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Impact of baseline plasma HIV-1 RNA and time to virological suppression on virological rebound according to first-line antiretroviral regimen.

François Raffi 1, 2 Matthieu Hanf 2, 3 Tristan Ferry 4 Lydie Khatchatourian 1, 2 Véronique Joly 5, 6 Pascal Pugliese 7 Christine Katlama 8, 9 Olivier Robineau 10 Catherine Chirouze 11 Christine Jacomet 12 Pierre Delobel 13, 14 Isabelle Poizot-Martin 15, 16 Isabelle Ravaux 17 Claudine Duvivier 18, 19 Amandine Gagneux-Bugnon 20 David Rey 21 Jacques Reynes 22 Thierry May 23 Firouzé Bani-Sadr 24 Bruno Hoen 25, 26 Marine Morrier 27 André Cabié 28 Clotilde Allavena 1, 2, *
* Corresponding author
Abstract : Objectives: We investigated the risk of virological rebound in HIV-1-infected patients achieving virological suppression on first-line combined ART (cART) according to baseline HIV-1 RNA, time to virological suppression and type of regimen. Patients and methods: Subjects were 10836 adults who initiated first-line cART (two nucleoside or nucleotide reverse transcriptase inhibitors!efavirenz, a ritonavir-boosted protease inhibitor or an integrase inhibitor) from 1 January 2007 to 31 December 2014. Cox proportional hazards models with multiple adjustment and propensity score matching were used to investigate the effect of baseline HIV-1 RNA and time to virological suppression on the occurrence of virological rebound. Results: During 411436 patient-months of follow-up, risk of virological rebound was higher in patients with baseline HIV-1 RNA 100000 copies/mL versus ,100000 copies/mL, in those achieving virological suppression in.6months versus ,6months, and lower with efavirenz or integrase inhibitors than with ritonavir-boosted protease inhibitors. Baseline HIV-1 RNA .100000 copies/mL was associated with virological rebound for ritonavir-boosted protease inhibitors but not for efavirenz or integrase inhibitors. Time to virological suppression .6months was strongly associated with virological rebound for all regimens. Conclusions: In HIV-1-infected patients starting cART, risk of virological rebound was lower with efavirenz or integrase inhibitors than with ritonavir-boosted protease inhibitors. These data, from a very large observational cohort, in addition to the more rapid initial virological suppression obtained with integrase inhibitors, reinforce the positioning of this class as the preferred one for first-line therapy.
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François Raffi, Matthieu Hanf, Tristan Ferry, Lydie Khatchatourian, Véronique Joly, et al.. Impact of baseline plasma HIV-1 RNA and time to virological suppression on virological rebound according to first-line antiretroviral regimen.. Journal of Antimicrobial Chemotherapy, Oxford University Press (OUP), 2017, pp.3425-3434. ⟨10.1093/jac/dkx300⟩. ⟨inserm-01686859⟩

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