UCL Discovery
UCL home » Library Services » Electronic resources » UCL Discovery

Factors associated with virological rebound in HIV-infected patients receiving protease inhibitor monotherapy

Stohr, W; Dunn, DT; Arenas-Pinto, A; Orkin, C; Clarke, A; Williams, I; Johnson, M; ... Paton, NI; + view all (2016) Factors associated with virological rebound in HIV-infected patients receiving protease inhibitor monotherapy. AIDS , 30 (17) pp. 2617-2624. 10.1097/QAD.0000000000001206. Green open access

[img]
Preview
Text
Stohr_Factors associated with virological rebound in HIV-infected patients receiving protease inhibitor monotherapy AAM.pdf - Accepted version

Download (555kB) | Preview

Abstract

OBJECTIVE: The Protease Inhibitor Monotherapy Versus Ongoing Triple Therapy (PIVOT) trial found that protease inhibitor monotherapy as a simplification strategy is well tolerated in terms of drug resistance but less effective than combination therapy in suppressing HIV viral load. We sought to identify factors associated with the risk of viral load rebound in this trial. METHODS: PIVOT was a randomized controlled trial in HIV-positive adults with suppressed viral load for at least 24 weeks on combination therapy comparing a strategy of physician-selected ritonavir-boosted protease inhibitor monotherapy versus ongoing triple therapy. In participants receiving monotherapy, we analysed time to confirmed viral load rebound and its predictors using flexible parametric survival models. RESULTS: Of 290 participants initiating protease inhibitor monotherapy (80% darunavir, 14% lopinavir, and 6% other), 93 developed viral load rebound on monotherapy. The risk of viral load rebound peaked at 9 months after starting monotherapy and then declined to approximately 5 per 100 person-years from 18 months onwards. Independent predictors of viral load rebound were duration of viral load suppression before starting monotherapy (hazard ratio 0.81 per additional year <50 copies/ml; P < 0.001), CD4+ cell count (hazard ratio 0.73 per additional 100 cells/µl for CD4+ nadir; P = 0.008); ethnicity (hazard ratio 1.87 for nonwhite versus white, P = 0.025) but not the protease inhibitor agent used (P = 0.27). Patients whose viral load was analysed with the Roche TaqMan-2 assay had a 1.87-fold risk for viral load rebound compared with Abbott RealTime assay (P = 0.012). CONCLUSION: A number of factors can identify patients at low risk of rebound with protease inhibitor monotherapy, and this may help to better target those who may benefit from this management strategy.

Type: Article
Title: Factors associated with virological rebound in HIV-infected patients receiving protease inhibitor monotherapy
Open access status: An open access version is available from UCL Discovery
DOI: 10.1097/QAD.0000000000001206
Publisher version: http://dx.doi.org/10.1097/QAD.0000000000001206
Language: English
Additional information: Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. This is a non-final version of an article published in final form in AIDS journal [Stohr, W; Dunn, DT; Arenas-Pinto, A; Orkin, C; Clarke, A; Williams, I; Johnson, M; (2016) Factors associated with virological rebound in HIV-infected patients receiving protease inhibitor monotherapy. AIDS , 30 (17) pp. 2617-2624. 10.1097/QAD.0000000000001206]
Keywords: Science & Technology, Life Sciences & Biomedicine, Immunology, Infectious Diseases, Virology, clinical trial, HIV, monotherapy, protease inhibitor, virological rebound, Suppressive Antiretroviral Therapy, Darunavir/ritonavir Monotherapy, Lopinavir/ritonavir Monotherapy, Clinical-trials, Failure, Risk, Simplification, Individuals, Maintenance, Adherence
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Life Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Life Sciences > Lab for Molecular Cell Bio MRC-UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology > MRC Clinical Trials Unit at UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health > Infection and Population Health
URI: https://discovery.ucl.ac.uk/id/eprint/1530764
Downloads since deposit
96Downloads
Download activity - last month
Download activity - last 12 months
Downloads by country - last 12 months

Archive Staff Only

View Item View Item