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| |  Delay in Treatment Modification After Non-Protease Inhibitor Therapy Failure Increases Risk of HIV Progression: Presented at CROI By Maria Bishop BOSTON, MA -- February 11, 2008 -- Patients who fail treatment for human immunodeficiency virus (HIV) with non-nucleoside reverse transcriptase inhibitors (NNRTIs) are at increased risk of disease progression if a modified treatment plan is delayed, according to results presented here at the 15th Conference on Retroviruses and Opportunistic Infections (CROI). In practice, treatment modification may be postponed due to delayed detection, sporadic follow-up, or lack of access to alternative regimens, stated Maya L. Petersen, PhD, Berkeley School of Public Health, University of California, Berkeley, California, in a presentation of prospective trial research on February 4. Dr. Petersen noted that highly active antiretroviral therapy (HAART) is expanding rapidly in settings where limited resources may preclude immediate modification of a patient's treatment plan. Understanding the consequences of delayed modification, she stressed, is crucial. The vast majority of patients globally are starting an NNRTI-based regimen in settings where plasma HIV ribonucleic acid level monitoring may not be available. A total of 982 subjects contributed a total of 3,414 person-years of follow-up after the first regimen failure. The majority of patients (76%) were treated with at least one protease inhibitor drug; 32% of these received ritonavir boosting. Delay until treatment modification was associated with an elevated hazard of mortality and immunologic failure among subjects failing a non-protease inhibitor (non-PI) regimen, but appeared to have a small protective effect among subjects failing a PI-based regimen. The impact of a delay in modification was similar across cohorts and following second HAART failure, and after excluding subjects on nonboosted PI regimens or with no history of antiretroviral use before HAART. Following failure on a non-PI regimen, the hazard of mortality increased sharply while on the failing therapy, reached a plateau with regimen modification, but remained elevated among subjects with delayed modification. Following failure on a PI-regimen, the hazard of mortality increased over time with little short-term difference between subjects who modified therapy immediately and those who delayed modification. "Within the context of resource constraints and the urgent need to scale up therapy as rapidly as possible," stated Dr. Petersen, "efforts should be made to minimize delay until modification."
[Presentation title: Long Term Consequences of the Delay Between Virologic Failure of Highly Active Antiretroviral Therapy and Regimen Modification: A Prospective Cohort Study. Abstract 798]
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