Dual nucleoside reverse transcriptase inhibitor therapy in the combination antiretroviral therapy era and predictors of discontinuation or switch to combination antiretroviral therapy.
BACKGROUND
Contrary to current HIV/AIDS management guidelines, and despite the arrival of potent combination antiretroviral therapy (cART) many years ago, some patients are still treated with dual nucleoside reverse transcriptase inhibitor (NRTI) regimens.


METHODS
We selected 5222 patients who received dual NRTI therapy for at least 6 months during 1998 to 2002, representing 9.9% of the 52,981 ARV-treated patients recorded in the French Hospital Database on HIV. Factors associated with switching to cART or with ARV discontinuation were identified by using Cox models.


RESULTS
The 3-year probabilities of switching to cART and of antiretroviral (ARV) drug discontinuation were 55.2% (95% confidence interval [CI]: 53.8 to 56.7) and 10.9% (95% CI: 10.1 to 11.8), respectively, whereas 1591 patients (30.5%) kept the dual NRTI therapy during all the study period. Place of birth and region of care did not influence the choice of treatment strategy. After adjustment, the likelihood of switching to cART was lower among women, intravenous drug users, and patients with an undetectable plasma viral load (pVL) on at least 1 occasion during follow-up; in contrast, it was higher among patients with AIDS and those with a low CD4 cell count at enrollment or at the last follow-up visit. The likelihood of ARV discontinuation was higher among women and intravenous drug users and lower among patients with a low CD4 cell count at inclusion or at the last follow-up visit and among patients with an undetectable pVL on at least 1 occasion during follow-up. The likelihood of switching to cART or discontinuing ARV drugs was higher among patients receiving zidovudine/zalcitabine or didanosine/stavudine than among those receiving zidovudine/lamivudine.


CONCLUSIONS
In France, until recent years, some patients (mainly women and intravenous drug users) were still receiving dual NRTI therapy despite free access to care and to highly effective ARV regimens. Dual NRTI therapy is gradually being replaced by cART, although some patients with satisfactory immunovirologic status are discontinuing all ARV drugs.
Selinger-Leneman
Hana
H
INSERM UMRS720, Université Pierre et Marie Curie-Paris, Paris, France.
Matheron
Sophie
S
Mahamat
Aba
A
Moreau
Jacques
J
Costagliola
Dominique
D
Abgrall
Sophie
S
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D005260:Female; D005602:France; D005843:Geography; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D012111:Residence Characteristics; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*; D012737:Sex Factors; D015819:Substance Abuse, Intravenous; D019562:Viral Load; D028761:Withholding Treatment
D019380:Anti-HIV Agents; D018894:Reverse Transcriptase Inhibitors