Effect of immediate initiation of antiretroviral treatment on the risk of acquired HIV drug resistance.

Lodi, Sara; Günthard, Huldrych F; Dunn, David; Garcia, Federico; Logan, Roger; Jose, Sophie; Bucher, Heiner C; Scherrer, Alexandra U; Schneider, Marie-Paule; Egger, Matthias; Glass, Tracy R; Reiss, Peter; van Sighem, Ard; Boender, T Sonia; Phillips, Andrew N; Porter, Kholoud; Hawkins, David; Moreno, Santiago; Monge, Susana; Paraskevis, Dimitrios; ... (2018). Effect of immediate initiation of antiretroviral treatment on the risk of acquired HIV drug resistance. AIDS, 32(3), pp. 327-335. Lippincott Williams & Wilkins 10.1097/QAD.0000000000001692

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OBJECTIVE We estimated and compared the risk of clinically identified acquired drug resistance under i) immediate initiation (the currently recommended ART initiation strategy), ii) initiation with CD4 < 500, and iii) initiation with CD4 < 350 cells/mm. DESIGN Cohort study based on routinely collected data from the HIV-CAUSAL Collaboration. METHODS For each individual, baseline was the earliest time when all eligibility criteria (ART-naïve, AIDS-free, and others) were met after 1999. Acquired drug resistance was defined using the Stanford classification as resistance to any antiretroviral drug that was clinically identified at least 6 months after ART initiation. We used the parametric g-formula to adjust for time-varying (CD4 count, HIV-RNA, AIDS, ART regimen and drug resistance testing) and baseline (calendar period, mode of acquisition, sex, age, geographical origin, ethnicity and cohort) characteristics. RESULTS In 50,981 eligible individuals, 10% had CD4 count>500 at baseline, and 63% initiated ART during follow-up. Of 2,672 tests for acquired drug resistance, 794 found resistance. The estimated 7-year risk (95% CI) of acquired drug resistance was 3.2% (2.8,3.5) for immediate initiation, 3.1% (2.7,3.3) for initiation with CD4 < 500, and 2.8% (2.5,3.0) for initiation with CD4 < 350 cells/mm. In analyses restricted to individuals with baseline in 2005-2015, the corresponding estimates were 1.9% (1.8, 2.5), 1.9% (1.7,2.4) and 1.8% (1.7,2.2). CONCLUSIONS Our findings suggest that the risk of acquired drug resistance is very low, especially in recent calendar periods, and that immediate ART initiation only slightly increases the risk. It is unlikely that drug resistance will jeopardize the proven benefits of immediate ART initiation.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine

UniBE Contributor:

Egger, Matthias

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

0269-9370

Publisher:

Lippincott Williams & Wilkins

Language:

English

Submitter:

Tanya Karrer

Date Deposited:

11 Jan 2018 11:27

Last Modified:

28 Oct 2019 21:04

Publisher DOI:

10.1097/QAD.0000000000001692

PubMed ID:

29135583

BORIS DOI:

10.7892/boris.107279

URI:

https://boris.unibe.ch/id/eprint/107279

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