Could better tolerated HIV drug regimens improve patient outcome?
File(s)
Author(s)
Type
Journal Article
Abstract
Objectives: To quantify the performance of existing first-line and second-line combination antiretroviral therapy (cART) regimens on patient's clinical outcomes in the Netherlands using ATHENA data and to evaluate the potential for new drug regimens to improve patient's clinical outcomes using a data-based mathematical model.
Design and methods: We analysed data from 3995 patients from the Dutch ATHENA national observational cohort between 2000 and 2010. We quantified the main drug-related reasons for switching from first-line and second-line cART, classified as toxicity, simplification/new medication becoming available, virological failure, or other reasons. We developed a deterministic model describing HIV infection and treatment in the Netherlands parameterized on the basis of these data. The model simulated how a new drug regimen, with either improved toxicity or virological failure profile, could impact on patient's clinical outcomes.
Results: The main reason for switching current first-line and second-line regimens was toxicity, accounting for around 50% of switching from first-line and from second-line cART. The model found that a new drug regimen with increased tolerability profile could have the highest potential impact on patient's outcomes, especially as a first-line treatment. A new first-line drug regimen with improved tolerability could increase the time patients spend on first-line cART, decrease their risk of switching from first-line cART and thus simplify patient management.
Conclusion: New drug regimens with improved toxicity profiles could have the greatest impact on patient outcomes and simplify patient management in the Netherlands.
Design and methods: We analysed data from 3995 patients from the Dutch ATHENA national observational cohort between 2000 and 2010. We quantified the main drug-related reasons for switching from first-line and second-line cART, classified as toxicity, simplification/new medication becoming available, virological failure, or other reasons. We developed a deterministic model describing HIV infection and treatment in the Netherlands parameterized on the basis of these data. The model simulated how a new drug regimen, with either improved toxicity or virological failure profile, could impact on patient's clinical outcomes.
Results: The main reason for switching current first-line and second-line regimens was toxicity, accounting for around 50% of switching from first-line and from second-line cART. The model found that a new drug regimen with increased tolerability profile could have the highest potential impact on patient's outcomes, especially as a first-line treatment. A new first-line drug regimen with improved tolerability could increase the time patients spend on first-line cART, decrease their risk of switching from first-line cART and thus simplify patient management.
Conclusion: New drug regimens with improved toxicity profiles could have the greatest impact on patient outcomes and simplify patient management in the Netherlands.
Date Issued
2012-09-24
ISSN
0269-9370
Publisher
LIPPINCOTT WILLIAMS & WILKINS
Start Page
1953
End Page
1959
Journal / Book Title
AIDS
Volume
26
Issue
15
Copyright Statement
© 2012 Lippincott Williams & Wilkins, Inc.
Sponsor
Medical Research Council (MRC)
Identifier
http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000309224100012&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
Grant Number
G0600719B
Subjects
Science & Technology
Life Sciences & Biomedicine
Immunology
Infectious Diseases
Virology
IMMUNOLOGY
INFECTIOUS DISEASES
VIROLOGY
antiretroviral therapy
ATHENA
mathematical models
new drug regimens
toxicity
ACTIVE ANTIRETROVIRAL THERAPY
VIROLOGICAL FAILURE
INFECTED INDIVIDUALS
GENERAL-POPULATION
MORTALITY
COHORT
ADHERENCE
COUNTRIES
RISK
DISCONTINUATION
Acquired Immunodeficiency Syndrome
Anti-HIV Agents
CD4 Lymphocyte Count
Cohort Studies
Drug Resistance, Viral
Drug Therapy, Combination
Evidence-Based Medicine
Female
HIV-1
Humans
Long-Term Care
Male
Models, Theoretical
Netherlands
Outcome Assessment (Health Care)
Prognosis
Viral Load
06 Biological Sciences
11 Medical And Health Sciences
17 Psychology And Cognitive Sciences
Publication Status
Published