TY - JOUR
T1 - The rate of viral rebound after attainment of an HIV load <50 copies/mL according to specific antiretroviral drugs in use: Results from a multicenter cohort study
AU - Smith, C J
AU - Phillips, A N
AU - Hill, T
AU - Fisher, M
AU - Gazzard, B
AU - Porter, K
AU - Gilson, R
AU - Easterbrook, P
AU - Matthias, R
AU - Scullard, G
AU - Johnson, M A
AU - Sabin, C A
PY - 2005/10/15
Y1 - 2005/10/15
N2 - Background. Relatively few data are available on the association between the use of specific antiretroviral drugs and the rate of viral rebound in those attaining a viral load (VL) <50 copies/mL while receiving highly active antiretroviral therapy ( HAART). Methods. Patients achieving a VL <50 copies/mL for the first time while receiving HAART were followed until viral rebound (2 consecutive VLs > 500 copies/ mL). Pre-HAART antiretroviral-naive patients were analyzed separately from those with nucleoside reverse transcriptase inhibitor (NRTI) experience. Results. Of 3565 suppressed antiretroviral-naive patients, 381 experienced viral rebound ( rate, 6.26 events/100 person-years of follow-up [pyrs][ 95% confidence interval {CI}, 5.63-6.89 events/ 100 pyrs]). For those receiving efavirenz, the rate was 4.08 ( 95% CI, 3.16-5.01) events/ pyrs. Compared with this, the rebound rate for those receiving indinavir was 1.52 times higher ( rate ratio [ RR], 1.52 [ 95% CI, 0.82-2.84]). RRs ( 95% CIs) for other drugs were: soft-gel saquinavir, 0.54 ( 0.07-3.97); nelfinavir, 2.44 ( 1.68-3.54); indinavir/ritonavir, 1.96 ( 1.02-3.77); saquinavir/ritonavir, 1.12 ( 0.48-2.61); lopinavir/ritonavir, 1.23 ( 0.58-2.59); nevirapine, 1.53 ( 1.11-2.10); and abacavir, 2.03 ( 1.26-3.25). Of 810 NRTI-exposed patients, 145 experienced viral rebound ( rate, 8.29 [ 95% CI, 6.94-9.64] events/ pyrs). For those receiving efavirenz, the rate was 5.25 ( 95% CI, 3.11-8.30) events/ pyrs. Compared with this, the RRs ( 95% CIs) were: indinavir, 1.75 ( 0.82-3.73); hard-gel saquinavir, 3.48 ( 0.36-33.37); nelfinavir, 2.64 ( 1.37-5.08); indinavir/ritonavir, 0.32 ( 0.04-2.49); saquinavir/ritonavir, 0.64 ( 0.23-1.80); nevirapine, 1.65 ( 0.90-3.02); and abacavir, 1.82 ( 0.73-4.52). Conclusions. We must make comparisons of antiretroviral outcomes in observational data with caution; however, our results suggest that, in those with VLs <50 copies/ mL, certain drugs may be associated with higher rebound rates than others
AB - Background. Relatively few data are available on the association between the use of specific antiretroviral drugs and the rate of viral rebound in those attaining a viral load (VL) <50 copies/mL while receiving highly active antiretroviral therapy ( HAART). Methods. Patients achieving a VL <50 copies/mL for the first time while receiving HAART were followed until viral rebound (2 consecutive VLs > 500 copies/ mL). Pre-HAART antiretroviral-naive patients were analyzed separately from those with nucleoside reverse transcriptase inhibitor (NRTI) experience. Results. Of 3565 suppressed antiretroviral-naive patients, 381 experienced viral rebound ( rate, 6.26 events/100 person-years of follow-up [pyrs][ 95% confidence interval {CI}, 5.63-6.89 events/ 100 pyrs]). For those receiving efavirenz, the rate was 4.08 ( 95% CI, 3.16-5.01) events/ pyrs. Compared with this, the rebound rate for those receiving indinavir was 1.52 times higher ( rate ratio [ RR], 1.52 [ 95% CI, 0.82-2.84]). RRs ( 95% CIs) for other drugs were: soft-gel saquinavir, 0.54 ( 0.07-3.97); nelfinavir, 2.44 ( 1.68-3.54); indinavir/ritonavir, 1.96 ( 1.02-3.77); saquinavir/ritonavir, 1.12 ( 0.48-2.61); lopinavir/ritonavir, 1.23 ( 0.58-2.59); nevirapine, 1.53 ( 1.11-2.10); and abacavir, 2.03 ( 1.26-3.25). Of 810 NRTI-exposed patients, 145 experienced viral rebound ( rate, 8.29 [ 95% CI, 6.94-9.64] events/ pyrs). For those receiving efavirenz, the rate was 5.25 ( 95% CI, 3.11-8.30) events/ pyrs. Compared with this, the RRs ( 95% CIs) were: indinavir, 1.75 ( 0.82-3.73); hard-gel saquinavir, 3.48 ( 0.36-33.37); nelfinavir, 2.64 ( 1.37-5.08); indinavir/ritonavir, 0.32 ( 0.04-2.49); saquinavir/ritonavir, 0.64 ( 0.23-1.80); nevirapine, 1.65 ( 0.90-3.02); and abacavir, 1.82 ( 0.73-4.52). Conclusions. We must make comparisons of antiretroviral outcomes in observational data with caution; however, our results suggest that, in those with VLs <50 copies/ mL, certain drugs may be associated with higher rebound rates than others
U2 - 10.1086/466534
DO - 10.1086/466534
M3 - Article
VL - 192
SP - 1387
EP - 1397
JO - Journal of Infectious Diseases
JF - Journal of Infectious Diseases
IS - 8
ER -
