Clinical outcomes of first-line antiretroviral therapy in Latin America: analysis from the LATINA retrospective cohort study.
Nearly 2 million people are infected with human immunodeficiency virus (HIV) in Latin America. However, information regarding population-scale outcomes from a regional perspective is scarce. We aimed to describe the baseline characteristics and therapeutic outcomes of newly-treated individuals with HIV infection in Latin America. A Retrospective cohort study was undertaken. The primary explanatory variable was combination antiretroviral therapy based on either a protease inhibitor (PI) or a non-nucleoside reverse transcriptase inhibitor (NNRTI). The main outcome was defined as the composite of all-cause mortality and the occurrence of an AIDS-defining clinical event or a serious non-AIDS-defining event during the first year of therapy. The secondary outcomes included the time to a change in treatment strategy. All analyses were performed according to the intention to treat principle. A total of 937 treatment-naive patients from four participating countries were included (228 patients with PI therapy and 709 with NNRTI-based treatment). At the time of treatment initiation, the patients had a mean age of 37 (SD: 10) years and a median CD4 + T-cell count of 133 cells/mm(3) (interquartile range: 47.5-216.0). Patients receiving PI-based regimens had a significantly lower CD4 + count, a higher AIDS prevalence at baseline and a shorter time from HIV diagnosis until the initiation of treatment. There was no difference in the hazard ratio for the primary outcome between groups. The only covariates associated with the latter were CD4 + cell count at baseline, study site and age. The estimated hazard ratio for the time to a change in treatment (NNRTI vs PI) was 0.61 (95% CI 0.47-0.80, p < 0.01). This study concluded that patients living with HIV in Latin America present with similar clinical outcomes regardless of the choice of initial therapy. Patients treated with PIs are more likely to require a treatment change during the first year of follow up.
CICAL, Buenos Aires, Argentina Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
Federico
F
Angriman
CICAL, Buenos Aires, Argentina Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
Waldo H
WH
Belloso
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México DF, México.
Juan
J
Sierra-Madero
Asociación Civil Impacta Salud y Educación, Lima, Perú
Jorge
J
Sánchez
Instituto de Pesquisa Clinica Evandro Chagas-FIOCRUZ, Rio de Janeiro, Brazil.
Ronaldo Ismerio
RI
Moreira
CICAL, Buenos Aires, Argentina.
Leandro O
LO
Kovalevski
CICAL, Buenos Aires, Argentina Deakin University, Melbourne, Australia.
Liliana C
LC
Orellana
Instituto de Pesquisa Clinica Evandro Chagas-FIOCRUZ, Rio de Janeiro, Brazil.
Sandra Wagner
SW
Cardoso
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México DF, México.
Brenda
B
Crabtree-Ramirez
Asociación Civil Impacta Salud y Educación, Lima, Perú
Alberto
A
La Rosa
CICAL, Buenos Aires, Argentina Hospital José M. Ramos Mejía, Buenos Aires, Argentina.
Marcelo H
MH
Losso
D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000208:ethnology / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D007843:Latin America / Q000453:epidemiology / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*; D015996:Survival Rate; D019562:Viral Load / Q000187:drug effects*; D055815:Young Adult
D019380:Anti-HIV Agents; D018894:Reverse Transcriptase Inhibitors
AIDS; CD4 cell lymphocyte count; HIV; Latin America; antiretroviral therapy; cohort studies; outcomes; treatment