Reasons for modifying
the first HAART regimen among older patients in an urban HIV/AIDS cohort in
S. Cardoso, T. Torres, V.G. Veloso, L. Velasque, L. Coelho, S. Ribeiro, B. Grinsztejn
Fundação Oswaldo Cruz, Instituto de Pesquisa Clínica Evandro Chagas, Rio de Janeiro, Brazil
Background: With the advent of
HAART, people with HIV infection are living longer. Increased longevity as well
as new infections in older patients are the reasons. Treatment toxicities may
be worse in older patients, particularly those with underlying comorbidities. Information on type and duration of the first
HAART regimen, and reason(s) for its modification/interruption (MOD) are
critical for logistical planning. Such data is scarce in developing countries.
In a previous analysis we found that Toxicity MOD was significantly more common
among older patients in our cohort. We examined the reasons for MOD of
the first HAART regimen for patients who started treatment at age ³ 50.
Methods: Patients initiating
HAART at age ³ 50 between January 1996
and December 2008 were included. Demographic, clinical, laboratory, HAART
regimen, and reason(s) for HAART MOD were assessed. Time to the first HAART MOD
was assessed by Kaplan-Meier. Factors associated this outcome were assessed by
Cox proportional hazards analysis.
Results: 95 patients met study criteria, 61% male.
At HAART initiation, mean age was 56; median CD4 was164 cells/mm3;
median VL4.8 log10; 36% initiated HAART before 2003 and 64%
after 2003. Mean follow up was 24 months. Overall MOD was 59%; median time
to MOD was 12 months. Main reasons for MOD were: therapeutic failure (23%),
short term toxicities (18%) long term toxicities (10%). Most frequent
toxicities were GI related. Overall MOD was significantly more common among
subjects starting HAART with CD4 < 100 (HR: 1.97; IC95% 1.08-3.61). The
lowest risk of MOD was in patients using ITRNN compared to PI (HR: 0.48; IC 95%
Conclusions: In Brazil, MOD of
first HAART is common, toxicities are the main reason. Among subjects starting
HAART at age ³ 50, low CD4 count was
found to be related to overall risk of MOD. Late HIV diagnosis significantly
contributes to this outcome.
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