Intermittent use of triple-combination therapy is predictive of mortality at baseline and after 1 year of follow-up

Robert S. Hogg, Katherine Heath, David Bangsberg, Benita Yip, Natasha Press, Michael V. O'Shaughnessy, Julio S G Montaner

Research output: Contribution to journalArticle

321 Citations (Scopus)

Abstract

Objective: To characterize the impact of intermittent use of triple drug antiretroviral therapy on survival. Design, setting and participants: Population-based analysis of 1282 antiretroviral therapy naive HIV-positive individuals aged 18 years and older in British Columbia who started triple-combination therapy between August 1996 and December 1999. Therapy use was estimated by dividing the number of months of medications dispensed by the number of months of follow-up. Intermittent therapy was defined as the participant having obtained less than 75% of their medication in the first 12 months. Main outcome measure: Cumulative all-cause mortality rates from the start of triple drug antiretroviral therapy to 30 September 2000. Results: As of 30 September 2000, 106 subjects had died. Cumulative mortality was 3.9% (± 0.5%) at 12 months. In a multivariate model, after controlling for other variables that were significant in the univariate analyses each 100 cell decrement in baseline CD4 cell count and the intermittent use of antiretroviral drugs were associated with increased mortality with risk ratios of 1.31 [95% confidence interval (CI), 1.16-1.49; P<0.001] and 2.90 (95% CI, 1.93-4.36; P<0.001), respectively. In order to control for downward drift, intermittent use of therapy was measured over the first year whereas other factors were measured at the end of year 1. After adjusting for all other factors, those participants who used antiretroviral drugs intermittently were 2.97 times (95% CI, 1.33-6.62; P = 0.008) more likely to die. Conclusion: Our study demonstrates that even after adjusting for other prognostic factors intermittent use of antiretroviral therapy was associated with increased mortality.

Original languageEnglish (US)
Pages (from-to)1051-1058
Number of pages8
JournalAIDS
Volume16
Issue number7
DOIs
StatePublished - May 3 2002
Externally publishedYes

Fingerprint

Mortality
Confidence Intervals
Therapeutics
Drug Therapy
British Columbia
CD4 Lymphocyte Count
Pharmaceutical Preparations
Odds Ratio
Outcome Assessment (Health Care)
HIV
Population

Keywords

  • Antiretroviral therapy
  • Effectiveness
  • Intermittent use of antiretrovirals
  • Mortality
  • Non-nucleoside reverse transcriptase inhibitor
  • Nucleoside reverse transcriptase inhibitors
  • Population based cohort
  • Protease inhibitors

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology

Cite this

Intermittent use of triple-combination therapy is predictive of mortality at baseline and after 1 year of follow-up. / Hogg, Robert S.; Heath, Katherine; Bangsberg, David; Yip, Benita; Press, Natasha; O'Shaughnessy, Michael V.; Montaner, Julio S G.

In: AIDS, Vol. 16, No. 7, 03.05.2002, p. 1051-1058.

Research output: Contribution to journalArticle

Hogg, Robert S. ; Heath, Katherine ; Bangsberg, David ; Yip, Benita ; Press, Natasha ; O'Shaughnessy, Michael V. ; Montaner, Julio S G. / Intermittent use of triple-combination therapy is predictive of mortality at baseline and after 1 year of follow-up. In: AIDS. 2002 ; Vol. 16, No. 7. pp. 1051-1058.
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abstract = "Objective: To characterize the impact of intermittent use of triple drug antiretroviral therapy on survival. Design, setting and participants: Population-based analysis of 1282 antiretroviral therapy naive HIV-positive individuals aged 18 years and older in British Columbia who started triple-combination therapy between August 1996 and December 1999. Therapy use was estimated by dividing the number of months of medications dispensed by the number of months of follow-up. Intermittent therapy was defined as the participant having obtained less than 75{\%} of their medication in the first 12 months. Main outcome measure: Cumulative all-cause mortality rates from the start of triple drug antiretroviral therapy to 30 September 2000. Results: As of 30 September 2000, 106 subjects had died. Cumulative mortality was 3.9{\%} (± 0.5{\%}) at 12 months. In a multivariate model, after controlling for other variables that were significant in the univariate analyses each 100 cell decrement in baseline CD4 cell count and the intermittent use of antiretroviral drugs were associated with increased mortality with risk ratios of 1.31 [95{\%} confidence interval (CI), 1.16-1.49; P<0.001] and 2.90 (95{\%} CI, 1.93-4.36; P<0.001), respectively. In order to control for downward drift, intermittent use of therapy was measured over the first year whereas other factors were measured at the end of year 1. After adjusting for all other factors, those participants who used antiretroviral drugs intermittently were 2.97 times (95{\%} CI, 1.33-6.62; P = 0.008) more likely to die. Conclusion: Our study demonstrates that even after adjusting for other prognostic factors intermittent use of antiretroviral therapy was associated with increased mortality.",
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T1 - Intermittent use of triple-combination therapy is predictive of mortality at baseline and after 1 year of follow-up

AU - Hogg, Robert S.

AU - Heath, Katherine

AU - Bangsberg, David

AU - Yip, Benita

AU - Press, Natasha

AU - O'Shaughnessy, Michael V.

AU - Montaner, Julio S G

PY - 2002/5/3

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N2 - Objective: To characterize the impact of intermittent use of triple drug antiretroviral therapy on survival. Design, setting and participants: Population-based analysis of 1282 antiretroviral therapy naive HIV-positive individuals aged 18 years and older in British Columbia who started triple-combination therapy between August 1996 and December 1999. Therapy use was estimated by dividing the number of months of medications dispensed by the number of months of follow-up. Intermittent therapy was defined as the participant having obtained less than 75% of their medication in the first 12 months. Main outcome measure: Cumulative all-cause mortality rates from the start of triple drug antiretroviral therapy to 30 September 2000. Results: As of 30 September 2000, 106 subjects had died. Cumulative mortality was 3.9% (± 0.5%) at 12 months. In a multivariate model, after controlling for other variables that were significant in the univariate analyses each 100 cell decrement in baseline CD4 cell count and the intermittent use of antiretroviral drugs were associated with increased mortality with risk ratios of 1.31 [95% confidence interval (CI), 1.16-1.49; P<0.001] and 2.90 (95% CI, 1.93-4.36; P<0.001), respectively. In order to control for downward drift, intermittent use of therapy was measured over the first year whereas other factors were measured at the end of year 1. After adjusting for all other factors, those participants who used antiretroviral drugs intermittently were 2.97 times (95% CI, 1.33-6.62; P = 0.008) more likely to die. Conclusion: Our study demonstrates that even after adjusting for other prognostic factors intermittent use of antiretroviral therapy was associated with increased mortality.

AB - Objective: To characterize the impact of intermittent use of triple drug antiretroviral therapy on survival. Design, setting and participants: Population-based analysis of 1282 antiretroviral therapy naive HIV-positive individuals aged 18 years and older in British Columbia who started triple-combination therapy between August 1996 and December 1999. Therapy use was estimated by dividing the number of months of medications dispensed by the number of months of follow-up. Intermittent therapy was defined as the participant having obtained less than 75% of their medication in the first 12 months. Main outcome measure: Cumulative all-cause mortality rates from the start of triple drug antiretroviral therapy to 30 September 2000. Results: As of 30 September 2000, 106 subjects had died. Cumulative mortality was 3.9% (± 0.5%) at 12 months. In a multivariate model, after controlling for other variables that were significant in the univariate analyses each 100 cell decrement in baseline CD4 cell count and the intermittent use of antiretroviral drugs were associated with increased mortality with risk ratios of 1.31 [95% confidence interval (CI), 1.16-1.49; P<0.001] and 2.90 (95% CI, 1.93-4.36; P<0.001), respectively. In order to control for downward drift, intermittent use of therapy was measured over the first year whereas other factors were measured at the end of year 1. After adjusting for all other factors, those participants who used antiretroviral drugs intermittently were 2.97 times (95% CI, 1.33-6.62; P = 0.008) more likely to die. Conclusion: Our study demonstrates that even after adjusting for other prognostic factors intermittent use of antiretroviral therapy was associated with increased mortality.

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KW - Effectiveness

KW - Intermittent use of antiretrovirals

KW - Mortality

KW - Non-nucleoside reverse transcriptase inhibitor

KW - Nucleoside reverse transcriptase inhibitors

KW - Population based cohort

KW - Protease inhibitors

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