Abstract

Reasons for modifying the first HAART regimen among older patients in an urban HIV/AIDS cohort in Brazil

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% 0.28-0.83).
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.