Adverse events to antiretrovirals in the Swiss HIV Cohort Study: effect on mortality and treatment modification

Keiser, Olivia; Fellay, Jacques; Opravil, Milos; Hirsch, Hans H; Hirschel, Bernard; Bernasconi, Enos; Vernazza, Pietro L; Rickenbach, Martin; Telenti, Amalio; Furrer, Hansjakob (2007). Adverse events to antiretrovirals in the Swiss HIV Cohort Study: effect on mortality and treatment modification. Antiviral therapy, 12(8), pp. 1157-64. London: International Medical Press

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BACKGROUND: Antiretroviral therapy (ART) decreases morbidity and mortality in HIV-infected patients but is associated with considerable adverse events (AEs). METHODS: We examined the effect of AEs to ART on mortality, treatment modifications and drop-out in the Swiss HIV Cohort Study. A cross-sectional evaluation of prevalence of 13 clinical and 11 laboratory parameters was performed in 1999 in 1,078 patients on ART. AEs were defined as abnormalities probably or certainly related to ART. A score including the number and severity of AEs was defined. The subsequent progression to death, drop-out and treatment modification due to intolerance were evaluated according to the baseline AE score and characteristics of individual AEs. RESULTS: Of the 1,078 patients, laboratory AEs were reported in 23% and clinical AEs in 45%. During a median follow up of 5.9 years, laboratory AEs were associated with higher mortality with an adjusted hazard ratio (HR) of 1.3 (95% confidence interval [CI] 1.2-1.5; P < 0.001) per score point. For clinical AEs no significant association with increased mortality was found. In contrast, an increasing score for clinical AEs (HR 1.11,95% CI 1.04-1.18; P = 0.002), but not for laboratory AEs (HR 1.07, 95% CI 0.97-1.17; P = 0.17), was associated with antiretroviral treatment modification. AEs were not associated with a higher drop-out rate. CONCLUSIONS: The burden of laboratory AEs to antiretroviral drugs is associated with a higher mortality. Physicians seem to change treatments to relieve clinical symptoms, while accepting laboratory AEs. Minimizing laboratory drug toxicity seems warranted and its influence on survival should be further evaluated.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine
04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Infectiology

UniBE Contributor:

Keiser, Olivia and Furrer, Hansjakob

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1359-6535

ISBN:

18240856

Publisher:

International Medical Press

Language:

English

Submitter:

Factscience Import

Date Deposited:

04 Oct 2013 14:53

Last Modified:

18 Jul 2016 17:46

PubMed ID:

18240856

Web of Science ID:

000252068600002

BORIS DOI:

10.7892/boris.22656

URI:

https://boris.unibe.ch/id/eprint/22656 (FactScience: 35736)

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