Prevalence and outcomes for heavily treatment-experienced individuals living with human immunodeficiency virus in a European cohort. JAIDS
Pelchen-Matthews et al. estimated the prevalence of and studied risk factors for becoming heavily treatment-experienced (HTE) patients living with HIV, and assessed clinical outcomes between individuals classified as HTE compared to those that were not HTE in the multinational EuroSIDA cohort.
All cohort participants between 2010 and 2016 were considered. The definition of HTE was based on three criteria: (1) 2 or less active drug classes remaining based on genotypic resistance testing, (2) history of 4 or more changes in anchor agents and (3) history of using 4 or more antiretroviral drugs. Patients meeting at least 2 of those criteria, or who met criteria 1 irrespective of the others, were classified as HTE. Risk factors for becoming HTE were assessed using multivariable Poisson regression, and 1:3 matching was performed to explore clinical outcomes after being classified as HTE.
The study included 13’577 patients. The prevalence of HTE increased from 5.8% (95% CI 5.4-6.3) in 2010 to 8.9% (CI 8.3-9.4) in 2016. Patients who became HTE were less likely to be female (incidence rate ratio [IRR] 0.78, CI 0.66-0.92), more likely to have a CD4 nadir below 200 cells/µL (IRR 1.51, CI 1.30 – 1.74) and were previously exposed to more antiretroviral drugs than individuals that were not HTE. Authors compared the clinical consequences between the 1040 patients who ever became HTE with 3210 index-date matched controls who did not become HTE. Although most patients classified as HTE achieved viral suppression within 6 months, the proportion of individuals with CD4 cell counts below 200 cells/µL continued to be larger in HTE patients compared to those not classified as HTE for more than 2 years of follow-up.
In summary, based on the proposed definition, the prevalence of HTE patients was high in the EuroSIDA cohort, with almost 10% in 2016. Although most HTE individuals achieved virologic suppression, immunologic recovery seemed to be impaired compared with non-HTE patients. Novel treatment options will be important in order to improve the treatment of this population.