@Article{info:doi/10.2196/33429,
author="Li, Yiping
and Wang, Qinjian
and Liang, Shu
and Feng, Chuanteng
and Yang, Hong
and Yu, Hang
and Yuan, Dan
and Yang, Shujuan",
title="Effect of Switching Antiretroviral Treatment Regimen in Patients With Drug-Resistant HIV-1 Infection: Retrospective Observational Cohort Study",
journal="JMIR Public Health Surveill",
year="2022",
month="Jun",
day="24",
volume="8",
number="6",
pages="e33429",
keywords="HIV; antiretroviral therapy; drug resistance; protease inhibitors; parametric g-formula",
abstract="Background: Evidence on the efficacy of antiretroviral therapy (ART) regimen switches on the mortality of patients with HIV drug resistance (HIVDR) is limited. Objective: We aim to provide policy guidance for ART regimen selection and evaluate the effectiveness of ART regime switches for people living with HIV and HIV-1 drug resistance. Methods: This retrospective observational cohort study included 179 people living with HIV and HIV-1 drug resistance from 2011 to 2020. The time that participants switched treatment regimens either to protease inhibitor (PI)--based ART regimens (PIs) or nonnucleoside reverse transcriptase inhibitor (NNRTI)--based ART regimens (NNRTIs) was taken as an observation starting point and followed up every 12 months. The parametric g-formula was used to estimate the 5-year risk of mortality under the situations of (1) natural course, (2) immediate switch to NNRTIs, (3) immediate switch to PIs, and (4) if CD4(+) T cells<200 switched to PIs. Results: The follow-up time of the 179 patients ranged from 30 to 119 months. The median follow-up time was 90 months. During a follow-up of 15,606 person-months, 27 individuals died in the cohort. The estimated 5-year risk of mortality under natural course, immediate switch to NNRTIs, immediate switch to PIs, and if CD4(+), and switch to PIs if T cells<200 were 11.62{\%} (95{\%} CI 7.82-17.11), 31.88{\%} (95{\%} CI 20.79-44.94), 2.87{\%} (95{\%} CI 0.32-7.07), and 5.30{\%} (95{\%} CI 2.07-10.21), respectively. The risk ratios (RRs) of immediate switch to NNRTIs, immediate switch to PIs, and switch to PIs if CD4(+) T cells<200, compared with natural course mortality rate, were 2.74 (95{\%} CI 2.01-3.47), 0.25 (95{\%} CI: 0.04-0.54), and 0.46 (95{\%} CI 0.22-0.71), respectively. The risk differences were 20.26{\%} (95{\%} CI 10.96-28.61), --8.76{\%} (95{\%} CI --13.34 to --5.09) and --6.32{\%} (95{\%} CI --9.75 to --3.11), respectively. Conclusions: Our study found that a PI-based ART regimen was beneficial for reducing mortality in people living with HIV and HIV-1 drug resistance. More effort should be given to find HIV-1 drug resistance earlier to ensure a timely adjustment to PI-based ART, thereby maximizing the benefit of early switch treatment for people living with HIV and HIV-1 drug resistance. ",
issn="2369-2960",
doi="10.2196/33429",
url="https://publichealth.jmir.org/2022/6/e33429",
url="https://doi.org/10.2196/33429",
url="http://www.ncbi.nlm.nih.gov/pubmed/35749212"
}