Behandeling van HIV-I in Nederland: Virologische en immunologische respons op antiretrovirale therapie

Translated title of the contribution: Treatment of HIV-I infection in the Netherlands: Virological and immunological response to antiretroviral therapy

M. Jambroes, G. J. Weverling, P. Reiss, S. A. Danner, S. Jurriaans, J. H. Ten Veen, M. E. Van Der Ende, M. Schutten, M. M.E. Schneider, R. Schuurman, J. W. Mulder, A. C.M. Kroes, J. M.A. Lange, F. De Wolf*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Objective. To evaluate the effect of treatment of HIV-I infection with combination therapy consisting of since 1996 in the Netherlands available protease and reverse transcriptase inhibitors. Design. Prospective cohort study. Methods. In an observational clinical cohort of HIV-I-infected individuals, the short-term successful treatment end point of antiviral therapy including at least one antiretroviral drug licensed in the Netherlands since July 1, 1996 (protease inhibitors and reverse transcriptase inhibitors), was HIV-I RNA plasma levels ≤ 500 copies/ml (virological success). Cox proportional hazard models were used to identify prognostic markers for therapy success. The study included 2,148 infected individuals with a median follow-up of 135 weeks of treatment; 1,049 had been pre-treated with antiretroviral drugs before starting their new regimen and 1,099 were treatment naive. Results. Plasma HIV-I RNA levels ≤ 500 copies/ml at 24 weeks of treatment were seen in 61% of all patients. The chance of therapy success for naive patients was twice that for pretreated patients (relative risk: 1.8; p ≤ 0.001. Following the first 24 weeks, the chance of virological success was higher in the naive group (78% versus 63%; p ≤ 0.001), and the number of naive patients failing therapy after initial success was smaller compared to pre-treated patients (22% versus 45%; p ≤ 0.001). In the naive group, the CD4+ T-cell number increased from 239 to 440 (× 106 cells/l) in case of success, and decreased from 150 to 320 in case of treatment failure. HIV-I related morbidity declined from 0.26 to 0.05 and mortality dropped from 0.07 to 0.03 per person-year of follow-up. Regimens were changed at least once in 76% of patients. Toxicity and therapy failure were the main reasons for regimen changes in naive and pre-treated patients, respectively. Conclusion. A combination of antiretroviral drugs, including at least one of the drugs licensed since 1996, led to a drop in HIV-I plasma concentrations. Morbidity and mortality also decreased. The chance of a better immunological and virological response to the new drug regimens was greatest in therapy-naive patients.

Translated title of the contributionTreatment of HIV-I infection in the Netherlands: Virological and immunological response to antiretroviral therapy
Original languageDutch
Pages (from-to)1591-1597
Number of pages7
JournalNederlands Tijdschrift voor Geneeskunde
Volume145
Issue number33
Publication statusPublished - 18 Aug 2001

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