[en] [en] OBJECTIVE: Describe the prevalence and characteristics of people living with HIV (PLWH) in Belgium with limited/exhausted treatment options.
METHODS: A cross-sectional, multicenter study involving adult treatment-experienced individuals with limited/exhausted treatment options defined as having a multi-drug resistant HIV-1 or a history of multiple treatment changes. The primary outcome was to determine the prevalence of these individuals and classify them based on their two most recent consecutive HIV-1 viral loads (VLs): suppressed (2 VLs < 50 copies/mL), intermediate (≥1 VL between 50-200 copies/mL), or unsuppressed (2 VLs > 200 copies/mL). Secondary outcome was to characterize the participants included in this analysis.
RESULTS: There were 119 individuals included (prevalence of 0.97%; 119 of 12 282 in care). The majority were aged > 50 years (88.2%), women represented 35.3%, and individuals were primarily White (54.7%). Median (IQR) CD4+ T-cell count was 635 (400-875) cells/µL and most (42%) were on a 3-drug ART regimen. Overall, 87.4% were classified as suppressed, 9.2% as intermediate, and 3.4% as unsuppressed. On multivariable analysis, CD4+ T-cell count < 200 cells/µL was associated with being classified as intermediate or unsuppressed (p = 0.004).
CONCLUSION: In this analysis of PLWH in Belgium, individuals with limited/exhausted treatment options represented a small fraction. Most were on a 3-drug ART regimen, were virologically suppressed, and had a CD4+ T-cell count within normal range. A small proportion were not virologically suppressed while others, despite being suppressed, were on ≥ 4-drug ART regimens. As such, new therapeutic options are needed to achieve and maintain virologic suppression in such individuals while decreasing their pill burden.
Disciplines :
Immunology & infectious disease
Author, co-author :
Nasreddine, Rakan ; Department of Infectious Diseases, Saint-Pierre University Hospital, Brussels, Belgium
Darcis, Gilles ; Université de Liège - ULiège > Département des sciences de la santé publique
Yombi, Jean Cyr; Department of Internal Medicine and Infectious Diseases, Cliniques Universitaires Saint-Luc, Brussels, Belgium
De Munter, Paul; Department of General Internal Medicine, Leuven University Hospital, Katholieke Universiteit Leuven, Leuven, Belgium
Florence, Eric; Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
Van Praet, Jens; Department of Nephrology and Infectious Diseases, AZ Sint-Jan Brugge-Oostende, Brugge, Belgium
Demeester, Rémy; Department of Internal Medicine and Infectious Diseases, University Hospital of Charleroi, Lodelinsart, Belgium
Allard, Sabine D; Department of Internal Medicine and Infectious Diseases, Universitair Ziekenhuis Brussel, Brussels, Belgium
Schroeder, Melanie; Medical Affairs, ViiV Healthcare, Middlesex, UK
Dusabineza, Ange-Clarisse; Medical Affairs, ViiV Healthcare, Wavre, Belgium
Delforge, Marc; Department of Infectious Diseases, Saint-Pierre University Hospital, Brussels, Belgium
De Wit, Stéphane; Department of Infectious Diseases, Saint-Pierre University Hospital, Brussels, Belgium
Language :
English
Title :
A characterization of the HIV population with limited/exhausted treatment options: a multicenter Belgian study.
Sciensano. Epidémiologie du sida et de l’infection à VIH en Belgique. 2021. [cited 2023 Jul5]. Available from: https://www.sciensano.be/en/biblio/epidemiologie-du-sida-et-de linfection-a-vih-en-belgique-situation-au-31-decembre-2021
Blanas DA, Nichols K, Bekele M, et al. HIV/AIDS among African-born residents in the United States. J Immigr Minor Health. 2013;15(4):718–724. doi: 10.1007/s10903-012-9691-6
Ross J, Akiyama MJ, Slawek D, et al. Undocumented African immigrants’ experiences of HIV testing and linkage to care. AIDS Patient Care STDS. 2019;33(7):336–341. doi: 10.1089/apc.2019.0036
Miller V, Staszewski S, Sabin C, et al. CD4 lymphocyte count as a predictor of the duration of highly active antiretroviral therapy–induced suppression of human immunodeficiency virus load. J Infect Dis. 1999;180(2):530–533. doi: 10.1086/314890
Pinkevych M, Cromer D, Tolstrup M, et al. HIV reactivation from latency after treatment interruption occurs on average every 5-8 days—implications for HIV remission. PLOS Pathog. 2015;11(7):e1005000. doi: 10.1371/journal.ppat.1005000
Boulassel MR, Chomont N, Pai NP, et al. CD4 T cell nadir independently predicts the magnitude of the HIV reservoir after prolonged suppressive antiretroviral therapy. J Clin Virol. 2012;53(1):29–32. doi: 10.1016/j.jcv.2011.09.018
Priest J, Hulbert E, Gilliam BL, et al. Characterization of heavily treatment-experienced people with HIV and impact on healthcare resource utilization in US commercial and medicare advantage health plans. Open Forum Infect Dis. 2021;8(12):ofab562. doi: 10.1093/ofid/ofab562
Hsu RK, Fusco JS, Henegar CE, et al. Heavily treatment-experienced people living with HIV in the OPERA® cohort: population characteristics and clinical outcomes. BMC Infect Dis. 2023;23(1):91. doi: 10.1186/s12879-023-08038-w
Henegar C, Vannappagari V, Viswanathan S, et al. Identifying heavily treatment-experienced patients in a large administrative claims database. In: [Abstract MOPEB236] 10th IAS Conference on HIV Science; 2019Jul21–24; Mexico City, Mexico.
Bajema KL, Nance RM, Delaney JAC, et al. Substantial decline in heavily treated therapy-experienced persons with HIV with limited antiretroviral treatment options. AIDS. 2020;34(14):2051–2059. doi: 10.1097/QAD.0000000000002679
Lima VD, Harrigan PR, Senecal M, et al. Epidemiology of antiretroviral multiclass resistance. Am J Epidemiol. 2010;172(4):460–468. doi: 10.1093/aje/kwq101
Abraham AG, Lau B, Deeks S, et al. Missing data on the estimation of the prevalence of accumulated human immunodeficiency virus drug resistance in patients treated with antiretroviral drugs in North America. Am J Epidemiol. 2011;174(6):727–735. doi: 10.1093/aje/kwr141
Pillay D, Green H, Matthias R, et al. Estimating HIV-1 drug resistance in antiretroviral-treated individuals in the United Kingdom. J Infect Dis. 2005;192:967–973.
De Luca A, Dunn D, Zazzi M, et al. Declining prevalence of HIV-1 drug resistance in antiretroviral treatment-exposed individuals in Western Europe. J Infect Dis. 2013;207(8):1216–1220. doi: 10.1093/infdis/jit017
Tamalet C, Fantini J, Tourres C, et al. Resistance of HIV-1 to multiple antiretroviral drugs in France: a 6-year survey (1997– 2002) based on an analysis of over 7000 genotypes. AIDS. 2003;17(16):2383–2388. doi: 10.1097/00002030-200311070-00014
Audelin AM, Lohse N, Obel N, et al. The incidence rate of HIV type-1 drug resistance in patients on antiretroviral therapy: a nationwide population-based Danish cohort study 1999–2005. Antivir Ther. 2009;14(7):995–1000. doi: 10.3851/IMP1412
von Wyl V, Yerly S, Burgisser P, et al. Long-term trends of HIV type 1 drug resistance prevalence among antiretroviral treatment-experienced patients in Switzerland. Clin Infect Dis. 2009;48:979–987. doi: 10.1086/597352
Gill VC, Lynch T, Ramazani S, et al. Reporting on the prevalence of antiretroviral drug resistance in a regional HIV population over 20 years: a word of caution. Antivir Ther. 2017;22(4):277–286. doi: 10.3851/IMP3105
Scherrer AU, von Wyl V, Yang WL, et al. Emergence of acquired HIV-1 drug resistance almost stopped in Switzerland: a 15-year prospective cohort analysis. Clin Infect Dis. 2016;62(10):1310–1317. doi: 10.1093/cid/ciw128
Gandhi RT, Tashima KT, Smeaton LM, et al. Long-term outcomes in a large randomized trial of HIV-1 salvage therapy: 96-week results of AIDS clinical trials group A5241 (OPTIONS). J Infect Dis. 2020;221(9):1407–1415. doi: 10.1093/infdis/jiz281
