title: Could better tolerated HIV drug regimens improve patient outcome?
abstract: OBJECTIVE
  To quantify the performance of existing first-line and second-line combination antiretroviral therapy (cART) regimens on patient's clinical outcomes in the Netherlands using ATHENA data and to evaluate the potential for new drug regimens to improve patient's clinical outcomes using a data-based mathematical model.
  
  
  METHODS
  We analysed data from 3995 patients from the Dutch ATHENA national observational cohort between 2000 and 2010. We quantified the main drug-related reasons for switching from first-line and second-line cART, classified as toxicity, simplification/new medication becoming available, virological failure, or other reasons. We developed a deterministic model describing HIV infection and treatment in the Netherlands parameterized on the basis of these data. The model simulated how a new drug regimen, with either improved toxicity or virological failure profile, could impact on patient's clinical outcomes.
  
  
  RESULTS
  The main reason for switching current first-line and second-line regimens was toxicity, accounting for around 50% of switching from first-line and from second-line cART. The model found that a new drug regimen with increased tolerability profile could have the highest potential impact on patient's outcomes, especially as a first-line treatment. A new first-line drug regimen with improved tolerability could increase the time patients spend on first-line cART, decrease their risk of switching from first-line cART and thus simplify patient management.
  
  
  CONCLUSIONS
  New drug regimens with improved toxicity profiles could have the greatest impact on patient outcomes and simplify patient management in the Netherlands.
authors: Department of Infectious Disease Epidemiology, Imperial College, Faculty of Medicine, London, UK. mikaela.smit@imperial.ac.uk
authors: Mikaela
authors: M
authors: Smit
authors: Colette
authors: C
authors: Smit
authors: Ide
authors: I
authors: Cremin
authors: Geoffrey P
authors: GP
authors: Garnett
authors: Timothy
authors: T
authors: Hallett
authors: Frank
authors: F
authors: de Wolf
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000009:adverse effects* / Q000494:pharmacology; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D024882:Drug Resistance, Viral / Q000187:drug effects*; D004359:Drug Therapy, Combination; D019317:Evidence-Based Medicine; D005260:Female; D015497:HIV-1 / Q000187:drug effects*; D006801:Humans; D008134:Long-Term Care; D008297:Male; D008962:Models, Theoretical; D009426:Netherlands / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents