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Stability of antiretroviral regimens in patients with viral suppression

Lodwick, Rebecca Ka; Smith, Colette Ja; Youle, Mikeb; Lampe, Fiona Ca; Tyrer, Mervynb; Bhagani, Sanjayb; Chaloner, Clintona; Sabin, Caroline Aa; Johnson, Margaret Ab; Phillips, Andrew Na

doi: 10.1097/QAD.0b013e3282fec415
Clinical Science

Objective: To study the rate of treatment change due to toxicities in patients who achieved viral suppression within 6 months of starting antiretroviral therapy and who have never experienced virological failure.

Methods: Included patients attended the Royal Free Hospital in London, started antiretroviral therapy in 2000–2005, and achieved viral suppression within 6 months. Included follow-up (censored at virological failure) was spent on a regimen of lamivudine or emtricitabine, with a second nucleoside/nucleotide reverse transcriptase inhibitor, and either a protease inhibitor or a nonnucleoside reverse transcriptase inhibitor.

Results: In 912 person-years, there were 140 treatment changes due to toxicities (rate = 15.4 per 100 person-years, confidence interval = 12.8–17.9). In the multivariable analysis, factors associated with a higher rate of treatment change due to toxicities included increased age (for every 10 years increase: incidence rate ratio = 1.28, confidence interval = 1.04–1.57), being on stavudine compared with zidovudine (incidence rate ratio = 2.04, confidence interval = 1.28–3.26), and being on lopinavir compared with efavirenz (incidence rate ratio = 1.55, confidence interval = 1.04–2.31), whereas factors associated with a lower rate were being on tenofovir compared with zidovudine (incidence rate ratio = 0.46, confidence interval = 0.29–0.73), and being on atazanavir compared with efavirenz (incidence rate ratio = 0.23, confidence interval = 0.06–0.91).

Conclusions: In patients who have never experienced virological failure, the rate of treatment change due to toxicities is low, and certain regimens are associated with an even lower rate of change. If virological failure is avoided, some regimens are so far proving to be sufficiently stable to suggest that very long-term use is potentially feasible.

From the aRoyal Free and University College Medical School, UK

bRoyal Free Hospital, London, UK.

Received 18 October, 2007

Revised 15 February, 2008

Accepted 21 February, 2008

Correspondence to Rebecca Lodwick, Research Department of Infection and Population Health, Division of Population Health, Royal Free and University College Medical School, Rowland Hill Street, London NW3 2PF, UK. E-mail: r.lodwick@pcps.ucl.ac.uk

© 2008 Lippincott Williams & Wilkins, Inc.