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Clinical and Virologic Outcomes after Changes in First Antiretroviral Regimen at 7 Sites in the Caribbean, Central and South America Network

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dc.contributor.author Wolff, M.
dc.contributor.author Shepherd, B.E.
dc.contributor.author Cortés, C.
dc.contributor.author Rebeiro, P.
dc.contributor.author Cesar, C.
dc.contributor.author Wagner Cardoso, S.
dc.contributor.author Pape, J.W.
dc.contributor.author Padgett, D.
dc.contributor.author Sierra-Madero, J.
dc.contributor.author Echevarria Zarate, Juan Ignacio
dc.contributor.author McGowan, C.C.
dc.contributor.author CCASAnet
dc.date.accessioned 2019-04-24T18:23:53Z
dc.date.available 2019-04-24T18:23:53Z
dc.date.issued 2016
dc.identifier.uri https://hdl.handle.net/20.500.12866/6469
dc.description.abstract Background: HIV-infected persons in resource-limited settings may experience high rates of antiretroviral therapy (ART) change, particularly because of toxicity or other nonfailure reasons. Few reports address patient outcomes after these modifications. Methods: HIV-infected adults from the 7 Caribbean, Central and South America network clinical cohorts who modified >1 drug from the first ART regimen (ART-1) for any reason thereby starting a second regimen (ART-2) were included. We assessed cumulative incidence of, and factors associated with, death, virologic failure (VF), and regimen change after starting ART-2. Results: Five thousand five hundred sixty-five ART-naive highly active ART initiators started ART-2 after a median of 9.8 months on ART-1; 39% changed to ART-2 because of toxicity and 11% because of failure. Median follow-up after starting ART-2 was 2.9 years; 45% subsequently modified ART-2. Cumulative incidences of death at 1, 3, and 5 years after starting ART-2 were 5.1%, 8.4%, and 10.5%, respectively. In adjusted analyses, death was associated with older age, clinical AIDS, lower CD4 at ART-2 start, earlier calendar year, and starting ART-2 because of toxicity (adjusted hazard ratio 1.5 vs. failure, 95% confidence interval: 1.0 to 2.1). Cumulative incidences of VF after 1, 3, and 5 years were 9%, 19%, and 25%. In adjusted analyses, VF was associated with younger age, earlier calendar year, lower CD4 at the start of ART-2, and starting ART-2 because of failure (adjusted hazard ratio 2.1 vs. toxicity, 95% confidence interval: 1.5 to 2.8). Conclusions: Among patients modifying the first ART regimen, risks of subsequent modifications, mortality, and virologic failure were high. Access to improved antiretrovirals in the region is needed to improve initial treatment success. en_US
dc.language.iso eng
dc.publisher Wolters Kluwer Health
dc.relation.ispartofseries Journal of Acquired Immune Deficiency Syndromes
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject abacavir en_US
dc.subject didanosine en_US
dc.subject efavirenz en_US
dc.subject emtricitabine en_US
dc.subject indinavir en_US
dc.subject lamivudine en_US
dc.subject lopinavir en_US
dc.subject nevirapine en_US
dc.subject nonnucleoside reverse transcriptase inhibitor en_US
dc.subject proteinase inhibitor en_US
dc.subject RNA directed DNA polymerase inhibitor en_US
dc.subject saquinavir en_US
dc.subject stavudine en_US
dc.subject tenofovir en_US
dc.subject zidovudine en_US
dc.subject anti human immunodeficiency virus agent en_US
dc.subject acquired immune deficiency syndrome en_US
dc.subject adult en_US
dc.subject age en_US
dc.subject antiviral therapy en_US
dc.subject Article en_US
dc.subject Caribbean en_US
dc.subject CD4 lymphocyte count en_US
dc.subject cohort analysis en_US
dc.subject female en_US
dc.subject follow up en_US
dc.subject highly active antiretroviral therapy en_US
dc.subject human en_US
dc.subject Human immunodeficiency virus infected patient en_US
dc.subject Human immunodeficiency virus infection en_US
dc.subject major clinical study en_US
dc.subject male en_US
dc.subject mortality en_US
dc.subject priority journal en_US
dc.subject South America en_US
dc.subject treatment outcome en_US
dc.subject adolescent en_US
dc.subject Central America en_US
dc.subject clinical protocol en_US
dc.subject drug substitution en_US
dc.subject epidemiology en_US
dc.subject highly active antiretroviral therapy en_US
dc.subject HIV Infections en_US
dc.subject immunology en_US
dc.subject incidence en_US
dc.subject middle aged en_US
dc.subject proportional hazards model en_US
dc.subject statistics and numerical data en_US
dc.subject virology en_US
dc.subject Adolescent en_US
dc.subject Adult en_US
dc.subject Age Factors en_US
dc.subject Anti-HIV Agents en_US
dc.subject Antiretroviral Therapy, Highly Active en_US
dc.subject Caribbean Region en_US
dc.subject CD4 Lymphocyte Count en_US
dc.subject Central America en_US
dc.subject Clinical Protocols en_US
dc.subject Cohort Studies en_US
dc.subject Drug Substitution en_US
dc.subject Female en_US
dc.subject HIV Infections en_US
dc.subject Humans en_US
dc.subject Incidence en_US
dc.subject Male en_US
dc.subject Middle Aged en_US
dc.subject Proportional Hazards Models en_US
dc.subject South America en_US
dc.title Clinical and Virologic Outcomes after Changes in First Antiretroviral Regimen at 7 Sites in the Caribbean, Central and South America Network en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1097/QAI.0000000000000817
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.03.08
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.01.05
dc.relation.issn 1944-7884


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