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About 10% With HIV in Europe Have Heavy Treatment Experience, Few Options - "Prevalence and outcomes for heavily treatment-experienced (HTE) individuals living with HIV in a European cohort"
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10th IAS Conference on HIV Science (IAS 2019), July 21-24, 2019, Mexico City
"Around 10% of HIV-positive individuals in the EuroSIDA cohort were estimated to be HTE with limited treatment options. HTE prevalence increased over time and THE individuals appeared to be at higher risk of developing new AIDS and non-AIDS events, which was largely explained by immunological parameters or by aging/comorbidities, respectively. Additional therapeutic options to ensure viral suppression and immune recovery as well as effective management of co-morbidities remain important to reduce clinical complications in the HTE population.
Clinical outcomes. HTE individuals experienced 2.4 and 1.3-fold higher incidence rates of new AIDS and non-AIDS clinical events [unadjusted IR 10.9 (95% CI 7.6-15.5) and 33.6 (27.3-41.3) events/1000 PYFU, respectively] than those who were not HTE [IR 4.5 (3.3-6.2) and 26.4 (23.1-30.1) AIDS and non-AIDS events/1000 PYFU]"
Mark Mascolini
One in 10 people in the EuroSIDA HIV cohort has heavy treatment experience and limited antiretroviral options, according to results of a 15,570-person study [1]. Heavily pretreated people ran a higher risk of AIDS and non-AIDS diseases than people with less treatment experience, but factors other than antiretroviral experience largely explained those differences.
Since 1994 more than 22,000 people with HIV have enrolled in EuroSIDA, an ongoing observational study. Focusing on cohort members enrolled from 2010 through 2016, EuroSIDA investigators set out to define the prevalence of heavy treatment experience (HTE), to determine the demographics of HTE individuals, and to assess outcomes in this group.
Researchers defined HTE based on genotypic resistance testing, modeling of antiretroviral resistance, and exposure to specific antiretroviral regimens. People with HTE had HIV resistant to the first three classes of antiretrovirals or met two of three study definitions of HTE. For every individual who became HTE on or after January 1, 2010, the investigators selected three cohort members who were never HTE. The investigators used Poisson regression to calculate incidence of clinical events per 1000 person-years of follow-up and incidence rate ratios of these events in HTE versus non-HTE participants.
Among 15,570 cohort members in 2010-2016, 1617 (10.4%) ever met the definition of HTE. From 2010 to 2016, HTE prevalence rose 0.5% yearly (95% confidence interval 0.34 to 0.66, P = 0.0004).
The researchers compared 1040 HTE individuals who had follow-up data with 3120 non-HTE controls. Compared with controls, the HTE group had a higher proportion with a CD4 count below 200 (about 10% versus 5% through up to 24 months of follow-up). Compared with non-HTE cohort members, those with HTE were significantly older (median 51.6 versus 48.1 years), took significantly more antiretrovirals (median 13 versus 7), and were more likely to be diagnosed with HIV for at least 10 years (91.9% versus 66.8%), more likely to have a pre-existing AIDS diagnosis (43.5% versus 28.0%), and more likely to have cardiovascular disease, a non-AIDS cancer, or chronic kidney disease (all P < 0.0001). Almost everyone with versus without HTE had taken a protease inhibitor (99.1% versus 76.9%) and a nonnucleoside (92.6% versus 72.4%), and almost half had taken an integrase inhibitor (48.1% versus 15.3%) (all P < 0.0001). Everyone with HTE had taken a nucleoside/nucleotide, as had 99.6% without HTE.
Compared with the non-HTE group, those with HTE had a 2.4-fold higher incidence of new AIDS diagnoses and a 1.3-fold higher incidence of non-AIDS diagnoses. After statistical adjustment for initial CD4 count, HTE status was no longer associated with a higher new-AIDS risk. Multivariable analysis also showed that the higher risk of new non-AIDS illnesses could be largely explained by older age, pre-existing non-AIDS diseases, and CD4 count in the HTE group.
The EuroSIDA investigators believe their findings underline the need for "additional therapeutic options to ensure viral suppression and immune recovery as well as effective management of comorbidities."
Reference
1. Pelchen-Matthews A, Borges AH, Reekie J, et al. Prevalence and outcomes for heavily treatment-experienced (HTE) individuals living with HIV in a European cohort. 10th IAS Conference on HIV Science (IAS 2019), July 21-24, 2019, Mexico City. Abstract TUPEB222. For e-poster: https://programme.ias2019.org//PAGMaterial/eposters/1280.pdf
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