The role of baseline HIV-1 RNA, drug resistance, and regimen type as determinants of response to first-line antiretroviral therapy

Andrea De Luca, Antonio Di Biagio, Stefano Rusconi, Alessio Signori, Irene Schiavetti, Bianca Bruzzone, Laura Monno, Grazia Punzi, Maria Grazia Colao, Giovanni Penco, Maurizio Zazzi, Andrea Giacometti, Luca Butini, Romana Del Gobbo, Patrizia Bagnarelli, Danilo Tacconi, Giovanni Corbelli, Stefania Zanussi, Franco Maggiolo, Annapaola CallegaroLeonardo Calza, Maria Carla Re, Raffaele Pristerà, Paola Turconi, Antonella Mandas, Alessandra Pozzo, Nuccia Simeone, Sauro Tini, Alessia Zoncada, Elisabetta Paolini, Giorgio Amadio, Laura Sighinolfi, Giuliano Zuccati, Massimo Morfini, Roberto Manetti, Paola Corsi, Luisa Galli, Massimo Di Pietro, Filippo Bartalesi, Grazia Colao, Andrea Tosti, Maurizio Setti, Michele Trezzi, Paolo Bonfanti, Riccardo Pardelli, Irene Arcidiacono, Alberto Degiuli, Michele De Gennaro, Alessandro Chiodera, Alfredo Scalzini, Loredana Palvarini, Paolo Almi, Giovanni Todaro, Paola Cicconi, Maria Rita Gismondo, Valeria Micheli, Maria Luisa Biondi, Nicola Gianotti, Amedeo Capetti, Paola Meraviglia, Enzo Boeri, Cristina Mussini, Monica Pecorari, Alessandro Soria, Sergio Malandrin, Maurizio Santirocchi, Diego Brustia, Paolo Ravanini, Federico Dal Bello, Nino Romano, Maurizio Mineo, Salvatrice Mancuso, Carlo Calzetti, Renato Maserati, Gaetano Filice, Fausto Baldanti, Daniela Francisci, Giustino Parruti, Ennio Polilli, Daria Sacchini, Chiara Martinelli, Rita Consolini, Linda Vatteroni, Angela Vivarelli, Alessandro Nerli, Lucia Lenzi, Giacomo Magnani, Patrizia Ortolani, Massimo Andreoni, Guido Palamara, Caterina Fimiani, Lucia Palmisano, Manuela Colafigli, Vincenzo Vullo, Ombretta Turriziani, Marco Montano, Cataldo Senatore, Chiara Dentone, Angela Gonnelli, Michele Palumbo, Valeria Ghisetti, Stefano Bonora, Palma Delle Foglie, Cristina Rossi, Paolo Grossi, Elena Seminari, Federica Poletti, Vincenzo Mondino, Marina Malena

Risultato della ricerca: Contributo in rivistaArticolo in rivista

17 Citazioni (Scopus)

Abstract

The factors influencing virological response to first-line combined antiretroviral therapy (cART) in an Italian cohort of HIV-1-infected patients were examined. Eligible patients were those enrolled in a national prospective observational cohort (Antiretroviral Resistance Cohort Analysis), starting first-line cART between 2001 and 2011 and who had at least one follow-up of HIV-1 RNA. The primary endpoint was virological success, defined as the first viral load <50  copies/ml. Time to events were analyzed by Kaplan-Meier analysis and Cox proportional hazard model. One thousand three hundred five patients met the study inclusion criteria. In a multivariable model adjusting for transmission mode, presence of transmitted drug resistance, baseline CD4(+) cell count, viral subtype, and type of NRTI backbone employed, independent predictors of virological success were higher baseline viral load (≥500,000 vs. <100,000 HR 0.52; P < 0.001), a weighted genotypic susceptibility score (wGSS) <3 (HR 0.58; P = 0.003), male sex (HR 0.76 P = 0.001), and type of initial third drug employed (integrase inhibitor vs. boosted protease inhibitors HR 3.23; P < 0.001). In the subset with HIV-1 RNA >100,000  copies/ml, virologic success was only associated with the use of integrase inhibitors in the first cART regimen. Independent predictors of immunological success were baseline CD4(+) cell count and wGSS <3. High baseline HIV-1 RNA, predicted activity of the first-line regimen based on genotypic resistance testing, gender, and use of new agents were found to predict time to achieve virological success. The type of initial nucleoside analog backbone was not found to predict virological response.
Lingua originaleEnglish
pagine (da-a)1648-1655
Numero di pagine8
RivistaJournal of Medical Virology
Volume86
DOI
Stato di pubblicazionePubblicato - 2014

Keywords

  • CD4
  • HIV-1 RNA
  • N(n)RTI backbone
  • drug regimen
  • drug resistance
  • wGSS

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