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Could better tolerated HIV drug regimens improve patient outcome?

Smit, Mikaelaa; Smit, Coletteb; Cremin, Idea; Garnett, Geoffrey P.a; Hallett, Timothya; de Wolf, Frankb

doi: 10.1097/QAD.0b013e32835722bd
Epidemiology and Social: Concise Communications

Objectives: To quantify the performance of existing first-line and second-line combination antiretroviral therapy (cART) regimens on patient's clinical outcomes in the Netherlands using ATHENA data and to evaluate the potential for new drug regimens to improve patient's clinical outcomes using a data-based mathematical model.

Design and methods: We analysed data from 3995 patients from the Dutch ATHENA national observational cohort between 2000 and 2010. We quantified the main drug-related reasons for switching from first-line and second-line cART, classified as toxicity, simplification/new medication becoming available, virological failure, or other reasons. We developed a deterministic model describing HIV infection and treatment in the Netherlands parameterized on the basis of these data. The model simulated how a new drug regimen, with either improved toxicity or virological failure profile, could impact on patient's clinical outcomes.

Results: The main reason for switching current first-line and second-line regimens was toxicity, accounting for around 50% of switching from first-line and from second-line cART. The model found that a new drug regimen with increased tolerability profile could have the highest potential impact on patient's outcomes, especially as a first-line treatment. A new first-line drug regimen with improved tolerability could increase the time patients spend on first-line cART, decrease their risk of switching from first-line cART and thus simplify patient management.

Conclusion: New drug regimens with improved toxicity profiles could have the greatest impact on patient outcomes and simplify patient management in the Netherlands.

aDepartment of Infectious Disease Epidemiology, Imperial College, Faculty of Medicine, London, UK

bHIV Monitoring Foundation, Amsterdam, The Netherlands.

Correspondence to Mikaela Smit, Department of Infectious Disease Epidemiology, Faculty of Medicine at St Mary's Campus, Imperial College London, W2 1PG. UK. E-mail:

Received 18 April, 2012

Revised 14 June, 2012

Accepted 19 June, 2012

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© 2012 Lippincott Williams & Wilkins, Inc.