Survival in an urban HIV-1 clinic in the era of highly active antiretroviral therapy: a 5-year cohort study.
OBJECTIVE
To examine the implications of early virologic response to highly active antiretroviral therapy (HAART) on long-term HAART utilization patterns, development of diabetes or hyperlipidemia, and mortality in an urban HIV-1 clinic.


METHODS
A cohort of 444 patients in an urban HIV-1 clinic, who started HAART prior to January 1, 1999, were categorized by virologic response in the first 18 months of therapy: durable viral suppression, initial suppression followed by rebound, and failure to achieve suppression. Antiretroviral exposure, HIV-1 RNA levels, CD4 cell counts, development of diabetes or hyperlipidemia, and survival were compared in the three groups.


RESULTS
Over 4 years of follow-up, patients in the durable suppression group used HAART 82% of the time compared with 60% in the rebound group (p <.001) and 23% in the failure to suppress group (p <.001). Through 4 years of follow-up, patients in the rebound group had a cumulative exposure to a median of seven antiretroviral drugs (interquartile range [IQR]: 6-9) compared with five drugs in the durable suppression group (IQR: 4-6) and five drugs in the failure to suppress group (IQR: 3-7) (p <.001 for both comparisons with the rebound group). At 5 years, the estimated proportions surviving were 89% in the durable suppression group, 76% in the rebound group (p =.04), and 56% in the failure to suppress group (p <.001). During follow-up, 35% in the durable suppression group developed diabetes or hyperlipidemia compared with 24% in the rebound group (p =.15) and 8% in the failure to suppress group (p <.001).


CONCLUSIONS
This study highlights the long-term implications of early virologic response to HAART for survival, accumulation of triple-class antiretroviral exposure, and development of HAART-associated toxicities.
Lucas
Gregory M
GM
Johns Hopkins University , Baltilmore, Maryland 21287, USA. glucas@jhmi.edu
Chaisson
Richard E
RE
Moore
Richard D
RD
D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects* / Q000706:statistics & numerical data; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000139:chemically induced; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy* / Q000821:virology; D015497:HIV-1 / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D006949:Hyperlipidemias / Q000139:chemically induced / Q000150:complications; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000097:blood; D019037:Urban Health Services
D019380:Anti-HIV Agents; D012367:RNA, Viral