Physician Experience in the Care of HIV-Infected Persons Is Associated With Earlier Adoption of New Antiretroviral Therapy

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Abstract
Summary:The outcome of second-line protease inhibitor (PI)-containing highly active antiretroviral therapy (HAART) was investigated in 263 patients who were failed by (n = 148) or intolerant of (n = 115) a first HAART regimen. The endpoints were virologic failure (decline in HIV RNA 34 years versus ≤34 years: 95% CI, 0.42-0.88), a saquinavir-containing first HAART (HR 0.57 versus indinavir: 95% CI, 0.34-0.93) and change due to intolerance/toxicity (HR 0.58 versus failure: 95% CI, 0.35-0.98). The independent variables predictive of discontinuation due to intolerance/toxicity were the reason for switching (HR 1.79 intolerance versus failure: 95% CI, 1.02-3.16) and the first protease inhibitor (PI) regimen (HR 0.42 ritonavir versus indinavir: 95% CI, 0.22-0.80). Given that patients who are failed by a first regimen are at high risk of having rescue therapy fail as well, second-line regimens including therapies directed by testing of drug resistance patterns of clinical viral isolates are warranted. Patients experiencing toxicity due to a first PI-containing regimen are at risk of toxicity to other PIs and should be addressed to PI-sparing HAART. Address correspondence and reprint requests to Antonella d'Arminio Monforte. Institute of Infectious and Tropical Diseases, University of Milan, L. Sacco Hospital, via GB Grassi, 74, 20157 Milan, Italy; email: [email protected] Manuscript received February 2, 2000; accepted March 9, 2000. © 2000 Lippincott Williams & Wilkins, Inc.