426. Effect of persistency of first-line ART regimen on clinical outcomes
Session: Poster Abstract Session: HIV - Antiretroviral Therapy
Friday, October 21, 2011
Room: Poster Hall B1
Background: Persistency is the time from initiation to discontinuation of therapy. Previous research has described patient and regimen level factors impacting persistency of initial antiretroviral therapy (ART); however, the impact of persistency on clinical outcomes is unknown.

Methods: Retrospective study of treatment naïve HIV patients initiating ART between 1/1/00 and 12/31/10 at the University of Alabama at Birmingham HIV/AIDS Clinic. Descriptive statistics and Cox proportional hazards regression models with persistency as a time-varying covariate were fit for these outcomes: (1) immunologic failure (subsequent CD4 lower than initial CD4); (2) development of an opportunistic infection (OI) or malignancy; and (3) mortality.

Results: Among 893 patients who started ART, mean age was 38 years (± 10) and most patients were racial/ethnic minority (59%), male (78%), with baseline CD4<200 cells/mm3 (52%) and viral load≤100,000 c/mL (58%).  There were 102 deaths, 93 OIs / malignancy, and 192 immunologic failures; mean persistency = 739 days.  In multi-variable modeling, increased persistency decreased the hazard for immunologic failure (0.80 per 180 additional days; 0.68-0.93; p = 0.005). Baseline viral load>100,000 c/mL (0.72 per 1.0 log10; 0.59-0.88) and lower baseline CD4 value (0.33 <200 vs >350 cells/mm3; 0.21-0.50) decreased the hazards of immunologic failure. Increased persistency exhibited a trend towards decreased hazard for occurrence of OI/malignancy (0.90; 0.79-1.02, p=0.09). Baseline CD4 <200 cells/mm3 increased the hazard for this outcome. No statistically significant association between persistency and mortality was found (0.95; 0.87-1.04; p=0.28).

Conclusion: In this study of the relationship between initial ART persistency and clinical outcomes, increased persistency was associated with a decreased hazard for the development of immunologic failure, a trend towards a decreased hazard for OI and malignancy and no statistically significant association with mortality.  Given these findings, the relationship between persistency and outcomes merits further study.


Subject Category: H. HIV/AIDS and other retroviruses

James H. Willig, MD, MSPH1, Andrew Westfall, MS2, Michael J. Mugavero, MD, MHSc2, Christa Nevin, MSPH2, Riddhi Modi, MBBS, MPH2, Todd Correll, PharmD3, Amit Duggal, PharmD4, Bill Guyer, PharmD5, Michael S. Saag, MD, FIDSA6 and Timothy R. Juday, PhD3, (1)UAB, Birmingham, AL, (2)University of Alabama at Birmingham, Birmingham, AL, (3)Bristol-Myers Squibb, Plainsboro, NJ, (4)Bristol Myers-Squibb, Plainsboro, NJ, (5)Gilead, Foster City, CA, (6)University of Alabama, Birmingham, AL

Disclosures:

J. H. Willig, Bristol Myers Squibb: Grant Investigator, Research grant and Research support
Definicare: Grant Investigator, Research grant
Gilead: Grant Investigator, Research support
Pfizer: Grant Investigator, Research support

A. Westfall, Definicare: Grant Investigator, Research grant
Bristol- Myers Squibb: Grant Investigator, Research grant
Gilead: Grant Investigator, Research grant

M. J. Mugavero, Bristol Myers Squibb: Grant Investigator and Scientific Advisor, Consulting fee and Research grant
Gilead Sciences: Research Contractor and Scientific Advisor, Consulting fee
Tibotec Therapeutics: Grant Investigator, Research grant
Pfizer: Grant Investigator, Research grant
Definicare: Grant Investigator, Research grant

C. Nevin, None

R. Modi, None

T. Correll, Bristol-Myers Squibb: Employee, Salary

A. Duggal, Bristol-Myers Squibb: Employee, Salary

B. Guyer, Gilead: Employee, Salary

M. S. Saag, Merck: Consultant and Scientific Advisor, Consulting fee
Adrea Biosciences: Consultant and Scientific Advisor, Consulting fee
Boehringer: Consultant and Scientific Advisor, Consulting fee
Ingelheim: Consultant and Scientific Advisor, Consulting fee
Bristol-Myers Squibb: Consultant and Scientific Advisor, Consulting fee
Gilead: Consultant and Scientific Advisor, Consulting fee
GSK: Consultant and Scientific Advisor, Consulting fee
Pfizer: Consultant and Scientific Advisor, Consulting fee
Vliv: Consultant and Scientific Advisor, Consulting fee
Tibotec: Consultant and Scientific Advisor, Consulting fee
Vertex: Scientific Advisor, Consulting fee
Monogram Biosciences: Research Contractor, Research support
NIH/NIAID: Grant Investigator, Grant recipient

T. R. Juday, Bristol-Myers Squibb: Employee, Salary

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.