The factors influencing virological response to first-line combined antiretroviral therapy (cART) in an Italian cohort of HIV-1-infected patients were examined. Eligible patients were those enrolled in a national prospective observational cohort (Antiretroviral Resistance Cohort Analysis), starting first-line cART between 2001 and 2011 and who had at least one follow-up of HIV-1 RNA. The primary endpoint was virological success, defined as the first viral load <50 copies/ml. Time to events were analyzed by Kaplan-Meier analysis and Cox proportional hazard model. One thousand three hundred five patients met the study inclusion criteria. In a multivariable model adjusting for transmission mode, presence of transmitted drug resistance, baseline CD4+ cell count, viral subtype, and type of NRTI backbone employed, independent predictors of virological success were higher baseline viral load (≥500,000 vs. <100,000 HR 0.52; P<0.001), a weighted genotypic susceptibility score (wGSS) <3 (HR 0.58; P=0.003), male sex (HR 0.76 P=0.001), and type of initial third drug employed (integrase inhibitor vs. boosted protease inhibitors HR 3.23; P<0.001). In the subset with HIV-1 RNA >100,000 copies/ml, virologic success was only associated with the use of integrase inhibitors in the first cART regimen. Independent predictors of immunological success were baseline CD4+ cell count and wGSS <3. High baseline HIV-1 RNA, predicted activity of the first-line regimen based on genotypic resistance testing, gender, and use of new agents were found to predict time to achieve virological success. The type of initial nucleoside analog backbone was not found to predict virological response.

The role of baseline HIV-1 RNA, drug resistance, and regimen type as determinants of response to first-line antiretroviral therapy

GROSSI, PAOLO ANTONIO;
2014-01-01

Abstract

The factors influencing virological response to first-line combined antiretroviral therapy (cART) in an Italian cohort of HIV-1-infected patients were examined. Eligible patients were those enrolled in a national prospective observational cohort (Antiretroviral Resistance Cohort Analysis), starting first-line cART between 2001 and 2011 and who had at least one follow-up of HIV-1 RNA. The primary endpoint was virological success, defined as the first viral load <50 copies/ml. Time to events were analyzed by Kaplan-Meier analysis and Cox proportional hazard model. One thousand three hundred five patients met the study inclusion criteria. In a multivariable model adjusting for transmission mode, presence of transmitted drug resistance, baseline CD4+ cell count, viral subtype, and type of NRTI backbone employed, independent predictors of virological success were higher baseline viral load (≥500,000 vs. <100,000 HR 0.52; P<0.001), a weighted genotypic susceptibility score (wGSS) <3 (HR 0.58; P=0.003), male sex (HR 0.76 P=0.001), and type of initial third drug employed (integrase inhibitor vs. boosted protease inhibitors HR 3.23; P<0.001). In the subset with HIV-1 RNA >100,000 copies/ml, virologic success was only associated with the use of integrase inhibitors in the first cART regimen. Independent predictors of immunological success were baseline CD4+ cell count and wGSS <3. High baseline HIV-1 RNA, predicted activity of the first-line regimen based on genotypic resistance testing, gender, and use of new agents were found to predict time to achieve virological success. The type of initial nucleoside analog backbone was not found to predict virological response.
2014
http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)1096-9071
CD4; Drug regimen; Drug resistance; HIV-1 RNA; N(n)RTI backbone; WGSS; Infectious Diseases; Virology
Di Biagio, Antonio; Rusconi, Stefano; Marzocchetti, Angela; Signori, Alessio; Schiavetti, Irene; Bruzzone, Bianca; Monno, Laura; Punzi, Grazia; Colao, Maria Grazia; Penco, Giovanni; Zazzi, Maurizio; De Luca, Andrea; Giacometti, Andrea; Butini, Luca; Del Gobbo, Romana; Bagnarelli, Patrizia; Tacconi, Danilo; Corbelli, Giovanni; Zanussi, Stefania; Maggiolo, Franco; Callegaro, Annapaola; Calza, Leonardo; Re, Maria Carla; Pristerà, Raffaele; Turconi, Paola; Mandas, Antonella; Pozzo, Alessandra; Simeone, Nuccia; Tini, Sauro; Zoncada, Alessia; Paolini, Elisabetta; Amadio, Giorgio; Sighinolfi, Laura; Zuccati, Giuliano; Morfini, Massimo; Manetti, Roberto; Corsi, Paola; Galli, Luisa; Di Pietro, Massimo; Bartalesi, Filippo; Colao, Grazia; Tosti, Andrea; Setti, Maurizio; Trezzi, Michele; Bonfanti, Paolo; Pardelli, Riccardo; Arcidiacono, Irene; Degiuli, Alberto; De Gennaro, Michele; Chiodera, Alessandro; Scalzini, Alfredo; Palvarini, Loredana; Almi, Paolo; Todaro, Giovanni; Cicconi, Paola; Gismondo, Maria Rita; Micheli, Valeria; Biondi, Maria Luisa; Gianotti, Nicola; Capetti, Amedeo; Meraviglia, Paola; Boeri, Enzo; Mussini, Cristina; Pecorari, Monica; Soria, Alessandro; Malandrin, Sergio; Santirocchi, Maurizio; Brustia, Diego; Ravanini, Paolo; Dal Bello, Federico; Romano, Nino; Mineo, Maurizio; Mancuso, Salvatrice; Calzetti, Carlo; Maserati, Renato; Filice, Gaetano; Baldanti, Fausto; Francisci, Daniela; Parruti, Giustino; Polilli, Ennio; Sacchini, Daria; Martinelli, Chiara; Consolini, Rita; Vatteroni, Linda; Vivarelli, Angela; Nerli, Alessandro; Lenzi, Lucia; Magnani, Giacomo; Ortolani, Patrizia; Andreoni, Massimo; Palamara, Guido; Fimiani, Caterina; Palmisano, Lucia; Di Gaimbenedetto, Simona; Colafigli, Manuela; Vullo, Vincenzo; Turriziani, Ombretta; Montano, Marco; Senatore, Cataldo; Dentone, Chiara; Gonnelli, Angela; Palumbo, Michele; Ghisetti, Valeria; Bonora, Stefano; Foglie, Palma Delle; Rossi, Cristina; Grossi, PAOLO ANTONIO; Seminari, Elena; Poletti, Federica; Mondino, Vincenzo; Malena, Marina
File in questo prodotto:
Non ci sono file associati a questo prodotto.

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11383/2061530
 Attenzione

L'Ateneo sottopone a validazione solo i file PDF allegati

Citazioni
  • ???jsp.display-item.citation.pmc??? ND
  • Scopus 20
  • ???jsp.display-item.citation.isi??? 22
social impact