A AM152MedChemExpress BMS-986020 change in cART class. Of the 57 changes in cART class
A change in cART class. Of the 57 changes in cART class, common changes were from boosted PI based therapy to either NNRTI (25 ) or entry or integrase inhibitor (14 ) based therapy, or from NNRTI based therapy to either boosted PI (9 ) or entry or integrase inhibitor (11 ) based therapy.Blip magnitude and subsequent viral reboundResultsStudy populationAs at May 2014, 4094 antiretroviral naive patients in the SHCS started treatment with a cART regimen and recorded a first episode of viral suppression using more sensitive assays; 1672 of these patients later recorded a subsequent episode of viral suppression on cART using more sensitive assays. The median length of first and subsequent suppression episodes was 2.9 [interquartile range, IQR, 1.3 to 5.0] and 2.3 [IQR 1.0 to 4.7] years, respectively. The median time between RNA measurements in first and subsequent suppression episodes was 3.3 [IQR, 2.8 to 4.4] and 3.3 months [IQR 2.9 to 4.4], respectively. Most suppression episodes (87 ) were recorded with TaqMan version 1 or 2 assays (Table 1). Patients typically started a first suppression episode with cART based on either aWhen fit to first and subsequent episodes, both interval censoring and gap-time Cox models suggest a gradual increase in the risk of viral rebound with PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/28388412 increasing blip magnitude rather than a threshold effect (Table 2). Under our model, estimates are: HR 1.20 (95 CI 0.89 PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/28914615 to 1.61), HR 1.42 (95 CI 0.96 to 2.19), HR 1.93 (95 CI 1.24 to 3.01) for low, medium and high magnitude blips respectively. Fitting these models to data from first episodes only led to similar but less precise estimates (Additional file 1: Appendix A). Replacing the three categories of blip magnitude with a continuous variable makes it easier to test whether the association between blip magnitude and viral rebound varies with other factors. For example, the relative risk of viral rebound with increasing blip magnitude, estimated in our model to be HR 1.09 (95 CI 1.03 to 1.15) per 100 copies/mL of HIV RNA, was similar in both first and subsequent suppression episodes (HR 1.11, 95 CI 1.03 to 1.19, and HR 1.07, 95 CI 1.00 to 1.15, per 100 copies/mL respectively). In the gaptime model, the relative risk of viral rebound with increasing blip magnitude was estimated to be HR 1.08 (95 CI 1.03 to 1.14) per 100 copies/mL. Survival curves show that this model simplification, from categories to a continuous blip magnitude, did not materially alter the predicted probabilities of viral rebound for a reference patient (Fig. 1). Note that while blip magnitude appears toYoung et al. BMC Infectious Diseases (2015) 15:Page 4 ofTable 1 Patient characteristics when starting a first suppression episode or a first subsequent suppression episode. Patients had to be antiretroviral treatment naive before achieving viral suppression on a first combination antiretroviral regimen. Viral suppression had to be recorded using a more sensitive assay: ultrasensitive versions of the Amplicor assay (if the lower limit of detection was recorded as <50 copies/ml), the Abbott RealTime assay, and the TaqMan assay versions 1 andCharacteristic Suppression episode First (4094 First subsequent (1672 patients) patientsa) Female ( ) Injection drug use ( )b Age (median, years) CD4 cell count (median, cells/ L) Year ( ) Before 2005 2005 to 2009 After 2009 Assay ( )c Roche Amplicor ultrasensitive Abbot RealTime Roche TaqMan version 1 Roche TaqMan version 2 cART class ( ) NNRTI Boo.
