Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Sep 7, 2021
Date Accepted: May 10, 2022
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Effect of Switching Antiretroviral Treatment Regimen on Patients with Drug-resistant HIV-1 Infection: A Retrospective Observational Cohort Study
ABSTRACT
Background:
The evidence on the efficacy of Antiretroviral therapy (ART) regimen switches on the mortality of HIV drug-resistant (HIVDR) patients is limited.
Objective:
We aim to provide policy guidance for ART regimen selection and evaluate the effectiveness of ART regimens switch in people living with HIV (PLWH) with HIV-1 drug resistance.
Methods:
This retrospective observational cohort study included 179 PLWH with HIV-1 drug resistance from 2011 to 2020. The time when participants switched treatment regimens (switched to the PIs-based ART regimens (PIs) or the non-nucleoside reverse transcriptase inhibitors [NNRTIs] based ART regimens (NNRTIs)) was taken as an observation starting point, and followed up every 12 months. Parametric g-formula was used to estimate the 5-year risk of mortality under the situation of (1) no interference, (2) immediate switch to NNRTIs, (3) immediate switch to PIs, (4) if CD4(+) T cells<200 switched to PIs.
Results:
The range of follow-up time of the 179 patients was from 30 to 119 months. The median follow-up time was 90 months. During a follow-up of 15,606 person months, 27 individuals died in the cohort. The estimated 5-year risk of mortality under no interference, immediate switch to NNRTIs, immediate switch to PIs, and if CD4(+) T cells<200 switched to PIs were 12.16% (95% CI:8.45, 16.85), 29.76% (95% CI:19.57, 40.98), 1.96% (95% CI:0.23, 5.06), 4.59% (95% CI:1.89, 8.34), respectively. The RRs of immediate switch to NNRTIs, immediate switch to PIs and switch to PIs if CD4(+) T cells<200, compared with no interference mortality rate, were 2.45 (95% CI: 1.79, 3.27), 0.16 (95% CI: 0.02, 0.40) and 0.38 (95% CI: 0.18, 0.62), respectively. The RDs were 17.59% (9.3%, 26.37%), -10.2% (-14.78%, -6.17%) and -7.58% (-11.33%, -3.84%), respectively.
Conclusions:
Our study found that PIs based ART regimen was beneficial in reducing mortality in PLWH with HIV-1 drug resistance. More effort should be given to find HIV-1 drug resistance earlier to ensure timely adjustment to PIs based ART, thereby maximizing the benefit of early switch treatment for PLWH with HIV-1 drug resistance.
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