of initial regimen type among HIV-infected women receiving highly active antiretroviral therapy. AU - Golub,Elizabeth T, AU - Benning,Lorie, AU - Sharma,Anjali, AU - Gandhi,Monica, AU - Cohen,Mardge H, AU - Young,Mary, AU - Gange,Stephen J, PY - 2008/1/4/pubmed PY - 2008/2/27/medline PY - 2008/1/4/entrez SP - 305 EP - 12 JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin Infect Dis VL - 46 IS - 2 N2 - BACKGROUND: It is important to elucidate differences among initial highly active antiretroviral therapy (HAART) regimen types in comparative studies of therapy effectiveness. We aimed to identify predictors of initiation with different HAART regimen types and the effect of initial regimen type on switching and immunologic response to therapy--controlling for those predictors--among human immunodeficiency virus (HIV)-infected women in the United States. METHODS: Participants in the Women's Interagency HIV Study underwent semiannual interview, venipuncture, and clinical examination. Those beginning with protease inhibitor-based, nonnucleoside reverse-transcriptase inhibitor (NNRTI)-based, or triple-nucleoside reverse-transcriptase inhibitor (NRTI)-based HAART during April 1996-March 2005 were eligible for analysis. Predictors of initial regimen type were assessed with polytomous logistic regression. Correlates of switching were assessed with discrete-time proportional hazards models, and immunologic response to therapy was assessed with linear regression. RESULTS: Among 1555 HAART initiators, CD4(+) lymphocyte count and HIV load were significant predictors of initial regimen type during 1996-2002; only sociodemographic predictors were significant during 2002-2005. Initial regimen type was not a significant predictor of subsequent regimen switching. Compared with those whose initial treatment was protease inhibitor-based HAART, those who began with triple-NRTI-based regimens had significantly lower CD4(+) cell counts at 1 year (P=.006) and 2 years (P=.004) after initiation; NNRTI initiators had lower CD4(+) cell counts after 2 years (P=.05). CONCLUSIONS: We demonstrate that predictors of initial regimen type among women in the United States have been changing over time. Protease inhibitor initiators had significantly higher CD4(+) cell counts than did NNRTI or triple-NRTI initiators up to 2 years after HAART initiation. Adjustment for biological predictors of initial regimen is important to avoid confounding in the study of treatment effectiveness. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/18171267/Patterns_predictors_and_consequences_of_initial_regimen_type_among_HIV_infected_women_receiving_highly_active_antiretroviral_therapy_ L2 - https://academic.oup.com/cid/article-lookup/doi/10.1086/524752 DB - PRIME DP - Unbound Medicine ER -