@article{4ed691f764334922ae77c5e4c91e8f99,
title = "Substantial decline in heavily treated therapy-experienced persons with HIV with limited antiretroviral treatment options",
abstract = "Objective:Historically, a high burden of resistance to antiretroviral therapy (ART) in heavily treatment-experienced (HTE) persons with HIV (PWH) resulted in limited treatment options (LTOs). We evaluated the prevalence, risk factors, and virologic control of HTE PWH with LTO throughout the modern ART era.Design:We examined all ART-experienced PWH in care between 2000 and 2017 in the Centers for AIDS Research Network of Integrated Clinical Systems cohort.Methods:We computed the annual prevalence of HTE PWH with LTO defined as having two or less available classes with two or less active drugs per class based on genotypic data and cumulative antiretroviral resistance. We used multivariable Cox proportional hazards models to examine risk of LTO by 3-year study entry periods adjusting for demographic and clinical characteristics.Results:Among 27 133 ART-experienced PWH, 916 were classified as having LTO. The prevalence of PWH with LTO was 5.2-7.5% in 2000-2006, decreased to 1.8% in 2007, and remained less than 1% after 2012. Persons entering the study in 2009-2011 had an 80% lower risk of LTO compared with those entering in 2006-2008 (adjusted hazard ratio 0.20; 95% confidence interval: 0.09-0.42). We found a significant increase in undetectable HIV viral loads among PWH ever classified as having LTO from less than 30% in 2001 to more than 80% in 2011, comparable with persons who never had LTO.Conclusion:Results of this large multicenter study show a dramatic decline in the prevalence of PWH with LTO to less than 1% with the availability of more potent drugs and a marked increase in virologic suppression in the current ART era.",
keywords = "HIV, antiretroviral drug resistance, antiretroviral therapy experienced, heavily treatment experienced, limited treatment options",
author = "Bajema, {Kristina L.} and Nance, {Robin M.} and Delaney, {Joseph A.C.} and Ellen Eaton and Thibaut Davy-Mendez and Karris, {Maile Y.} and Moore, {Richard D.} and Eron, {Joseph J.} and Benigno Rodriguez and Mayer, {Kenneth H.} and Elvin Geng and Cindy Garris and Saag, {Michael S.} and Crane, {Heidi M.} and Kitahata, {Mari M.}",
note = "Funding Information: The project received support from ViiV Healthcare and NIH including CNICS (NIAID grant R24AI067039), and CFARs at the University of Alabama at Birmingham (P30AI027767), University of Washington (P30AI027757), University of California, San Diego (P30AI036214), University of California, San Francisco (P30AI027763), Case Western Reserve University (P30AI036219), Johns Hopkins University (P30AI094189, U01DA036935), Fenway Health/Harvard (P30AI060354), and University of North Carolina Chapel Hill (P30AI50410). No funders had access to primary data. Funding Information: E.E. has received research support to UAB on her behalf from the Gilead HIV Research Scholarship and ViiV Healthcare. M.Y.K. has received funding to her institution from ViiV Healthcare and Gilead Sciences. J.J.E. is an ad-hoc consultant to Merck, Gilead Sciences, Janssen and ViiV Healthcare, and the University of North Carolina receives funding for clinical trials from Gilead, Janssen and ViiV Healthcare for which he is the site principal investigator. B.R. has received honoraria from Gilead Sciences and ViiV Healthcare that are not related to his participation in this article. K.H.M. has received unrestricted research grants from Gilead Sciences and Merck to study antiretrovirals for prevention and from Janssen to study HIV vaccines and is on Scientific Advisory Boards for Gilead and Merck. C.G. is an employee of ViiV Healthcare, sponsor of this study, and owns stock in GSK, parent company of ViiV Healthcare. M.S.S. has received grant support paid to his institution from ViiV Healthcare and Gilead Sciences. H.M.C. has received grant support paid to her institution from ViiV Healthcare. K.L.B., R.M.N., J.A.C.D., T.D.-M., R.D.M., E.G., and M.M.K. have no conflicts of interest to report. Publisher Copyright: {\textcopyright} 2020 Lippincott Williams and Wilkins. All rights reserved.",
year = "2020",
month = nov,
day = "15",
doi = "10.1097/QAD.0000000000002679",
language = "English (US)",
volume = "34",
pages = "2051--2059",
journal = "AIDS",
issn = "0269-9370",
publisher = "Lippincott Williams and Wilkins",
number = "14",
}