Long-term immunologic and virologic responses on raltegravir-containing regimens among ART-experienced participants in the HIV Outpatient Study

Details

• Alternative Title:
  HIV Clin Trials
• Personal Author:
  Buchacz, Kate ; Wiegand, Ryan ; Armon, Carl ; Chmiel, Joan S. ; Wood, Kathleen ; Brooks, John T. ; Palella, Frank J.
• Corporate Authors:
  HIV Outpatient Study (HOPS) Investigators
• Description:
  Objectives
  
  Raltegravir (RAL)-containing antiretroviral therapy (ART) produced better immunologic and virologic responses than optimized background ART in clinical trials of heavily ART-experienced patients, but few data exist on long-term outcomes in routine HIV care.
  
  Methods
  
  We studied ART-experienced HIV outpatient study (HOPS) participants seen at 10 US HIV-specialty clinics during 2007–2011. We identified patients who started (baseline date) either continuous ≥30 days of RAL-containing or RAL-sparing ART, and used propensity score (PS) matching methods to account for baseline clinical and demographic differences. We used Kaplan–Meier methods and log-rank tests for the matched subsets to evaluate probability of death, achieving HIV RNA <50 copies/ml, and CD4 cell count (CD4) increase of ≥50 cells mm−3 during follow-up.
  
  Results
  
  Among 784 RAL-exposed and 1062 RAL-unexposed patients, 472 from each group were matched by PS. At baseline, the 472 RAL-exposed patients (mean nadir CD4, 205 cells mm−3; mean baseline CD4, 460 cells mm−3; HIV RNA <50 copies ml−1 in 61%; mean years on prescribed ART, 7.5) were similar to RAL unexposed. During a mean follow-up of over 3 years, mortality rates and immunologic and virologic trajectories did not differ between the two groups. Among patients with detectable baseline HIV RNA levels, 76% of RAL-exposed and 63% of RAL-unexposed achieved HIV RNA <50 copies ml−1 (P=0.51); 69 and 58%, respectively, achieved a CD4 increase ≥50 cells mm−3 (P=0.70).
  
  Discussion
  
  In our large cohort of US ART-experienced patients with a wide spectrum of clinical history, similar outcomes were observed when prescribed RAL containing versus other contemporary ART.
  
  
• Subjects:
  Anti-HIV Agents CD4 Lymphocyte Count Cohort Studies Female HIV Infections Humans Kaplan-Meier Estimate Male Middle Aged Outpatients Prospective Studies Raltegravir Potassium Viral Load

  More +
• Keywords:
  Clinical Outcomes HIV Cohort Mortality Raltegravir Viral Load Viremia
• Source:
  HIV Clin Trials. 16(4):139-146
• Pubmed ID:
  26126549
• Pubmed Central ID:
  PMC4657741
• Document Type:
  Journal Article
• Funding:
  CC999999/Intramural CDC HHSUnited States/
• Volume:
  16
• Issue:
  4
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:43706e37e4c141464038acd55109235a0c16b1984580665b631b2aa6bc35c6ebd3d064dcf1c00eab23498cf51824f94ce27055e92665cea2f5e4a4b4c17eceb8
• Download URL:
  https://stacks.cdc.gov/view/cdc/36220/cdc_36220_DS1.pdf
• File Type:
  [PDF - 691.59 KB ]