title: Does short-term virologic failure translate to clinical events in antiretroviral-naïve patients initiating antiretroviral therapy in clinical practice?
abstract: OBJECTIVE
  To determine whether differences in short-term virologic failure among commonly used antiretroviral therapy (ART) regimens translate to differences in clinical events in antiretroviral-naïve patients initiating ART.
  
  
  METHODS
  Observational cohort study of patients initiating ART between January 2000 and December 2005.
  
  
  METHODS
  The Antiretroviral Therapy Cohort Collaboration (ART-CC) is a collaboration of 15 HIV cohort studies from Canada, Europe, and the United States.
  
  
  METHODS
  A total of 13 546 antiretroviral-naïve HIV-positive patients initiating ART with efavirenz, nevirapine, lopinavir/ritonavir, nelfinavir, or abacavir as third drugs in combination with a zidovudine and lamivudine nucleoside reverse transcriptase inhibitor backbone.
  
  
  METHODS
  Short-term (24-week) virologic failure (>500 copies/ml) and clinical events within 2 years of ART initiation (incident AIDS-defining event, death, and a composite measure of these two outcomes).
  
  
  RESULTS
  Compared with efavirenz as initial third drug, short-term virologic failure was more common with all other third drugs evaluated; nevirapine (adjusted odds ratio = 1.87, 95% confidence interval (CI) = 1.58-2.22), lopinavir/ritonavir (1.32, 95% CI = 1.12-1.57), nelfinavir (3.20, 95% CI = 2.74-3.74), and abacavir (2.13, 95% CI = 1.82-2.50). However, the rate of clinical events within 2 years of ART initiation appeared higher only with nevirapine (adjusted hazard ratio for composite outcome measure 1.27, 95% CI = 1.04-1.56) and abacavir (1.22, 95% CI = 1.00-1.48).
  
  
  CONCLUSIONS
  Among antiretroviral-naïve patients initiating therapy, between-ART regimen, differences in short-term virologic failure do not necessarily translate to differences in clinical outcomes. Our results should be interpreted with caution because of the possibility of residual confounding by indication.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mugavero
authors.forename: Margaret
authors.initials: M
authors.lastname: May
authors.forename: Ross
authors.initials: R
authors.lastname: Harris
authors.forename: Michael S
authors.initials: MS
authors.lastname: Saag
authors.forename: Dominique
authors.initials: D
authors.lastname: Costagliola
authors.forename: Matthias
authors.initials: M
authors.lastname: Egger
authors.forename: Andrew
authors.initials: A
authors.lastname: Phillips
authors.forename: Huldrych F
authors.initials: HF
authors.lastname: Günthard
authors.forename: Francois
authors.initials: F
authors.lastname: Dabis
authors.forename: Robert
authors.initials: R
authors.lastname: Hogg
authors.forename: Frank
authors.initials: F
authors.lastname: de Wolf
authors.forename: Gerd
authors.initials: G
authors.lastname: Fatkenheuer
authors.forename: M John
authors.initials: MJ
authors.lastname: Gill
authors.forename: Amy
authors.initials: A
authors.lastname: Justice
authors.forename: Antonella
authors.initials: A
authors.lastname: D'Arminio Monforte
authors.forename: Fiona
authors.initials: F
authors.lastname: Lampe
authors.forename: Jose M
authors.initials: JM
authors.lastname: Miró
authors.forename: Schlomo
authors.initials: S
authors.lastname: Staszewski
authors.forename: Jonathan A C
authors.initials: JA
authors.lastname: Sterne
mesh_terms: D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D018572:Disease-Free Survival; D004347:Drug Interactions; D024882:Drug Resistance, Viral; D004359:Drug Therapy, Combination; D004812:Epidemiologic Methods; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D015497:HIV-1; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012367:RNA, Viral / Q000378:metabolism*; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*; D016896:Treatment Outcome; D019562:Viral Load; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents; D012367:RNA, Viral; D018894:Reverse Transcriptase Inhibitors