Determinants
of Discontinuation
of Initial HAART
Achieving
complete and
durable HIV
suppression
and better tolerability
are required
elements for
achieving the
best prognosis
for HIV positive
patients. The
objective of
the current
study was to
discover the
determinants
of discontinuation
of therapy.
Researchers
at the Bristol-Myers
Squibb Pharmaceutical
Research Institute
analyzed data
from a cohort
of US HIV who
initiated HAART
for the first
time from 1996
to 2003 were
included in
the analysis.
The investigators
considered time-updated
viral load
and
CD4 count
data for analyzing
the time to
first discontinuation
of HAART.
Results
| 3414
treatment-naive
HAART patients
were identified.
|
 | During
a median follow-up
period of 211
days, 628 patients
(18.4%) reportedly
discontinued
the HAART regimen
because of drug
toxicity.
|
| 456
(13.4%) discontinued
because of non-compliance.
|
| 257
(7.5%) discontinued
because of treatment
failure.
|
|
In addition
to the recorded
reasons for
discontinuation,
black ethnicity,
current smoking,
high pill burden,
and recent viral
control were
all predictive
of discontinuation.
|
| Only
high pill burden
(>15 pills/day),
which is considered
to be a surrogate
for treatment
regimen complexity,
and the most
recent poor
viral control
(HIV RNA) were
found to be
consistently
associated with
a higher likelihood
of discontinuation.
|
Based
on these findings,
the study authors
conclude, "Risk
factors other
than physician-
or patient-reported
reasons play
a role in discontinuation
of initial HAART
regimens. Identification
of these risk
factors and
simplification
of treatment
regimens in
those at high
risk for discontinuation
appear to be
necessary in
order to maximize
the effectiveness
of HAART regimens."
03/14/06
Reference
Y
Yuan and others.
Determinants
of discontinuation
of initial highly
active antiretroviral
therapy regimens
in a US HIV-infected
patient cohort.
HIV Medicine
7(3): 156-162.
April 2006.
