Impact of discontinuation of initial protease inhibitor therapy on further virological response in a cohort of human immunodeficiency virus-infected patients.
Although discontinuation of antiretroviral drug therapy is common, the impact on outcome in routine clinical practice is unknown. The Antiprotéases Cohorte (APROCO) Cohort Study enrolled 1281 patients at the time they started a protease inhibitor (PI)-containing regimen from 1997 through 1999. After a median duration of follow-up of 20 months, 51% of patients had discontinued their initial PI. Prospectively recorded reasons for discontinuation were intolerance (52% of patients), poor adherence (22%), and failure of therapy (15%). In a multivariate logistic regression analysis, only discontinuation due to poor adherence was associated with a lower frequency of human immunodeficiency virus RNA level in plasma of <500 copies/mL 12 months after initiation of therapy (odds ratio, 0.27 vs. no change; P<.0001); discontinuation due to intolerance was not associated with virological response (odds ratio, 0.89; P=.58). Patients experiencing intolerance should be reassured that changing therapy will probably not be harmful. Multidisciplinary efforts should concentrate on ways to avoid discontinuation of treatment for adherence reasons.
Le Moing
Vincent
V
Service des Maladies Infectieuses et Tropicales, Hôpital Bichat-Claude Bernard, Paris, France.
Chêne
Geneviève
G
Leport
Catherine
C
Lewden
Charlotte
C
Duran
Ségolène
S
Garré
Michel
M
Masquelier
Bernard
B
Dupon
Michel
M
Raffi
François
F
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D015331:Cohort Studies; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D005602:France; D015658:HIV Infections / Q000188:drug therapy*; D017320:HIV Protease Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D015497:HIV-1 / Q000187:drug effects; D006801:Humans; D008297:Male; D011446:Prospective Studies; D019258:Saquinavir / Q000009:adverse effects / Q000627:therapeutic use; D017211:Treatment Failure; D016312:Treatment Refusal / Q000706:statistics & numerical data
D017320:HIV Protease Inhibitors; D019258:Saquinavir