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Effectiveness of second-line antiretroviral therapy: the impact of drug switches

机译：二线抗逆转录病毒治疗的有效性：药物交换机的影响

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Including antiretroviral drug switches as a measure of ART failure could be more suitable than conventional measures to evaluate health outcomes in real-world settings. This is part of a historical cohort of HIV-infected adults who initiated ART from 2001-2005, and were followed up for a maximum of five years in three HIV/AIDS centers in Belo Horizonte, Brazil. Follow-up information included data from 2001-2010. All patients switched from first-line ART were included. Second-line ART effectiveness was measured as the time-to-ART failure. Failure was defined simulating two scenarios: (1) Clinical, immunological and virological failure (scenario 1); and scenario 1 plus ART switches (scenario 2). Descriptive analysis, Kaplan-Meier curves, log-rank test, and Cox proportional hazards model were performed. We identified 119 eligible patients; most had protease inhibitor (PI)-based regimens prescribed as second-line. The incidence of failure was different for the two scenarios (29.4% vs. 54.6% for scenario 1 and 2, respectively; p<0.001). The main identifiers of failure were increase in viral load (31.1%) for scenario 1 and ART switches (42.8%) for scenario 2.Median duration on second-line ART was 36.8 vs. 19.8 months for scenario 1 and 2, respectively. In the Cox analysis of scenario 2, increased risk was found for patients given PI-based second-line regimens (HR=2.26; 95% CI: 1.09-3.17). There is a high incidence of ART failure associated with PI-based regimens when ART switches are considered as an indicator of failure. This demonstrates the impact of ART switches in representing lack of ART effectiveness.
机译：包括抗逆转录病毒药物开关作为艺术措施的措施可能比传统措施更适合评估现实世界中的健康结果。这是从2001 - 2005年开始发起艺术的艾滋病毒感染成年人的历史队的历史队列的一部分，并在巴西贝罗奥里藏地的三个艾滋病毒/艾滋病中心进行了最多五年。后续信息包括2001-2010的数据。包括从一线艺术转换的所有患者。将第二线艺术效能作为最新的效果。定义失败模拟两种情况：（1）临床，免疫学和病毒学失败（情景1）;和场景1加艺术开关（方案2）。描述性分析，Kaplan-Meier曲线，对数级测试和COX比例危险模型进行了描述。我们确定了119名符合条件的患者;大多数有蛋白酶抑制剂（PI）基础的方案，规定为第二线。两种情况的失败发生率不同（平面1和2的29.4％与54.6％; P <0.001）。失败的主要标识是病毒载荷（31.1％）的情况下，情景1和艺术交换机（42.8％）的场景2.第二线艺术的持续时间分别为36.8与19.8个月，分别为36.8个月，方案1和2。在情景2的COX分析中，发现对PI基二线方案的患者发现增加的风险（HR = 2.26; 95％CI：1.09-3.17）。当艺术开关被认为是失败的指示器时，存在与基于PI的方案相关的艺术失败的发病率高。这证明了艺术交换机的影响代表缺乏艺术效果。

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