International AIDS Society

Staying With First ART Regimen Longer Cuts CD4 Failure Risk in USA

Author: Mark Mascolini

03 May 2013

Staying on a first-line antiretroviral therapy (ART) regimen longer—called persistency—significantly lowered chances of CD4 failure in a study at the University of Alabama at Birmingham. Persistency was associated with trends toward lower mortality and lower risk of an opportunistic infection (OI) or malignancy.

Previous research has analyzed persistency in people taking ART, but this is the first study to measure the impact of persistency on clinical outcomes. The retrospective analysis involved 879 antiretroviral-naive people who started their first regimen between January 2000 and December 2010 at the University of Alabama medical center.

Age averaged 38 years in study participants, most of whom (80%) were male and racial/ethnic minorities (59%). About half (52%) had a CD4 count below 200 cells/µL when they started their first regimen. During follow-up, 100 people (11%) died, 94 (11%) had an OI or a malignancy, and 183 (21%) had immunologic failure, defined as a CD4 count lower than the initially meausred CD4 count.

Multivariate analysis determined that every 180-day longer ART persistency was associated with a 16% lower risk of immunologic failure (0.84 per 180 days, 95% confidence interval [CI] 0.70 to 1.00, P = 0.045).

Longer persistency was associated with a trend toward lower risk of OI/malignancy (0.91 per 180 days, 95% CI 0.80 to 1.03, P = 0.124) and with a trend toward a lower death risk (0.42 per 180 days, 95% CI 0.17 to 1.06, P = 0.067).

Because of these findings, the researchers call for further assessment of the relationship between ART persistency and clinical outcomes.

Source: James H. Willig, Andrew O. Westfall, Michael Mugavero, Christa R. Nevin, Todd Correll, Amit Duggal, William Guyer, Michael S. Saag, Timothy Juday. Effect of persistency of first-line HIV antiretroviral therapy on clinical outcomes. AIDS Research and Human Retroviruses. 2013; 29: 698-703.

For the study abstract

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