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1 December 2004

Volume 190, Number 11
The Journal of Infectious Diseases 2004;190:1947–1956
© 2004 by the Infectious Diseases Society of America. All rights reserved.
0022-1899/2004/19011-0010$15.00
DOI: 10.1086/425424
MAJOR ARTICLE

Time to Virological Failure of 3 Classes of Antiretrovirals after Initiation of Highly Active Antiretroviral Therapy: Results from the EuroSIDA Study Group

A. Mocroft,1

B. Ledergerber,3

J. P. Viard,4

S. Staszewski,5

M. Murphy,2

A. Chiesi,6

A. Horban,7

A.‐B. E. Hansen,8

A. N. Phillips,1 and

J. D. Lundgren,9 for the

EuroSIDA Study Groupa

1Royal Free Centre for HIV Medicine and Department of Primary Care and Population Sciences, Royal Free and University College London Medical Schools, and 2St. Bartholmews Hospital, London, United Kingdom; 3University Hospital, Zurich, Switzerland; 4Hôpital Necker‐Enfants Malades, Paris, France; 5J. W. Goethe University Hospital, Frankfurt, Germany; 6Istituto Superiore di Sanita, Rome, Italy; 7Centrum Diagnostyki i Terapii AIDS, Warsaw, Poland; 8Rigshospitalet and 9Hvidovre Hospital, Copenhagen, Denmark

Objective.The purpose of the present study was to determine the prevalence and incidence of virological triple drug–class failure (TCF) and to summarize the clinical outcome for patients who started receiving highly active antiretroviral therapy (HAART).

Methods.The present study is an observational longitudinal study of 3496 treatment‐experienced (TE) and treatment‐naive (TN) patients monitored from the time they started receiving HAART (baseline) until TCF occurred (as determined on the basis of viral loads), until AIDS was newly diagnosed, or until death.

Results.Four hundred forty‐five patients (12.7%) had TCF; 370 (16.6%) of 2230 patients were TE, and 75 (5.9%) of 1266 patients were TN. At 6 years after starting HAART, 21.4% of TE and 11.2% of TN patients had TCF ( ). The prevalence of TCF at or after 2002 was 15.5% in TE patients and 4.8% in TN patients. TN patients had a 32% annual increase in the incidence of TCF (95% confidence interval [CI], 14%–54%; ); at 5 years after starting HAART, the rate was comparable for TE and TN patients (3.3 and 3.4 cases/100 person‐years of follow‐up [PYFU], respectively). The incidence of new cases of AIDS or death was 2.7 cases/100 PYFU in patients who did not experience TCF and 5.0 cases/100 PYFU in patients who did experience TCF, an estimated 36% increase with each category of TCF (95% CI, 19%–56%; ).

Conclusion.The prevalence of TCF was low after patients started receiving HAART, particularly among TN patients. Despite the influx of patients who had started receiving HAART more recently, the prevalence of TCF increased over calendar time. Patients with TCF had a higher incidence of newly diagnosed AIDS or death. Treatment of patients with TCF deserves further investigation.

Received 29 March 2004; accepted 4 June 2004; electronically published 28 October 2004.

Reprints or correspondence: Dr. A. Mocroft, Royal Free Centre for HIV Medicine and Dept. of Primary Care and Population Sciences, Royal Free and University College London Medical Schools, Royal Free Campus, Rowland Hill St., London, NW3 2PF, UK ().

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  • Presented in part: 11th Conference on Retroviruses and Opportunistic Infections, San Francisco, 8–11 February 2004 (abstract 554).

    Financial support: European Commission BIOMED 1 (grant CT94‐1637); European Commission BIOMED 2 (grant CT97‐2713); European Commission Fifth framework (grant QLK2‐2000‐00773); Bristol‐Myers Squibb (unrestricted grant); GlaxoSmithKline (unrestricted grant); Roche (unrestricted grant); Boehringer‐Ingelheim (unrestricted grant); Swiss Federal Office for Education and Science (grant to the centers in Switzerland).

  • Members of the EuroSIDA Study Group are listed after the text.

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