Roughly 10% of PLWH in Europe can be considered heavily treatment-experienced (HTE), a proportion that inches upward year over year—but that classification does not necessarily mean worse clinical outcomes, according to data published in Journal of Acquired Immune Deficiency Syndromes.
The EuroSIDA cohort, from which these data were drawn, included 15,570 PLWH from across Europe, Israel, and Argentina who were followed between 2010 and 2016. HTE was defined as having virus resistant to NRTIs, NNRTIs, and PIs, having switched the antiretroviral treatment (ART) regimen basis ≥ 4 times, or having ≤ 2 antiretroviral drug classes remaining. The percentage of the cohort that was classified as HTE increased by 0.5% each year during the study period.
Virologic control was defined as < 400 copies/mL. At baseline (i.e., before starting antiretroviral therapy), 80% of HTE participants met that definition compared to 91% of non-HTE participants, but most participants achieved viral control six months later.
The proportion of participants with low CD4 cell counts remained higher in the treatment-experienced group (13% had ≤ 200 cells/µL; 33% had ≤ 350 cells/µL) compared to the non-HTE group (5% had ≤ 200 cells/µL; 18% had ≤ 350 cells/µL).
While the incidence of AIDS and non-AIDS-defining events was higher among HTE individuals than non-HTE individuals, the difference was explained by older age, lower CD4 counts and pre-existing comorbidities.
Results show that PLWH with few treatment options left can successfully control their virus with new antiretrovirals, but that ART strategies are not always individually optimized in this population, study authors noted. While newer drugs help heavily-treatment experienced PLWH control their virus, resistance is likely to develop eventually, requiring even newer medications to control HIV, they stated.
Given the importance of comorbidities for clinical events in the HTE population, study authors recommended that HIV guidelines list HTE individuals as a priority for managing comorbidities.