6th International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV 25–28 October 2004 - Washington, DC, USA

WHY DO PATIENTS WITH HIV STOP ANTIRETROVIRALS USED AS PART OF AN INITIAL HIGHLY ACTIVE ANTIRETROVIRAL REGIMEN?

Antiviral Therapy 2004; 9(6):L44 (abstract no. 74)

A Mocroft¹, AN Phillips¹, V Soriano², J Rockstroh³, A Blaxhult⁴, C Katlama⁵, A Boron-Kaczmarska⁶, L Viksna⁷, O Kirk⁸, JD Lundgren⁸ for the EuroSIDA study group
¹Royal Free Centre for HIV Medicine and Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London, UK; ²Hospital Carlos III, Madrid, Spain; ³Universitäts Klinik, Bonn, Germany; ⁴Karolinska Hospital, Stockholm, Sweden; ⁵Hôpital de la Pitié-Salpêtière, Paris, France; ⁶Medical University, Szczecin, Poland; ⁷Infectology Centre of Latvia, Riga, Latvia; and ⁸Copenhagen HIV Program, Hvidovre Hospital, Copenhagen, Denmark

BACKGROUND: Low adherence and toxicities among HIV-positive patients starting highly active antiretroviral therapy (HAART) can lead to discontinuation of therapy and treatment failure. Little is known about hepatitis C (HCV) status and discontinuation of HAART.

METHODS: Poisson regression was used to determine factors related to discontinuation of any part of an initial HAART regimen due to treatment failure (TF) or toxicities and patient/physician choice (TOX), and to investigate the relationship between HCV and discontinuation of a HAART regimen in 1052 patients staring HAART after 1999 from the EuroSIDA study.

RESULTS: At 1 year after starting HAART, 65% of patients remained on their original regimen, 28% had changed and 7% were off all treatment. The most frequent reason for discontinuation was toxicities (31%). The incidence of any discontinuation has decreased over time by 18% per year (95% CI 11–24%, P<0.0001). The main decline was among patients who discontinued due to TOX. Patients with HCV had a higher incidence of discontinuation due to TOX during the first 6 months of HAART (incidence rate ratio (IRR) 2.14, 95% CI 1.05–5.92, P=0.035) or after 6 months on therapy (IRR 2.09; 95% CI 1.02–4.28, P=0.044) compared with patients without HCV.

CONCLUSIONS: Patients with HCV were more likely to discontinue all or part of their HAART regimens due to toxicity or patient/physician choice. Managing adverse events must remain a key intervention in maintaining HAART. There is a need for further studies to describe the relationship between HCV, specific antiretrovirals and different treatment strategies.

2004-10-25
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