AEGiS-14IAC: Virologic and clinical outcomes in pretreated patients receiving regimen containing a protease inhibitor or a non nucleoside analogue as first HAART.

14th International AIDS Conference

Barcelona, Spain - July 7-12, 2002

Virologic and clinical outcomes in pretreated patients receiving regimen containing a protease inhibitor or a non nucleoside analogue as first HAART.

Int Conf AIDS 2002 Jul 7-12; 14:(abstract no. B10200)

Grabar S, Arvieux C, Lang JM, Pradier C, Reliquet V, Simon A, Costagliola D
Inserm SC4, Paris, France

BACKGROUND: Clinical prognosis of patients treated with non-nucleoside analogues (NNRTI) is poorly studied. We studied virologic and clinical outcomes of patients who started a triple regimen with 2 nucleoside analogues (NRTI) and either one protease inhibitor (PI) or NNRTI.

METHODS:879 pretreated patients who started a triple therapy in 1998 were selected from the French Hospital Database on HIV. Inclusion criteria were: 1/ first treatment with 2 NRTI's and either one PI or one NNRTI and 2/ available viral load (VL) at 6 months. Clinical endpoints were the progression to a new AIDS defining event or death. Virologic suppression was defined as a VL < 500 copies/ml 6 months after HAART introduction. Multivariate analyses were performed using Cox model and logistic regression.

RESULTS:283 (32.2%) patients initiated HAART with indinavir (IDV), 353 (40.2%) with nelfinavir (NFV) and 243 (27.6%) with nevirapine (NVP). The median CD4 cell count was 351/mm³ and the median VL 3300 copies/ml. VL suppression was achieved at 6 months for 67.8%, 58.9% and 49.8% of the patients taking IDV, NFV or NVP respectively. After a median follow-up of 23 months, 27 clinical events were reported. Compared with the use of NVP, use of IDV or NFV were associated with higher chance of virologic suppression OR=2.42 (CI95%=1.67-3.51) and OR=1.68 (CI95%=1.19-2.38) respectively. Patients under NFV had a significantly lower risk of clinical progression (RR=0.34 CI95%:0.12-0.95) compared with patients taking NVP. There was no difference evidenced for clinical progression between patients treated with IDV versus NVP (RR=0.64 CI95%=0.26-1.57) or NFV (RR=1.88 CI95%=0.68-5.23).

CONCLUSION: Biases can never be excluded from non-randomized studies. Nevertheless, in this setting of previously treated patients, triple regimen containing PI as first HAART appears to have better virologic and clinical effect than combined therapy with NVP. Other studies are required to confirm these results.

Keywords: AEGIS, Antiretroviral Therapy, Highly Active, Protease Inhibitors, Nevirapine, CD4 Lymphocyte Count, Nelfinavir, Viral Load, HIV Infections, Indinavir, Human, virology

020707
B10200