[TuOrB1142] Intermittent use of triple combination therapy and not non-nucleoside reverse transcriptase inhibitor use is predictive of mortality among persons initiating antiretroviral therapy in a population-based setting

14th International AIDS Conference

Barcelona, Spain — July 7-12, 2002

[TITLE:] Intermittent use of triple combination therapy and not non-nucleoside reverse transcriptase inhibitor use is predictive of mortality among persons initiating antiretroviral therapy in a population-based setting

[AUTHOR(S):] R S Hogg, K V Heath, B Yip, J S G Montaner¹

Int Conf AIDS. 2002 Jul 7-12;14:Abstract No. TuOrB1142

BACKGROUND: To characterize the impact of non-nucleoside reverse transcriptase inhibitor (NNRTI) versus protease inhibitor (PI) based triple drug antiretroviral therapy on survival.

METHODS: Population-based analysis of antiretroviral therapy naïve HIV-positive individuals aged 18 years and older who initiated triple combination therapy between 08/1996 and 07/2000. Cumulative mortality rates were estimated using Kaplan-Meier methods.

RESULTS: Our analysis was based on 1,416 persons, of whom 439 (31%) started with NNRTIs [413 (94 %) on nevirapine, 15 (3%) on efavirenz, and 11 (3%) on delavirdine] and 977 (69%) started with PIs [699 (72%) on inidinavir, 160 (16%) on nelfinavir, 79 (8%) on saquinavir, 38 (4%) on ritonavir, and 1 (0.1%) on lopinavir/r]. As of July 31, 2001, a 132 persons had died. Cumulative mortality was 3.8% at 12 months. The inclusion of NNRTIs in the initial regimen (OR=0.58; 95% CI: 0.37, 0.93), AIDS at baseline, HIV RNA levels, CD4 cell count, intermittent use of therapy, and age were found to be predictors of survival in the univariate analysis. In a multivariate model, after controlling for all significant variables and changes in therapeutic guidelines, NNRTI use in the initial regimen (RR=0.84; (95% CI: 0.51, 1.38) was not associated with mortality. In this multivariate model, only age, intermittent use of antiretrovirals, and CD4 cell counts <50/uL and 50-199 /uL versus 200 /uL and above were independently associated with mortality with risk ratios of 1.02 (95% CI: 1.00, 1.04; p = 0.016), 3.04 (95% CI: 2.10, 4.40; p <0.001), 5.23 (95% CI: 3.23, 8.45; p <0.001), and 2.65 (95% CI: 1.72, 4.07; p <0.001), respectively.

CONCLUSIONS: Our study demonstrates that after adjusting for other prognostic factors intermittent use of antiretrovirals, CD4 cell count and age and not NNRTI use were associated with mortality. These results are consistent with those of recent clinical trials, but contrast with some observational analyses.

Presenting author: R S Hogg

1BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard St., Vancouver, V6Z 1Y6 Canada

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