BACKGROUND: Virological success (VS) and immunological reconstitution (IR) of antiretroviral-naïve HIV-1 infected patients with pre-therapy viral load (VL) >500,000 copies/mL was assessed after 12 months of treatment according to initial drug-class regimens.
METHODS: An observational multicenter retrospective study was performed. VS was defined as the first VL <50 copies/mL from treatment start. IR was defined as an increase of at least 150 CD4+ T-lymphocytes from treatment start. Survival analysis was used to estimate the probability and predictors of VS and IR by 12 months of therapy.
RESULTS: 428 HIV-1 infected patients were analysed. Patients were grouped according to the different first-line drug-classes used: i) a non-nucleoside reverse transcriptase inhibitor (NNRTI) plus two NRTIs (NNRTI-group; N=105 [24.5%]); ii) a protease inhibitor (PI) plus two NRTIs (PI-group; N=260 [60.8%]); iii) a four-drug regimen containing a PI-regimen plus an integrase inhibitor (PI+INI-group; N=63 [14.7%]). : Patients in PI-group showed the lowest probability of VS (PI-group: 72.4%; NNRTI-group: 75.5%; PI+INI-group: 81.0%) (p<0.0001). By Cox regression, patients in PI+INI and NNRTI-groups showed a higher adjusted hazard ratio [95%CI] of VS compared to those in PI-group (PI+INI-group: 1.48 [1.08-2.03], p=0.014; NNRTI-group: 1.37 [1.06-1.78], p=0.015). : The probability of IR was 76.2%, and was similar among groups. Patients with AIDS showed a lower adjusted hazard ratio [95%CI] of IR compared to non-AIDS presenter (0.70 [0.54-0.90], p=0.005).
CONCLUSIONS: In this multicentre retrospective study, patients with viremia >500,000 copies/mL who start a first-line regimen containing PI+INI or NNRTI yield a better VS compared to those receiving a PI-based regimen.
- Journal Article