Changes in First-Line cART Regimens and Short-Term Clinical Outcome between 1996 and 2010 in The Netherlands
Author(s)
Type
Journal Article
Abstract
Objectives: Document progress in HIV-treatment in the Netherlands since 1996 by reviewing changing patterns of cART use
and relating those to trends in patients’ short-term clinical outcomes between 1996 and 2010.
Design and Methods: 1996–2010 data from 10,278 patients in the Dutch ATHENA national observational cohort were
analysed. The annual number of patients starting a type of regimen was quantified. Trends in the following outcomes were
described: i) recovery of 150 CD4 cells/mm3 within 12 months of starting cART; ii) achieving viral load (VL) suppression
#1,000 copies/ml within 12 months of starting cART; iii) switching from first-line to second-line regimen within three years
of starting treatment; and iv) all-cause mortality rate per 100 person-years within three years of starting treatment.
Results: Between 1996 and 2010, first-line regimens changed from lamivudine/zidovudine-based or lamivudine/stavudinebased
regimens with unboosted-PIs to tenofovir with either emtricitabine or lamivudine with NNRTIs. Mortality rates did not
change significantly over time. VL suppression and CD4 recovery improved over time, and the incidence of switching due to
virological failure and toxicity more than halved between 1996 and 2010. These effects appear to be related to the use of
new regimens rather than improvements in clinical care.
Conclusion: The use of first-line cART in the Netherlands closely follows changes in guidelines, to the benefit of patients.
While there was no significant improvement in mortality, newer drugs with better tolerability and simpler dosing resulted in
improved immunological and virological recovery and reduced incidences of switching due to toxicity and virological
failure.
and relating those to trends in patients’ short-term clinical outcomes between 1996 and 2010.
Design and Methods: 1996–2010 data from 10,278 patients in the Dutch ATHENA national observational cohort were
analysed. The annual number of patients starting a type of regimen was quantified. Trends in the following outcomes were
described: i) recovery of 150 CD4 cells/mm3 within 12 months of starting cART; ii) achieving viral load (VL) suppression
#1,000 copies/ml within 12 months of starting cART; iii) switching from first-line to second-line regimen within three years
of starting treatment; and iv) all-cause mortality rate per 100 person-years within three years of starting treatment.
Results: Between 1996 and 2010, first-line regimens changed from lamivudine/zidovudine-based or lamivudine/stavudinebased
regimens with unboosted-PIs to tenofovir with either emtricitabine or lamivudine with NNRTIs. Mortality rates did not
change significantly over time. VL suppression and CD4 recovery improved over time, and the incidence of switching due to
virological failure and toxicity more than halved between 1996 and 2010. These effects appear to be related to the use of
new regimens rather than improvements in clinical care.
Conclusion: The use of first-line cART in the Netherlands closely follows changes in guidelines, to the benefit of patients.
While there was no significant improvement in mortality, newer drugs with better tolerability and simpler dosing resulted in
improved immunological and virological recovery and reduced incidences of switching due to toxicity and virological
failure.
Date Issued
2013-09-30
Date Acceptance
2013-08-19
Citation
PLOS One, 2013, 8 (9)
ISSN
1932-6203
Publisher
Public Library of Science
Journal / Book Title
PLOS One
Volume
8
Issue
9
Copyright Statement
© 2013 Smit et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original author and source are credited.
use, distribution, and reproduction in any medium, provided the original author and source are credited.
License URL
Publication Status
Published
Coverage Spatial
Amsterdam, Netherlands
Article Number
e76071