Predictors of first-line antiretroviral therapy discontinuation due to drug-related adverse events in HIV-infected patients: a retrospective cohort study

被引:68
作者
Prosperi, Mattia C. F. [3 ,4 ,5 ]
Fabbiani, Massimiliano [3 ]
Fanti, Iuri [3 ]
Zaccarelli, Mauro [1 ,2 ]
Colafigli, Manuela [3 ]
Mondi, Annalisa [3 ]
D'Avino, Alessandro [3 ]
Borghetti, Alberto [3 ]
Cauda, Roberto [3 ]
Di Giambenedetto, Simona [3 ]
机构
[1] Natl Inst Infect Dis Lazzaro Spallanzani, Viral Immunodeficiency Unit, Rome, Italy
[2] Natl Inst Infect Dis Lazzaro Spallanzani, Clin Dept, I-00149 Rome, Italy
[3] Univ Cattolica Sacro Cuore, I-00168 Rome, Italy
[4] Univ Florida, Coll Med, Emerging Pathogens Inst, Gainesville, FL USA
[5] Univ Florida, Coll Med, Dept Pathol Immunol & Lab Med, Gainesville, FL USA
关键词
HIV; HAART; Toxicity; Side effects; Therapy-naive; HIV-1-INFECTED PATIENTS; VIROLOGICAL FAILURE; HAART REGIMEN; RESISTANCE; PREVALENCE; EFAVIRENZ; EVOLUTION; DURABILITY; ADHERENCE; SUBTYPE;
D O I
10.1186/1471-2334-12-296
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
Background: Drug-related toxicity has been one of the main causes of antiretroviral treatment discontinuation. However, its determinants are not fully understood. Aim of this study was to investigate predictors of first-line antiretroviral therapy discontinuation due to adverse events and their evolution in recent years. Methods: Patients starting first-line antiretroviral therapy were retrospectively selected. Primary end-point was the time to discontinuation of therapy due to adverse events, estimating incidence, fitting Kaplan-Meier and multivariable Cox regression models upon clinical/demographic/chemical baseline patients' markers. Results: 1,096 patients were included: 302 discontinuations for adverse events were observed over 1,861 person years of follow-up between 1988 and 2010, corresponding to an incidence (95% CI) of 0.16 (0.14-0.18). By Kaplan-Meier estimation, the probabilities (95% CI) of being free from an adverse event at 90 days, 180 days, one year, two years, and five years were 0.88 (0.86-0.90), 0.85 (0.83-0.87), 0.79 (0.76-0.81), 0.70 (0.67-0.74), 0.55 (0.50-0.61), respectively. The most represented adverse events were gastrointestinal symptoms (28.5%), hematological (13.2%) or metabolic (lipid and glucose metabolism, lipodystrophy) (11.3%) toxicities and hypersensitivity reactions (9.3%). Factors associated with an increased hazard of adverse events were: older age, CDC stage C, female gender, homo/bisexual risk group (vs. heterosexual), HBsAg-positivity. Among drugs, zidovudine, stavudine, zalcitabine, didanosine, full-dose ritonavir, indinavir but also efavirenz (actually recommended for first-line regimens) were associated to an increased hazard of toxicity. Moreover, patients infected by HIV genotype F1 showed a trend for a higher risk of adverse events. Conclusions: After starting antiretroviral therapy, the probability of remaining free from adverse events seems to decrease over time. Among drugs associated with increased toxicity, only one is currently recommended for first-line regimens but with improved drug formulation. Older age, CDC stage, MSM risk factor and gender are also associated with an increased hazard of toxicity and should be considered when designing a first-line regimen.
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页数:11
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