AEGiS-14IAC: ~32/wt CCR5 genotype, viral load and previous nucleoside analogue (NRTI) experience do not effect the viral outcome after five years in an unselected cohort of advanced HIV-1 patients who started Protease Inhibitor based antiretroviral treatment (PI-ART) in 1996.

14th International AIDS Conference

Barcelona, Spain - July 7-12, 2002

~32/wt CCR5 genotype, viral load and previous nucleoside analogue (NRTI) experience do not effect the viral outcome after five years in an unselected cohort of advanced HIV-1 patients who started Protease Inhibitor based antiretroviral treatment (PI-ART) in 1996.

Int Conf AIDS 2002 Jul 7-12; 14:(abstract no. B10198)

Karlsson A, Bratt G, Koppel K, Nilsson A, Hejdeman B, Hedman P, Ingmar S, Grutzmeier S, Fredriksson EL, Sandstrom E
Venhalsan, Stockholm Soder hospital, Stockholm, Sweden

BACKGROUND: The efficacy of PI-ART in HIV-1 disease is well established, although there are few reports on long-term follow-ups from clinical practice.

METHOD: 202 unselected patients with known HIV-1 infection for 80 ±44 months who, in 1996, started PI-ART with at least two NRTI in combination with either indinavir or ritonavir. 33% had a diagnosis of AIDS and 72%, had previously been treated with NRTI for a mean time of 60 ±42 months. Treatment changes have been made for most patients due to viral failure or adverse effects.

RESULTS: At PI-ART start the CD4 count was 194 ±158 cells/mm³ and the median viral load 67700 copies/ml. Heterozygosity for the ~32 deletion of the CCR5 gene (~32/wt) was found in 24%. After 5 years, 18 (9%) had died and 11 were lost to follow-up. Of the remaining patients, 151 (87%) were still on ART (91 on PI-ART; 42 on NNRTI-based ART; 18 on NRTI-based ART (in 17/18 including Abacavir)), while 22 had treatment pause. Of the 151 patients still on ART, HIV-RNA was below 500 copies/ml in 89% and below 50 copies/ml in 76% and the CD4 count had risen to 502 ±243 cells/mm³. The CD4 rise was similar among those on ART with HIV-RNA <50 copies/ml as among those with HIV-RNA >50 copies/ml (+325 cells/mm³ and +274 cells/mm³, resp.; ns). There were no significant differences in viral response between the NRTI-naïve patients as compared to the experienced, patients with ~32/wt CCR5 genotype as compared to patients without this deletion, and patients with HIV-RNA below median at PI-ART start as compared to those with HIV RNA above median.

CONCLUSION: Thus the 5-year survival in an unselected cohort starting PI-ART during 1996 is around 90%. The viral outcome after five years of ART was not correlated to previous NRTI treatment, viral load or CCR5 genotype. An active approach to changes in therapy when viral failure or adverse effects occur is probably the most important factor for long time antiviral efficacy.

Keywords: AEGIS, Viral Load, HIV-1, CD4 Lymphocyte Count, Protease Inhibitors, HIV Infections, Ritonavir, Antiretroviral Therapy, Highly Active, Dideoxynucleosides, Indinavir, Acquired Immunodeficiency Syndrome, Genotype, Drug Therapy, Combination, abacavir, Human, virology, therapy, genetics, drug therapy

020707
B10198