Selection method of rescue treatment in patients with HIV-1: response and survival
DOI:
https://doi.org/10.51481/amc.v63i3.1133Keywords:
Genotypic resistance test, antiretroviral therapy, HIV1, virological failureAbstract
Objective: To determine the impact of the use of genotypic resistance testing on the response and long-term survival of HIV-1 infected patients who have failed antiretroviral therapy.
Methods: A retrospective cohort study was carried out; two groups were defined based on the method of selection of the rescue therapy used: based on the result of the genotypic resistance test (group A) and based on the criteria of experts (group B). The patients were evaluated before the change of rescue therapy according to demographic, clinical and laboratory variables and evaluated at 6, 12, 18, and 24 months after the change of treatment according to virological response, CD4 + cell response, incidence of opportunistic diseases. and survival. The information was obtained from the minutes of the National Commission for Antiretroviral Therapy, the IPK database and the Medical Records. Absolute numbers and percentages, mean and median, with their respective standard deviations (SD), Chi2, were used, the Relative Risk (RR), the Mann-Whitney U test, and the Kaplan-Meier method were applied.
Results: Group A patients were 1.44 times more likely to achieve complete virological suppression than group B patients at 6 months, RR 1.44 (1.046-2.054) p = 0.017. The average increase in CD4 + T lymphocytes was 117.40 cells / mm3 in group A patients and 30.04 cells / mm3 in group B patients, p <0.005 12 months after starting treatment. The incidence of opportunistic diseases was 25.7% in group B and 5.6% in group A. The highest percentage of cumulative survival was observed in group A (98.1%), compared to the group B (79%).
Conclusions: Patients in whom salvage treatment was chosen based on a genotypic resistance test had a better virological response, a greater increase in CD4 + T lymphocytes, and a longer survival than those in whom treatment was chosen based on expert judgment.
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