Use of the protease inhibitor saquinavir hard gel in human immunodeficiency virus-infected patients in the early period of highly active antiretroviral therapy: does it affect long-term treatment outcome?
Saquinavir hard gel capsule (hgc), the first human immunodeficiency virus (HIV) protease inhibitor (PI) used in clinical practice, has been shown to have insufficient effectiveness. A population-based cohort study assessed the long-term consequences of using saquinavir hgc as initial PI in HIV-infected patients pre-exposed to nucleoside reverse transcriptase inhibitors. 121 patients starting a regimen with saquinavir hgc were compared with 91 starting with non-boosted indinavir (n = 72) or ritonavir (n = 19). Median follow-up time was 4.6 and 4.7 y for the 2 groups. Starting with saquinavir hgc was associated with a lower overall probability of achieving an undetectable viral load [risk ratio (RR) = 0.41, 95%, confidence interval (95% CI) 0.30-0.56]. However, the lower probability of having undetectable viral load during follow-up declined over time with odds ratios (OR) = 0.27 (95%, CI 0.14-0.54), 0.35 (951% CI 0.19-0.66), 0.47 (95% CI 0.24-0.91) and 0.73 (95% CI 0.34-1.55) at 60, 120, 180 and 240 weeks, respectively, after starting HAART. Starting with saquinavir hgc was correlated with a higher risk of having the initial PI discontinued (RR = 1.89, 95% CI 1.39-2.58). The insufficient suppression of viral load in patients starting with saquinavir hgc subsided during follow-up, probably owing to the earlier discontinuation of saquinavir hcg in favour of newer and more potent HAART regimens.
Jensen-Fangel
Søren
S
Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark. fangel@dadlnet.dk
Pedersen
Court
C
Nielsen
Henrik
H
Tauris
Palle
P
Møller
Axel
A
Sørensen
Henrik Toft
HT
Obel
Niels
N
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D002214:Capsules; D015331:Cohort Studies; D003718:Denmark; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy* / Q000821:virology; D017320:HIV Protease Inhibitors / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D016017:Odds Ratio; D019258:Saquinavir / Q000627:therapeutic use*; D016896:Treatment Outcome; D019562:Viral Load
D019380:Anti-HIV Agents; D002214:Capsules; D017320:HIV Protease Inhibitors; D019258:Saquinavir