Triple class experience after initiation of combination antiretroviral treatment in Australia: survival and projections
Sadaf Marashi Pour A F , Ian Woolley B , Peter Canavan C , John Chuah D , Darren B. Russell E , Matthew Law A and Kathy Petoumenos AA National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, NSW 2052, Australia.
B Monash Medical Centre and Department of Medicine Monash University, Clayton, Vic. 3168, Australia.
C National Association of People Living With HIV/AIDS, Sydney, NSW 2042, Australia.
D Gold Coast Sexual Health Clinic, Miami, Qld 4220, Australia.
E Cairns Sexual Health Service, Cairns, Qld 4870, Australia.
F Corresponding author. Email: sadaf.marashipour@doh.health.nsw.gov.au
Sexual Health 8(3) 295-303 https://doi.org/10.1071/SH10008
Submitted: 29 January 2010 Accepted: 29 October 2010 Published: 23 May 2011
Abstract
Background: Patients who have become triple class experienced (TCE) are at a high risk of exhausting available treatment options. This study aims to investigate factors associated with becoming TCE and to explore the effect of becoming TCE on survival. We also project the prevalence of TCE in Australia to 2012. Methods: Patients were defined as TCE when they stopped a combination antiretroviral treatment (cART) that introduced the third of the three major antiretroviral classes. Cox proportional hazards models were used to investigate factors associated with TCE and the effect of TCE on survival. To project TCE prevalence, we used predicted rates of TCE by fitting a Poisson regression model, together with the estimated number of patients who started cART in each year in Australia, assuming a mortality rate of 1.5 per 100 person-years. Results: Of the 1498 eligible patients, 526 became TCE. Independent predictors of a higher risk of TCE included current CD4 counts below 200 cells μL–1 and earlier calendar periods. No significant difference in survival was observed between those who were TCE and those who were not yet TCE. An increasing number of patients are using cART in Australia and if current trends continue, the number of patients who are TCE is estimated to increase from 2800 in 2003 to 5000 in 2012. Conclusion: Our results suggest that the prevalence of TCE in Australia is estimated to plateau after 2003. However, as an increasing number of patients are becoming TCE, it is necessary to develop new drugs that come from new classes or do not have overlapping resistance.
Additional keywords: antiretroviral therapy, cohort studies, HIV, prevalence, survival analysis, trends.
References
[1] Correll PK, Law MG, McDonald AM, Cooper DA, Kaldor JM. HIV disease progression in Australia in the time of combination antiretroviral therapies. Med J Aust 1998; 169 469–72.[2] Law MG, Li Y, McDonald AM, Cooper DA, Kaldor JM. Estimating the population impact in Australia of improved antiretroviral treatment for HIV infection. AIDS 2000; 14 197–201.
| Estimating the population impact in Australia of improved antiretroviral treatment for HIV infection.Crossref | GoogleScholarGoogle Scholar |
[3] Palella FJ, Delaney KM, Moorman AC, Loveless MO, Fuhrer J, Satten GA, et al Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. N Engl J Med 1998; 338 853–60.
| Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators.Crossref | GoogleScholarGoogle Scholar |
[4] Carr A, Cooper DA. Adverse effects of antiretroviral therapy. Lancet 2000; 356 1423–30.
| Adverse effects of antiretroviral therapy.Crossref | GoogleScholarGoogle Scholar |
[5] French MA. Disorders of immune reconstitution in patients with HIV infection responding to antiretroviral therapy. Curr HIV/AIDS Rep 2007; 4 16–21.
| Disorders of immune reconstitution in patients with HIV infection responding to antiretroviral therapy.Crossref | GoogleScholarGoogle Scholar |
[6] Australian HIV Observational Database. Rates of combination antiretroviral treatment change in Australia, 1997–2000. HIV Med 2002; 3 28–36.
| Rates of combination antiretroviral treatment change in Australia, 1997–2000.Crossref | GoogleScholarGoogle Scholar |
[7] Sabin CA, Hill T, Lampe F, Matthias R, Bhagani S, Gilson R, et al Treatment exhaustion of highly active antiretroviral therapy (HAART) among individuals infected with HIV in the United Kingdom: multicentre cohort study. BMJ 2005; 330 695
| Treatment exhaustion of highly active antiretroviral therapy (HAART) among individuals infected with HIV in the United Kingdom: multicentre cohort study.Crossref | GoogleScholarGoogle Scholar |
[8] National Centre in HIV Epidemiology and Clinical Research. HIV/AIDS, viral hepatitis and sexually transmissible infections in Australia. Annual Surveillance Report 2008. Sydney: National Centre in HIV Epidemiology and Clinical Research, The University of New South Wales; 2008.
[9] Ledergerber B, Lundgren JD, Walker AS, Sabin C, Justice A, Reiss P, et al Predictors of trend in CD4-positive T-cell count and mortality among HIV-1-infected individuals with virological failure to all three antiretroviral-drug classes. Lancet 2004; 364 51–62.
| Predictors of trend in CD4-positive T-cell count and mortality among HIV-1-infected individuals with virological failure to all three antiretroviral-drug classes.Crossref | GoogleScholarGoogle Scholar |
[10] Mocroft A, Horban A, Clotet B, d’Arminio Monforte A, Bogner JR, Aldins P, et al Regional differences in the risk of triple class failure in European patients starting combination antiretroviral therapy after 1 January 1999. HIV Med 2008; 9 41–6.
| Regional differences in the risk of triple class failure in European patients starting combination antiretroviral therapy after 1 January 1999.Crossref | GoogleScholarGoogle Scholar |
[11] Lohse N, Obel N, Kronborg G, Laursen A, Pedersen C, Larsen CS, et al Declining risk of triple-class antiretroviral drug failure in Danish HIV-infected individuals. AIDS 2005; 19 815–22.
| Declining risk of triple-class antiretroviral drug failure in Danish HIV-infected individuals.Crossref | GoogleScholarGoogle Scholar |
[12] Mocroft A, Ledergerber B, Viard JP, Staszewski S, Murphy M, Chiesi A, et al Time to virological failure of 3 classes of antiretrovirals after initiation of highly active antiretroviral therapy: results from the EuroSIDA study group. J Infect Dis 2004; 190 1947–56.
| Time to virological failure of 3 classes of antiretrovirals after initiation of highly active antiretroviral therapy: results from the EuroSIDA study group.Crossref | GoogleScholarGoogle Scholar |
[13] Phillips AN, Leen C, Wilson A, Anderson J, Dunn D, Schwenk A, et al Risk of extensive virological failure to the three original antiretroviral drug classes over long-term follow-up from the start of therapy in patients with HIV infection: an observational cohort study. Lancet 2007; 370 1923–8.
| Risk of extensive virological failure to the three original antiretroviral drug classes over long-term follow-up from the start of therapy in patients with HIV infection: an observational cohort study.Crossref | GoogleScholarGoogle Scholar |
[14] Falster K, Gelgor L, Shaik A, Zablotska I, Prestage G, Grierson J, et al Trends in antiretroviral treatment use and treatment response in three Australian states in the first decade of combination antiretroviral treatment. Sex Health 2008; 5 141–54.
| Trends in antiretroviral treatment use and treatment response in three Australian states in the first decade of combination antiretroviral treatment.Crossref | GoogleScholarGoogle Scholar |
[15] Petoumenos K, Law MG. Risk factors and causes of death in the Australian HIV Observational Database. Sex Health 2006; 3 103–12.
| Risk factors and causes of death in the Australian HIV Observational Database.Crossref | GoogleScholarGoogle Scholar |
[16] National Centre in HIV Epidemiology and Clinical Research. Australian HIV observational database annual report. Sydney: National Centre in HIV Epidemiology and Clinical Research, The University of New South; 2008.
[17] Petoumenos K. The role of observational data in monitoring trends in antiretroviral treatment and HIV disease stage: results from the Australian HIV observational database. J Clin Virol 2003; 26 209–22.
| The role of observational data in monitoring trends in antiretroviral treatment and HIV disease stage: results from the Australian HIV observational database.Crossref | GoogleScholarGoogle Scholar |
[18] Ockenga J, Tillmann HL, Trautwein C, Stoll M, Manns MP, Schmidt RE. Hepatitis B and C in HIV-infected patients. Prevalence and prognostic value. J Hepatol 1997; 27 18–24.
| Hepatitis B and C in HIV-infected patients. Prevalence and prognostic value.Crossref | GoogleScholarGoogle Scholar |
[19] Thio CL, Seaberg EC, Skolasky R, Phair J, Visscher B, Munoz A, et al HIV-1, hepatitis B virus, and risk of liver-related mortality in the Multicenter Cohort Study (MACS). Lancet 2002; 360 1921–6.
| HIV-1, hepatitis B virus, and risk of liver-related mortality in the Multicenter Cohort Study (MACS).Crossref | GoogleScholarGoogle Scholar |
[20] Petoumenos K, Ringland C. Antiretroviral treatment change among HIV, hepatitis B virus and hepatitis C virus co-infected patients in the Australian HIV Observational Database. HIV Med 2005; 6 155–63.
| Antiretroviral treatment change among HIV, hepatitis B virus and hepatitis C virus co-infected patients in the Australian HIV Observational Database.Crossref | GoogleScholarGoogle Scholar |
[21] Lincoln D, Petoumenos K, Dore GJ. HIV/HBV and HIV/HCV coinfection, and outcomes following highly active antiretroviral therapy. HIV Med 2003; 4 241–9.
| HIV/HBV and HIV/HCV coinfection, and outcomes following highly active antiretroviral therapy.Crossref | GoogleScholarGoogle Scholar |
[22] Glesby MJ, Hoover DR. Survivor treatment selection bias in observational studies: examples from the AIDS literature. Ann Intern Med 1996; 124 999–1005.
