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. 2013 Sep 30;8(9):e76071.
doi: 10.1371/journal.pone.0076071. eCollection 2013.

Changes in first-line cART regimens and short-term clinical outcome between 1996 and 2010 in The Netherlands

Mikaela Smit  1 , Colette Smit, Suzanne Geerlings, Luuk Gras, Kees Brinkman, Timothy B Hallett, Frank de Wolf; Athena Observational Cohort
Collaborators, Affiliations

Changes in first-line cART regimens and short-term clinical outcome between 1996 and 2010 in The Netherlands

Mikaela Smit et al. PLoS One. .

Abstract

Objectives: Document progress in HIV-treatment in The Netherlands since 1996 by reviewing changing patterns of cART use and relating those to trends in patients' short-term clinical outcomes between 1996 and 2010.

Design and methods: 1996-2010 data from 10,278 patients in the Dutch ATHENA national observational cohort were analysed. The annual number of patients starting a type of regimen was quantified. Trends in the following outcomes were described: i) recovery of 150 CD4 cells/mm(3) within 12 months of starting cART; ii) achieving viral load (VL) suppression ≤1,000 copies/ml within 12 months of starting cART; iii) switching from first-line to second-line regimen within three years of starting treatment; and iv) all-cause mortality rate per 100 person-years within three years of starting treatment.

Results: Between 1996 and 2010, first-line regimens changed from lamivudine/zidovudine-based or lamivudine/stavudine-based regimens with unboosted-PIs to tenofovir with either emtricitabine or lamivudine with NNRTIs. Mortality rates did not change significantly over time. VL suppression and CD4 recovery improved over time, and the incidence of switching due to virological failure and toxicity more than halved between 1996 and 2010. These effects appear to be related to the use of new regimens rather than improvements in clinical care.

Conclusion: The use of first-line cART in the Netherlands closely follows changes in guidelines, to the benefit of patients. While there was no significant improvement in mortality, newer drugs with better tolerability and simpler dosing resulted in improved immunological and virological recovery and reduced incidences of switching due to toxicity and virological failure.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. First-line cART regimens.
A. First-line cART regimens prescribed in the Netherlands between 1996 and 2010. Relative distribution of patients starting first-line regimens per year by B. NRTI backbone and C. third cART component.
Figure 2
Figure 2. Mortality rate per 100 person-years.
The black dotted line is the mortality rate; the grey shaded area represents the 95% confidence-intervals.
Figure 3
Figure 3. Rates of CD4 recovery and VL suppression.
Unadjusted Kaplan-Meier curves for A) Rates of CD4 recovery of 150 cells/mm3 by 12 months and B) Rates of VL suppression to below 1,000 copies/ml by 12 months.
Figure 4
Figure 4. Rate of switching per 100 person-years. Calendar time refers to time of switching.
Figure 5
Figure 5. Three toxicity categories that are the cause of most regimen switches per time period.
See this image and copyright information in PMC

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