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The successful application of a national peer advisory committee for physicians who provide salvage regimens to heavily antiretroviral-experienced patients in mexican human immunodeficiency virus clinics.

Calva JJ, Sierra-Madero J, Soto-Ramírez LE, Aguilar-Salinas P - Open Forum Infect Dis (2014)

Bottom Line: Our aim was to assess the virologic and immunologic effects of the treatment recommendations drafted by a peer advisory board to physicians caring for heavily ARV-experienced patients.A total of 611 patients were observed (median ARV therapy exposure = 10.5 years; median prior regimens = 4).Of the 531 patients who achieved a confirmed plasma HIV-RNA level below 200 copies per mL, the median increase in blood CD4(+) T-cell count was 162 cells per mL (IQR = 45-304 cells per mL).

View Article: PubMed Central - PubMed

Affiliation: Department of Infectious Diseases , Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán," México City , México.

ABSTRACT

Background: Designing optimal antiretroviral (ARV) salvage regimens for multiclass drug-resistant, human immunodeficiency virus (HIV)-infected patients demands specific clinical skills. Our aim was to assess the virologic and immunologic effects of the treatment recommendations drafted by a peer advisory board to physicians caring for heavily ARV-experienced patients.

Methods: We conducted a nationwide, HIV clinic-based, cohort study in Mexico. Adults infected with HIV were assessed for a median of 33 months (interquartile range [IQR] = 22-43 months). These patients had experienced the virologic failure of at least 2 prior ARV regimens and had detectable viremia while currently being treated; their physicians had received therapeutic advice, by a panel of experts, regarding the ARV salvage regimen. The primary endpoint was the incidence of loss of virologic response (plasma HIV-RNA levels of <200 copies per mL, followed by levels above this threshold) during the follow-up assessment using an observed-failure competing risks regression analysis.

Results: A total of 611 patients were observed (median ARV therapy exposure = 10.5 years; median prior regimens = 4). The probabilities of virologic failure were 11.9%, 14.4%, 16.9%, and 19.4% at the 12-, 24-, 36-, and 48-month follow-up assessments, respectively. Of the 531 patients who achieved a confirmed plasma HIV-RNA level below 200 copies per mL, the median increase in blood CD4(+) T-cell count was 162 cells per mL (IQR = 45-304 cells per mL).

Conclusions: In routine practice, a high rate of patients with extensive ARV experience, who received an optimized salvage regimen recommended by a peer advisory committee, achieved a long-term sustained virologic response and immune reconstitution.

No MeSH data available.


Related in: MedlinePlus

Time to loss of virologic response (111 events). O-F approach. The plot represents 1 minus the probability of remaining event-free as estimated using the competing risks regression analysis. The presented number of events is the total number of events throughout follow-up (57 months).
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OFU081F2: Time to loss of virologic response (111 events). O-F approach. The plot represents 1 minus the probability of remaining event-free as estimated using the competing risks regression analysis. The presented number of events is the total number of events throughout follow-up (57 months).

Mentions: The median follow-up time of the 611 patients was 33 months (IQR = 22–43 months). The patients were distributed according to the outcome definitions as follows: 438 (72%) patients were persistent responders who completed follow-up; 62 (10.1%) patients were persistent responders until the premature end of follow-up (22 dropped out, 20 changed their drug regimens, and 20 died); 13 (2.1%) patients were classified as responders with a loss of virologic control (rebounders) and subsequent low levels of viremia; 18 (3%) patients were classified as responders with loss of virologic control (rebounders) and subsequent high levels of viremia; 67 (11%) patients were nonresponders; and 13 (2.1%) patients were partial responders. After using the OF approach, the cumulative incidences of the loss of viral response were 11.9%, 14.4%, 16.9%, and 19.4% at the 12-, 24-, 36-, and 48-month follow-up assessments, respectively (Figure 2). Applying the NC = F approach, the cumulative incidences of the loss of viral response were 14.7%, 21.4%, 27.7%, and 35.5% at the 12-, 24-, 36-, and 48-month follow-up assessments, respectively.Figure 2.


The successful application of a national peer advisory committee for physicians who provide salvage regimens to heavily antiretroviral-experienced patients in mexican human immunodeficiency virus clinics.

Calva JJ, Sierra-Madero J, Soto-Ramírez LE, Aguilar-Salinas P - Open Forum Infect Dis (2014)

Time to loss of virologic response (111 events). O-F approach. The plot represents 1 minus the probability of remaining event-free as estimated using the competing risks regression analysis. The presented number of events is the total number of events throughout follow-up (57 months).
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4281798&req=5

OFU081F2: Time to loss of virologic response (111 events). O-F approach. The plot represents 1 minus the probability of remaining event-free as estimated using the competing risks regression analysis. The presented number of events is the total number of events throughout follow-up (57 months).
Mentions: The median follow-up time of the 611 patients was 33 months (IQR = 22–43 months). The patients were distributed according to the outcome definitions as follows: 438 (72%) patients were persistent responders who completed follow-up; 62 (10.1%) patients were persistent responders until the premature end of follow-up (22 dropped out, 20 changed their drug regimens, and 20 died); 13 (2.1%) patients were classified as responders with a loss of virologic control (rebounders) and subsequent low levels of viremia; 18 (3%) patients were classified as responders with loss of virologic control (rebounders) and subsequent high levels of viremia; 67 (11%) patients were nonresponders; and 13 (2.1%) patients were partial responders. After using the OF approach, the cumulative incidences of the loss of viral response were 11.9%, 14.4%, 16.9%, and 19.4% at the 12-, 24-, 36-, and 48-month follow-up assessments, respectively (Figure 2). Applying the NC = F approach, the cumulative incidences of the loss of viral response were 14.7%, 21.4%, 27.7%, and 35.5% at the 12-, 24-, 36-, and 48-month follow-up assessments, respectively.Figure 2.

Bottom Line: Our aim was to assess the virologic and immunologic effects of the treatment recommendations drafted by a peer advisory board to physicians caring for heavily ARV-experienced patients.A total of 611 patients were observed (median ARV therapy exposure = 10.5 years; median prior regimens = 4).Of the 531 patients who achieved a confirmed plasma HIV-RNA level below 200 copies per mL, the median increase in blood CD4(+) T-cell count was 162 cells per mL (IQR = 45-304 cells per mL).

View Article: PubMed Central - PubMed

Affiliation: Department of Infectious Diseases , Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán," México City , México.

ABSTRACT

Background: Designing optimal antiretroviral (ARV) salvage regimens for multiclass drug-resistant, human immunodeficiency virus (HIV)-infected patients demands specific clinical skills. Our aim was to assess the virologic and immunologic effects of the treatment recommendations drafted by a peer advisory board to physicians caring for heavily ARV-experienced patients.

Methods: We conducted a nationwide, HIV clinic-based, cohort study in Mexico. Adults infected with HIV were assessed for a median of 33 months (interquartile range [IQR] = 22-43 months). These patients had experienced the virologic failure of at least 2 prior ARV regimens and had detectable viremia while currently being treated; their physicians had received therapeutic advice, by a panel of experts, regarding the ARV salvage regimen. The primary endpoint was the incidence of loss of virologic response (plasma HIV-RNA levels of <200 copies per mL, followed by levels above this threshold) during the follow-up assessment using an observed-failure competing risks regression analysis.

Results: A total of 611 patients were observed (median ARV therapy exposure = 10.5 years; median prior regimens = 4). The probabilities of virologic failure were 11.9%, 14.4%, 16.9%, and 19.4% at the 12-, 24-, 36-, and 48-month follow-up assessments, respectively. Of the 531 patients who achieved a confirmed plasma HIV-RNA level below 200 copies per mL, the median increase in blood CD4(+) T-cell count was 162 cells per mL (IQR = 45-304 cells per mL).

Conclusions: In routine practice, a high rate of patients with extensive ARV experience, who received an optimized salvage regimen recommended by a peer advisory committee, achieved a long-term sustained virologic response and immune reconstitution.

No MeSH data available.


Related in: MedlinePlus