Effect of Switching Antiretroviral Treatment Regimen in Patients With Drug-Resistant HIV-1 Infection: Retrospective Observational Cohort Study
Open Access
- 24 June 2022
- journal article
- research article
- Published by JMIR Publications Inc. in JMIR Public Health and Surveillance
- Vol. 8 (6), e33429
- https://doi.org/10.2196/33429
Abstract
Background: Evidence on the efficacy of antiretroviral therapy (ART) regimen switches on the mortality of patients with HIV drug resistance (HIVDR) is limited. Objective: We aim to provide policy guidance for ART regimen selection and evaluate the effectiveness of ART regime switches for people living with HIV and HIV-1 drug resistance. Methods: This retrospective observational cohort study included 179 people living with HIV and HIV-1 drug resistance from 2011 to 2020. The time that participants switched treatment regimens either to protease inhibitor (PI)–based ART regimens (PIs) or nonnucleoside reverse transcriptase inhibitor (NNRTI)–based ART regimens (NNRTIs) was taken as an observation starting point and followed up every 12 months. The parametric g-formula was used to estimate the 5-year risk of mortality under the situations of (1) natural course, (2) immediate switch to NNRTIs, (3) immediate switch to PIs, and (4) if CD4(+) T cells<200 switched to PIs. Results: The follow-up time of the 179 patients ranged from 30 to 119 months. The median follow-up time was 90 months. During a follow-up of 15,606 person-months, 27 individuals died in the cohort. The estimated 5-year risk of mortality under natural course, immediate switch to NNRTIs, immediate switch to PIs, and if CD4(+), and switch to PIs if T cells<200 were 11.62% (95% CI 7.82-17.11), 31.88% (95% CI 20.79-44.94), 2.87% (95% CI 0.32-7.07), and 5.30% (95% CI 2.07-10.21), respectively. The risk ratios (RRs) of immediate switch to NNRTIs, immediate switch to PIs, and switch to PIs if CD4(+) T cells<200, compared with natural course mortality rate, were 2.74 (95% CI 2.01-3.47), 0.25 (95% CI: 0.04-0.54), and 0.46 (95% CI 0.22-0.71), respectively. The risk differences were 20.26% (95% CI 10.96-28.61), –8.76% (95% CI –13.34 to –5.09) and –6.32% (95% CI –9.75 to –3.11), respectively. Conclusions: Our study found that a PI-based ART regimen was beneficial for reducing mortality in people living with HIV and HIV-1 drug resistance. More effort should be given to find HIV-1 drug resistance earlier to ensure a timely adjustment to PI-based ART, thereby maximizing the benefit of early switch treatment for people living with HIV and HIV-1 drug resistance.This publication has 40 references indexed in Scilit:
- Trends in Prevalence of HIV-1 Drug Resistance in Thailand 2009-2010Journal of Clinical Laboratory Analysis, 2013
- A Review of the Toxicity of HIV MedicationsJournal of Medical Toxicology, 2013
- Viral suppression after 12 months of antiretroviral therapy in low- and middle-income countries: a systematic reviewBulletin of the World Health Organization, 2013
- Meta-Analysis of the Safety, Tolerability, and Efficacy of Lopinavir/Ritonavir-Containing Antiretroviral Therapy in HIV-1–Infected WomenHIV Research & Clinical Practice, 2012
- Predictors of treatment failure and time to detection and switching in HIV-infected Ethiopian children receiving first line anti-retroviral therapyBMC Infectious Diseases, 2012
- Intervening on risk factors for coronary heart disease: an application of the parametric g-formulaInternational Journal of Epidemiology, 2009
- Prevalence of HIV‐1 Drug Resistance after Failure of a First Highly Active Antiretroviral Therapy Regimen in KwaZulu Natal, South AfricaClinical Infectious Diseases, 2008
- HIV-1 protease and reverse transcriptase mutations for drug resistance surveillanceAIDS, 2007
- Estimating causal effects from epidemiological dataJournal of Epidemiology and Community Health, 2006
- Web Resources for HIV Type 1 Genotypic-Resistance Test InterpretationClinical Infectious Diseases, 2006