Predictors of having a resistance test following confirmed virological failure of combination antiretroviral therapy: data from EuroSIDA

TY - JOUR

T1 - Predictors of having a resistance test following confirmed virological failure of combination antiretroviral therapy: data from EuroSIDA

AU - Fox, Zoe V

AU - Cozzi-Lepri, Alessandro

AU - D'Arminio Monforte, Antonella

AU - Karlsson, Anders

AU - Phillips, Andrew N

AU - Kronborg, Gitte

AU - Kjaer, Jesper

AU - Clotet, Bonaventura

AU - Lundgren, Jens D

AU - EuroSIDA

PY - 2011/1/1

Y1 - 2011/1/1

N2 - Background: Guidelines suggest that patients on continuous antiretroviral therapy for >4 months with current viral load (VL)>1,000 copies/ml should be tested for resistance. There are limited data showing the frequency of resistance testing in routine clinical practice following these recommendations. Methods: In EuroSIDA, virological failure (VF) was defined as confirmed VL>1,000 copies/ml after ≥4 months continuous use of any antiretroviral in a ≥3-drug regimen started during or after 2002. We assessed whether a resistance test was performed around VF (from 4 months before to 1 year after VF) and used logistic regression analysis to assess factors associated with having a resistance test. Results: A total of 1,090 patients experienced VF a median 8.1 months (range 4 months to 6.3 years) after starting their regimen. There were 395 (36.2%; 95% CI 33.4-39.1) patients with a resistance test around the time of VF. Predictors of having a resistance test following VF include availability of a resistance test earlier than 4 months before VF (OR 2.20, 95% CI 1.77-2.75 for yes versus no; P<0.0001), region (OR 0.29, 95% CI 0.14-0.62 for Eastern Europe versus Northern Europe and OR 0.64, 95% CI 0.48-0.85 for Southern Europe versus Northern Europe; global P=0.0006) and current calendar year (OR 0.45, 95% CI 0.30-0.68 for ≥2007 versus 2004; global P=0.003).Conclusions: This analysis suggests a delay in genotypic testing after VF that seems longer than expected given current treatment guidelines. This delay is highly variable across Europe.

AB - Background: Guidelines suggest that patients on continuous antiretroviral therapy for >4 months with current viral load (VL)>1,000 copies/ml should be tested for resistance. There are limited data showing the frequency of resistance testing in routine clinical practice following these recommendations. Methods: In EuroSIDA, virological failure (VF) was defined as confirmed VL>1,000 copies/ml after ≥4 months continuous use of any antiretroviral in a ≥3-drug regimen started during or after 2002. We assessed whether a resistance test was performed around VF (from 4 months before to 1 year after VF) and used logistic regression analysis to assess factors associated with having a resistance test. Results: A total of 1,090 patients experienced VF a median 8.1 months (range 4 months to 6.3 years) after starting their regimen. There were 395 (36.2%; 95% CI 33.4-39.1) patients with a resistance test around the time of VF. Predictors of having a resistance test following VF include availability of a resistance test earlier than 4 months before VF (OR 2.20, 95% CI 1.77-2.75 for yes versus no; P<0.0001), region (OR 0.29, 95% CI 0.14-0.62 for Eastern Europe versus Northern Europe and OR 0.64, 95% CI 0.48-0.85 for Southern Europe versus Northern Europe; global P=0.0006) and current calendar year (OR 0.45, 95% CI 0.30-0.68 for ≥2007 versus 2004; global P=0.003).Conclusions: This analysis suggests a delay in genotypic testing after VF that seems longer than expected given current treatment guidelines. This delay is highly variable across Europe.

U2 - 10.3851/imp1801

DO - 10.3851/imp1801

M3 - Journal article

C2 - 21817201

SN - 1359-6535

VL - 16

SP - 781

EP - 785

JO - Antiviral Therapy

JF - Antiviral Therapy

IS - 5

ER -