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Abstract
Background: To evaluate long term outcomes in patients maintaining a NVP based regimen for more than 10 years.
Materials and methods: Retrospective, multicenter, cohort study including virologically suppressed patients, currently receiving a NVP-based regimen that had been started at least 10 years previously. Demographic, clinical, and analytical variables were recorded.
Results: Two hundred and seventy four subjects were included. Median (IQR) follow up was 17.1 (13.8–18.5) years. Dyslipidemia (29.9%), hypertension (11.4%) and diabetes (8%) were the most common reported co-morbidities. After a median of 17 years of follow-up we observed a significant increase in general health markers such as hemoglobin and CD4 cells (all p<0.001) as well as a significant reduction in CD8 and ALT [−111 cells/uL (−346.5−151) p 0.003 and ALT median (IQR) -4.2 (−18.5−4) p<0.001 respectively]. LDL-c and serum triglyceride levels decreased significantly [−0,1 (−1−0.6) p:<0.001 and −0,3 (−1.2−0.4) p:0.002 respectively]. HDL-c increased significantly 0.3 (00.5−0.6). Median (IQR) time with persistent HIV VL <50 copies was 16 (13−18) years. During follow up, subjects presented with median (IQR) 1 (0-2) blip (HIV VL >50<1000 copies/ml).
Conclusions: Based on the extensive experience as well as a good tolerance and efficacy profile, NVP should be considered for treatment continuation in those patients already receiving this inexpensive generic drug.
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Notes on contributors
Juan Tiraboschi
Dr Juan Manuel Tiraboschi He obtained a Medical Degree from the National University of Córdoba, Argentina in 1999. He trained in Medicine and Infectious Diseases in Argentina and France (2000–2007). He obtained a PhD degree in 2015 by the University of Barcelona investigating on “Penetration and antiviral activity of antiretroviral drugs in the Central Nervous System”. Between 2013 and 2016, Dr. Tiraboschi completed a fellowship as Clinical Research Doctor in HIV at St Thomas Hospital in London, UK. He joined the HIV and STI Unid at Bellvitge University Hospital in 2016. His clinical and research interests include the effects of HIV and antiretroviral therapy on Central Nervous System and viral reservoirs.
Natalia Lattour
Dr Natalia Lattour trained in Infectious Diseases at the Hospital San Martin in La Plata, Argentina between 2014 and 2019. In 2018 she completed a two month stage at the HIV and STI Unit of the Bellvitge University Hospital in Barcelona. She is currently working as an ID specialist in Buenos Aires, Argentina.
Hernando Knobel
Dr Hernando Knobel Head of the Infectious Diseases Service, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain.
Pere Domingo
Pere Domingo is currently Senior Consultant and HIV/AIDS Program Director at the Infectious Diseases Unit of the Hospital de la Santa Creu i Sant Pau, in Barcelona. He graduated with honours in the University of Barcelona in 1980 and achieved his PhD degree in the Autonomous University of Barcelona in 1993 (Magna cum laude). He has been devoted to infectious diseases and HIV-1 infection since 1989. He is Associate Professor of Medicine at the Medicine School (Autonomous University of Barcelona) since 1994. He has authored or co-authored more than 500 scientific papers and more than 100 book chapters. He has been the speaker in more than 400 meetings or congresses, and is currently reviewer for more than 50 international journals, international agencies, and international meetings and conferences. He is now member of 7 Editorial Boards of medical journals. Dr. Domingo is expert member of the Spanish Medicines Agency and of the European Medicines Agency. His main research interests are antiretroviral therapy and its complications, especially fat redistribution syndromes, metabolic alterations, insulin resistance, cardiovascular risk, and early senescence, but also meningococcal disease and bacterial meningitis in adults. Dr. Domingo is the past President of the Spanish AIDS study group (2011-2013), of the Spanish Society of Infectious Diseases and Clinical Microbiology. He currently coordinates evaluation of research project in the area of Clinical Medicine and Epidemiology for the Spanish National Evaluation Agency.
Esteve Ribera
Dr Esteve Ribera Senior Consultant in HIV and Infectious Diseases at the Vall d' Hebron Hospital in Barcelona, Spain.
Daniel Podzamczer
Dr Daniel Podzamczer He qualified from the University of Buenos Aires and undertook training in Internal Medicine at Bellvitge University Hospital (Barcelona, Spain). He obtained a PhD degree in 1991 investigating on “predictors of progression to AIDS” (University of Barcelona, Spain). He started to see HIV-infected patients in the first years of the epidemic, that is in the mid of 80’. Thus he has lived very different periods in the history of AIDS. Beginning when AIDS was a fatal disease and patients died every day until now when HIV has become a chronic disease with a prolonged survival and an excellent life quality of patients receiving antiretroviral therapy. He is currently the head of an HIV and STI Unit within an Infectious Disease Service in a University teaching hospital in Barcelona. In his position he has contributed to clinical research, participating and organizing clinical trials related to opportunistic infections, HIV complications and antiretroviral therapy. He is a co-author of more than 250 scientific papers published in national and international Journals such as New Engl. J Med, Lancet, Ann Intern Med, Clin. Infect Dis., J Infect Dis., AIDS and JAIDS among others. He has also participated in expert panels for Guidelines for the management of opportunistic infections (NIH/CDC/IDSA), antiretroviral therapy, opportunistic infections and neurocognitive disorders (GESIDA). He is also a peer reviewer for a number of international Journals.