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1

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Effectiveness and safety of first-line antiretroviral regimens in clinical practice: a multicentre cohort study

Alejos, Belén ; Suárez-García, Inés ; Rava, Marta ; [et al.]

Oxford University Press (OUP) ; 2020

In: Journal of Antimicrobial Chemotherapy Vol. 75, No. 10 ( 2020-10-01), p. 3004-3014

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In: Journal of Antimicrobial Chemotherapy, Oxford University Press (OUP), Vol. 75, No. 10 ( 2020-10-01), p. 3004-3014

Abstract: We compared 48 week effectiveness and safety of first-line antiretroviral regimens. Methods We analysed HIV treatment-naive adults from the Cohort of the Spanish HIV/AIDS Research Network (CoRIS) starting the most commonly used antiretroviral regimens from 2014 to 2018. We used multivariable regression models to assess the impact of initial regimen on: (i) viral suppression (VS) (viral load & lt;50 copies/mL); (ii) change in CD4 cell count; (iii) CD4/CD8 normalization ( & gt;0.4 and & gt;1); (iv) CD4 percentage normalization ( & gt;29%); (v) multiple T-cell marker recovery (MTMR: CD4 & gt; 500 cells/mm3 plus CD4 percentage & gt;29% plus CD4/CD8 & gt; 1); (vi) lipid, creatinine and transaminase changes; and (vii) discontinuations due to adverse events (AE). Results Among 3945 individuals analysed, the most frequently prescribed regimens were ABC/3TC/DTG (34.0%), TAF/FTC/EVG/CBT (17.2%), TDF/FTC + DTG (11.9%), TDF/FTC/EVG/CBT (11.7%), TDF/FTC/RPV (11.5%), TDF/FTC + bDRV (8.3%) and TDF/FTC + RAL (5.3%). At 48 weeks, 89.7% of individuals achieved VS with no significant differences by initial regimen. CD4 mean increase was 257.8 (249.3; 266.2) cells/mm3, and it was lower with TAF/FTC/EVG/CBT and TDF/FTC/RPV compared with ABC/3TC/DTG. CD4 percentage normalization was less likely with TAF/FTC/EVG/CBT, and MTMR was less likely with TAF/FTC/EVG/CBT and TDF/FTC + RAL. The proportion of discontinuations due to AE was higher with TDF/FTC + bDRV (9.7%), followed by TDF/FTC/EVG/CBT (9.5%) and TDF/FTC + DTG (7.9%). Compared with ABC/3TC/DTG, cholesterol and LDL mean increases were higher with TAF/FTC/EVG/CBT and lower with TDF/FTC + DTG, TDF/FTC/RPV and TDF/FTC + RAL. Higher mean increases in triglycerides were significantly associated with TAF/FTC/EVG/CBT. Regimens containing DTG showed higher creatinine increases. Conclusions The significantly greater immunological response and safety of some combinations may be useful for making decisions when initiating treatment.

Type of Medium: Online Resource

ISSN: 0305-7453 , 1460-2091

URL: Article

DOI: 10.1093/jac/dkaa246

Language: English

Publisher: Oxford University Press (OUP)

Publication Date: 2020

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Expanding HIV clinical monitoring: the role of CD4, CD8, and CD4/CD8 ratio in predicting non-AIDS events

Martínez-Sanz, Javier ; Díaz-Álvarez, Jorge ; Rosas Cancio-Suarez, Marta ; [et al.]

Elsevier BV ; 2023

In: eBioMedicine Vol. 95 ( 2023-09), p. 104773-

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In: eBioMedicine, Elsevier BV, Vol. 95 ( 2023-09), p. 104773-

Type of Medium: Online Resource

ISSN: 2352-3964

URL: Article

DOI: 10.1016/j.ebiom.2023.104773

Language: English

Publisher: Elsevier BV

Publication Date: 2023

detail.hit.zdb_id: 2799017-5

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3

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Effects of first-line antiretroviral therapy on the CD4/CD8 ratio and CD8 cell counts in CoRIS: a prospective multicentre cohort study

Serrano-Villar, Sergio ; Martínez-Sanz, Javier ; Ron, Raquel ; [et al.]

Elsevier BV ; 2020

In: The Lancet HIV Vol. 7, No. 8 ( 2020-08), p. e565-e573

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In: The Lancet HIV, Elsevier BV, Vol. 7, No. 8 ( 2020-08), p. e565-e573

Type of Medium: Online Resource

ISSN: 2352-3018

URL: Article

DOI: 10.1016/S2352-3018(20)30202-2

Language: English

Publisher: Elsevier BV

Publication Date: 2020

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Physicians’ opinions on generic antiretroviral drugs and single-tablet regimen de-simplification for the treatment of HIV infection: a multicentre survey in Spain

Suárez-García, Inés ; Ruiz-Algueró, Marta ; García Yubero, Cristina ; [et al.]

Oxford University Press (OUP) ; 2019

In: Journal of Antimicrobial Chemotherapy ( 2019-10-29)

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In: Journal of Antimicrobial Chemotherapy, Oxford University Press (OUP), ( 2019-10-29)

Abstract: To assess the attitudes and opinions about generic antiretroviral drugs (ARVs) and single-tablet regimen (STR) de-simplification among physicians prescribing HIV treatment in the cohort of the Spanish HIV/AIDS Research Network (CoRIS). Methods An online questionnaire with 27 structured questions was sent to all physicians (n = 199) who prescribed ARVs among the 45 centres participating in the cohort. Results A total of 169 (84.9%) physicians answered the questionnaire. Only 4.1% of the physicians would never prescribe generic ARVs, but 53.3% would not prescribe them if the number of pills per day increased and 89.3% would not prescribe them if the number of doses per day increased. However, 84.0% of the physicians agreed to prescribe generic ARVs if doing so would decrease costs for the public healthcare system. The percentages of physicians stating that generic ARVs (compared with branded ones) would be associated with worse adherence, more adverse effects or more probability of virological failure, provided that the number of pills and doses per day would not change, were low: 0.6%, 7.7% and 3.6%, respectively. However, these percentages were much higher if the generic ARV entailed breaking an STR: 63.9%, 18.9% and 42.0%, respectively. Most physicians stated that they needed more information about the effectiveness and safety of generic ARVs and the price difference compared with their branded equivalents. Conclusions Although most physicians were confident about prescribing generic ARVs, the majority had strong concerns about de-simplifying STR, and they also needed more information about generic drugs.

Type of Medium: Online Resource

ISSN: 0305-7453 , 1460-2091

URL: Article

DOI: 10.1093/jac/dkz439

Language: English

Publisher: Oxford University Press (OUP)

Publication Date: 2019

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5

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Effectiveness of the combination elvitegravir/cobicistat/tenofovir/emtricitabine (EVG/COB/TFV/FTC) plus darunavir among treatment-experienced patients in clinical practice: a multicentre cohort study

Suárez-García, Inés ; Moreno, Cristina ; Ruiz-Algueró, Marta ; [et al.]

Springer Science and Business Media LLC ; 2020

In: AIDS Research and Therapy Vol. 17, No. 1 ( 2020-12)

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In: AIDS Research and Therapy, Springer Science and Business Media LLC, Vol. 17, No. 1 ( 2020-12)

Abstract: The aim of this study was to investigate the effectiveness and tolerability of the combination elvitegravir/cobicistat/tenofovir/emtricitabine plus darunavir (EVG/COB/TFV/FTC + DRV) in treatment-experienced patients from the cohort of the Spanish HIV/AIDS Research Network (CoRIS). Methods Treatment-experienced patients starting treatment with EVG/COB/TFV/FTC + DRV during the years 2014–2018 and with more than 24 weeks of follow-up were included. TFV could be administered either as tenofovir disoproxil fumarate or tenofovir alafenamide. We evaluated virological response, defined as viral load (VL) 〈 50 copies/ml and 〈 200 copies/ml at 24 and 48 weeks after starting this regimen, stratified by baseline VL ( 〈 50 or ≥ 50 copies/ml at the start of the regimen). Results We included 39 patients (12.8% women). At baseline, 10 (25.6%) patients had VL 〈 50 copies/ml and 29 (74.4%) had ≥ 50 copies/ml. Among patients with baseline VL 〈 50 copies/ml, 85.7% and 80.0% had VL 〈 50 copies/ml at 24 and 48 weeks, respectively, and 100% had VL 〈 200 copies/ml at 24 and 48 weeks. Among patients with baseline VL ≥ 50 copies/ml, 42.3% and 40.9% had VL 〈 50 copies/ml and 69.2% and 68.2% had VL 〈 200 copies/ml at 24 and 48 weeks. During the first 48 weeks, no patients changed their treatment due to toxicity, and 4 patients (all with baseline VL ≥ 50 copies/ml) changed due to virological failure. Conclusions EVG/COB/TFV/FTC + DRV was well tolerated and effective in treatment-experienced patients with undetectable viral load as a simplification strategy, allowing once-daily, two-pill regimen with three antiretroviral drug classes. Effectiveness was low in patients with detectable viral loads.

Type of Medium: Online Resource

ISSN: 1742-6405

URL: Article

DOI: 10.1186/s12981-020-00302-2

Language: English

Publisher: Springer Science and Business Media LLC

Publication Date: 2020

detail.hit.zdb_id: 2173450-1

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6

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Discovering HIV related information by means of association rules and machine learning

Araujo, Lourdes ; Martinez-Romo, Juan ; Bisbal, Otilia ; [et al.]

Springer Science and Business Media LLC ; 2022

In: Scientific Reports Vol. 12, No. 1 ( 2022-10-28)

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In: Scientific Reports, Springer Science and Business Media LLC, Vol. 12, No. 1 ( 2022-10-28)

Abstract: Acquired immunodeficiency syndrome (AIDS) is still one of the main health problems worldwide. It is therefore essential to keep making progress in improving the prognosis and quality of life of affected patients. One way to advance along this pathway is to uncover connections between other disorders associated with HIV/AIDS—so that they can be anticipated and possibly mitigated. We propose to achieve this by using Association Rules (ARs). They allow us to represent the dependencies between a number of diseases and other specific diseases. However, classical techniques systematically generate every AR meeting some minimal conditions on data frequency, hence generating a vast amount of uninteresting ARs, which need to be filtered out. The lack of manually annotated ARs has favored unsupervised filtering, even though they produce limited results. In this paper, we propose a semi-supervised system, able to identify relevant ARs among HIV-related diseases with a minimal amount of annotated training data. Our system has been able to extract a good number of relationships between HIV-related diseases that have been previously detected in the literature but are scattered and are often little known. Furthermore, a number of plausible new relationships have shown up which deserve further investigation by qualified medical experts.

Type of Medium: Online Resource

ISSN: 2045-2322

URL: Article

DOI: 10.1038/s41598-022-22695-y

Language: English

Publisher: Springer Science and Business Media LLC

Publication Date: 2022

detail.hit.zdb_id: 2615211-3

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7

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Integrase inhibitors in children and adolescents: clinical use and resistance

Torres-Fernandez, David ; Jiménez de Ory, Santiago ; Fortuny, Claudia ; [et al.]

Oxford University Press (OUP) ; 2022

In: Journal of Antimicrobial Chemotherapy Vol. 77, No. 10 ( 2022-09-30), p. 2784-2792

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In: Journal of Antimicrobial Chemotherapy, Oxford University Press (OUP), Vol. 77, No. 10 ( 2022-09-30), p. 2784-2792

Abstract: Although integrase inhibitor (INI)-based regimens are now the first-line choice for all people living with HIV, experience among children and adolescents is still scarce. We describe the characteristics and outcomes of a paediatric/adolescent cohort on INI-based ART. Methods Retrospective analysis of HIV-infected patients below 18 years of age who started an INI-based regimen from 2007 to 2019, enrolled in the Spanish National Adult (CoRIS) and Paediatric (CoRISpe) cohorts. Resistance mutations were identified by the Stanford HIV Drug Resistance Database. Results Overall, 318 INI-based regimens were implemented in 288 patients [53.8% female; median age at start of 14.3 years (IQR 12.0–16.3)]. Most were born in Spain (69.1%), vertically infected (87.7%) and treatment-experienced (92.7%). The most frequently prescribed INI was dolutegravir (134; 42.1%), followed by raltegravir (110; 34.6%) and elvitegravir (73; 23.0%). The median exposure was 2.0 years (IQR 1.1–3.0). The main reasons to start an INI-based therapy were treatment simplification (54.4%) and virological failure (34.3%). In total, 103 (32.4%) patients interrupted their regimen: 14.5% for simplification and 8.5% due to virological failure. Most subjects who received dolutegravir (85.8%) and elvitegravir (83.6%) did not interrupt their regimen and maintained undetectable viral load. There were only five virological failures with dolutegravir and three with elvitegravir. There were no interruptions related to adverse events. Seven patients with virological failure presented major resistance mutations to INIs; none of them were on dolutegravir. Conclusions INI-based regimens were effective and safe for HIV treatment in children and adolescents. Dolutegravir and elvitegravir presented an excellent profile, and most patients achieved and maintained viral suppression.

Type of Medium: Online Resource

ISSN: 0305-7453 , 1460-2091

URL: Article

DOI: 10.1093/jac/dkac259

Language: English

Publisher: Oxford University Press (OUP)

Publication Date: 2022

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8

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Effectiveness and tolerability of dolutegravir/lamivudine for the treatment of HIV-1 infection in clinical practice

Suárez-García, Inés ; Alejos, Belén ; Hernando, Victoria ; [et al.]

Oxford University Press (OUP) ; 2023

In: Journal of Antimicrobial Chemotherapy Vol. 78, No. 6 ( 2023-06-01), p. 1423-1432

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In: Journal of Antimicrobial Chemotherapy, Oxford University Press (OUP), Vol. 78, No. 6 ( 2023-06-01), p. 1423-1432

Abstract: To assess the effectiveness and tolerability of dolutegravir (DTG)/lamivudine (3TC) among treatment-naive and virologically suppressed treatment-experienced individuals in the multicentre cohort of the Spanish HIV/AIDS Research Network (CoRIS) during the years 2018–2021. Methods We used multivariable regression models to compare viral suppression (VS) [HIV RNA viral load (VL) & lt;50 copies/mL] and the change in CD4 cell counts at 24 and 48 (±12) weeks after initiation with dolutegravir/lamivudine or other first-line ART regimens. Results We included 2160 treatment-naive subjects, among whom 401 (18.6%) started with dolutegravir/lamivudine. The remaining subjects started bictegravir (BIC)/emtricitabine (FTC)/tenofovir alafenamide (TAF) (n = 949, 43.9%), DTG + FTC/tenofovir disoproxil fumarate (TDF) (n = 282, 13.1%), DTG/3TC/abacavir (ABC) (n = 255, 11.8%), darunavir (DRV)/cobicistat(COBI)/FTC/TAF (n = 147, 6.8%) and elvitegravir (EVG)/COBI/FTC/TAF (n = 126, 5.8%). At 24 and 48 weeks after starting dolutegravir/lamivudine, 91.4% and 93.8% of the subjects, respectively, achieved VS. The probability of achieving VS with dolutegravir/lamivudine was not significantly different compared with any other regimen at 24 or 48 weeks, with the exception of a lower chance of achieving VS at 24 weeks for DRV/COBI/FTC/TAF (adjusted OR: 0.47; 95% CI: 0.30–0.74) compared with dolutegravir/lamivudine. For the analysis of treatment-experienced virally suppressed subjects we included 1456 individuals who switched to dolutegravir/lamivudine, among whom 97.4% and 95.5% maintained VS at 24 and 48 weeks, respectively. During the first 48 weeks after dolutegravir/lamivudine initiation, 1.0% of treatment-naive and 1.5% of treatment-experienced subjects discontinued dolutegravir/lamivudine due to an adverse event. Conclusions In this large multicentre cohort, effectiveness and tolerability of dolutegravir/lamivudine were high among treatment-naive and treatment-experienced subjects.

Type of Medium: Online Resource

ISSN: 0305-7453 , 1460-2091

URL: Article

DOI: 10.1093/jac/dkad102

Language: English

Publisher: Oxford University Press (OUP)

Publication Date: 2023

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