Response to first-line ritonavir-boosted protease inhibitors (PI/r)-based regimens in HIV positive patients presenting to care with low CD4 counts: Data from the Icona Foundation Cohort

A. D'Arminio Monforte, Alessandro Cozzi-Lepri, F. Maggiolo, G. Rizzardini, P. E. Manconi, Nicola Gianotti, T. Quirino, Carmela Pinnetti, Stefano Rusconi, A. De Luca, Andrea Antinori, M. Andreoni, G. Angarano, Francesco Castelli, R. Cauda, Giovanni Di Perri, Massimo Galli, R. Iardino, Giuseppe Ippolito, Adriano LazzarinCarlo Federico Perno, F. Von Schloesser, P. Viale, Antonella Castagna, F. Ceccherini-Silberstein, Enrico Girardi, S. Lo Caputo, Cristina Mussini, Massimo Puoti, Adriana Ammassari, Claudia Balotta, Alessandra Bandera, Paolo Bonfanti, S. Bonora, M. Borderi, Andrea Calcagno, Leonardo Calza, Maria Rosaria Capobianchi, Antonella Cingolani, Paola Cinque, Antonio Di Biagio, A. Gori, Giovanni Guaraldi, Giuseppe Lapadula, Miriam Lichtner, Giordano Madeddu, G. Marchetti, Simone Marcotullio, L. Monno, Silvia Nozza, E. Quiros Roldan, Roberto Rossotti, Maria Mercedes Santoro, A. Saracino, Mauro Zaccarelli, Iuri Fanti, Laura Galli, Patrizia Lorenzini, A. Rodano, M. Shanyinde, A. Tavelli, Fabrizio Carletti, Stefania Carrara, Antonino Di Caro, S. Graziano, F. Petrone, G. Prota, Serena Quartu, S. Truffa, Andrea Giacometti, Andrea Costantini, C. Valeriani, L. Monno, C. Santoro, C. Suardi, V. Donati, G. Verucchi, E. Quiros-Roldan, C. Minardi, C. Abeli, P. Piano, Bruno Cacopardo, B. M. Celesia, J. Vecchiet, K. Falasca, L. Sighinolfi, D. Segala, F. Mazzotta, F. Vichi, Giovanni Cassola, Claudio Viscoli, A. Alessandrini, Nicoletta Bobbio, G. Mazzarello, C. Mastroianni, V. Belvisi, I. Caramma, A. Chiodera, A. P. Castelli, M. Puoti, Annalisa Ridolfo, R. Piolini, S. Salpietro, L. Carenzi, M. C. Moioli, C. Tincati, G. Marchetti, Cristina Mussini, C. Puzzolante, A. Gori, G. Lapadula, N. Abrescia, A. Chirianni, G. Borgia, F. Di Martino, L. Maddaloni, Ivan Gentile, R. Orlando, F. Baldelli, D. Francisci, G. Parruti, T. Ursini, G. Magnani, M. A. Ursitti, A. Antinori, Vincenzo Vullo, A. Cristaudo, Antonella Cingolani, Gianmaria Baldin, Stefania Cicalini, L. Gallo, Emanuele Nicastri, Rosa Antonietta Acinapura, M. Capozzi, Raffaella Libertone, Stefano Savinelli, Alessandra Latini, M. Cecchetto, F. Viviani, M. S. Mura, Giordano Madeddu, Barbara Rossetti, P. Caramello, G. C. Orofino, Stefano Bonora, M. Sciandra, Matteo Bassetti, A. Londero, G. Pellizzer, Vinicio Manfrin

Research output: Contribution to journalArticle

Abstract

Background There are no data comparing the response to PI/r-based regimens in people presenting for care with low CD4 counts or AIDS (LC). Aim To compare the response to LPV/r-, DRV/r- or ATV/r-based cART regimens in LC initiating cART from ART-naive. Methods We included people enrolled in Icona with either CD4 counts ≤350 cells/mm3 (low CD4-LC) or CD4 counts ≤200 cells/mm3 (very low CD4-VLC) and/or AIDS, starting their first PI/rbased regimen after 2008. Initial regimens were compared by intention-to-treat: i) time to viral failure (VF) (first of 2 consecutive VL>200 copies/mL after ≥6 months); II) time to PI/r discontinuation/switching for any cause (TD) and for toxicity (TDT); III) treatment failure (TF) (VF or TD). Kaplan-Meier and Cox analyses were used. Results 1,362 LC patients were included (DRV/r 607; ATV/r 552; LPV/r 203); 813 VLC. In a median of 18 months (IQR:7-35), the 1-year probability of VF and TF were 2.8% (1.9-3.8) and 21.1% (18.7-23.4). In the adjusted analysis, patients initiating ATV/r had a 53% lower chance, and those initiating DRV/r a 61% lower chance of TD, as compared to LPV/r; the risk of TF was more likely in people starting LPV/r. Results were similar among VLC; in this subgroup LPV/r including regimens demonstrated a lower chance of VF. Conclusions We confirmed in LC a low chance of virological failure by 1 year, with small differences according to PI/r. However, larger differences were observed when comparing longer-term endpoints such as treatment failure. These results are important for people presenting late for care.

Original languageEnglish
Article numbere0156360
JournalPLoS One
Volume11
Issue number6
DOIs
Publication statusPublished - Jun 1 2016

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

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    D'Arminio Monforte, A., Cozzi-Lepri, A., Maggiolo, F., Rizzardini, G., Manconi, P. E., Gianotti, N., Quirino, T., Pinnetti, C., Rusconi, S., De Luca, A., Antinori, A., Andreoni, M., Angarano, G., Castelli, F., Cauda, R., Di Perri, G., Galli, M., Iardino, R., Ippolito, G., ... Manfrin, V. (2016). Response to first-line ritonavir-boosted protease inhibitors (PI/r)-based regimens in HIV positive patients presenting to care with low CD4 counts: Data from the Icona Foundation Cohort. PLoS One, 11(6), [e0156360]. https://doi.org/10.1371/journal.pone.0156360