Universität zu Köln

Bickel, Markus, Hoffmann, Christian, Wolf, Eva, Baumgarten, Axel, Wyen, Christoph, Spinner, Christoph D., Jaeger, Hans, Postel, Nils, Esser, Stefan, Mueller, Markus, Stoehr, Albrecht, Preis, Stefan, Klauke, Stephan and Schewe, Knud (2020). High effectiveness of recommended first-line antiretroviral therapies in Germany: a nationwide, prospective cohort study. Infection, 48 (3). S. 453 - 462. HEIDELBERG: SPRINGER HEIDELBERG. ISSN 1439-0973

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Abstract

Purpose Current German/Austrian antiretroviral treatment guidelines recommend more than 20 combination regimens for first-line therapy, without a preference. Regimens include two nucleoside reverse transcriptase inhibitors (NRTIs) plus either an integrase strand transfer inhibitor (INSTI), a non-NRTI (NNRTI) or a boosted protease inhibitor (PI). The objective was to examine the outcomes of recommended first-line ART in Germany. Methods This nationwide observational study included treatment-naive chronically HIV-1 infected patients receiving one of the recommended first-line regimens. Patients were allocated to three arms (INSTI, NNRTI, PI) and were prospectively followed for 24 months. Delayed treatment initiation was defined by a baseline CD4 T-cell count of < 350/mu l or CDC clinical stage C. Results Among a total of 434 patients enrolled, virologic failure was rare and occurred in 4.3% (6/141) in the PI arm, in 3.3% (4/122) in the NNRTI arm and in 0.6% (1/171) in the INSTI arm (p = 0.10). De novo drug resistance mutations developed in only two patients in the NNRTI arm. Nonetheless, treatment modifications were frequent (51%) and mostly performed for strategic reasons. Retention on all initial compounds at month 24 was 64%, 49%, and 22% in the INSTI, NNRTI and PI arms respectively. Delayed treatment initiation was common (47%) and more frequently observed in patients in the PI arm. It was not associated with virological failure. Conclusion High efficacy and low virological failure rates were observed with recommended first-line regimens independent of delayed treatment initiation, chosen regimen and subsequent treatment modifications, demonstrating the validity of the current treatment guidelines.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Bickel, Markus UNSPECIFIED UNSPECIFIED UNSPECIFIED Hoffmann, Christian UNSPECIFIED UNSPECIFIED UNSPECIFIED Wolf, Eva UNSPECIFIED UNSPECIFIED UNSPECIFIED Baumgarten, Axel UNSPECIFIED UNSPECIFIED UNSPECIFIED Wyen, Christoph UNSPECIFIED UNSPECIFIED UNSPECIFIED Spinner, Christoph D. UNSPECIFIED UNSPECIFIED UNSPECIFIED Jaeger, Hans UNSPECIFIED UNSPECIFIED UNSPECIFIED Postel, Nils UNSPECIFIED UNSPECIFIED UNSPECIFIED Esser, Stefan UNSPECIFIED UNSPECIFIED UNSPECIFIED Mueller, Markus UNSPECIFIED UNSPECIFIED UNSPECIFIED Stoehr, Albrecht UNSPECIFIED UNSPECIFIED UNSPECIFIED Preis, Stefan UNSPECIFIED UNSPECIFIED UNSPECIFIED Klauke, Stephan UNSPECIFIED UNSPECIFIED UNSPECIFIED Schewe, Knud UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-334065
DOI:	10.1007/s15010-020-01428-1
Journal or Publication Title:	Infection
Volume:	48
Number:	3
Page Range:	S. 453 - 462
Date:	2020
Publisher:	SPRINGER HEIDELBERG
Place of Publication:	HEIDELBERG
ISSN:	1439-0973
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language RESISTANCE MUTATIONS; HIV; INHIBITOR; NAIVE; REGIMENS Multiple languages Infectious Diseases Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/33406