Addition of Etravirine Does Not Enhance the Initial Decline of HIV-1 RNA in Treatment-Experienced Patients Receiving Raltegravir

Philippe Flandre (1) , Anne-Geneviève Marcelin (1, 2) , Vincent Calvez (1, 2)

1 iPLESP - Institut Pierre Louis d'Epidémiologie et de Santé Publique
2 CHU Pitié-Salpêtrière [AP-HP]

Objective : The importance of an early reduction of HIV-1 RNA as a marker for positive longer term outcome is still under debate. We investigate whether antiretroviral-experienced patients receiving raltegravir plus etravirine have a higher early reduction of HIV-1 RNA compared with patients receiving raltegravir. Design: An observational study of treatment-experienced patients. Methods: The objective is investigated in 349 patients included in a raltegravir resistance study. The early outcome is defined as a reduction of HIV-1 RNA at week 8. The crude method that consists to define all measurements below the limit of quantification to be equal to the limit of quantification provides biased estimates. Such a reduction is censored by the limit of quantification and is subject to selection bias in observational studies. Results: Crude method showed a significant higher reduction in HIV-1 RNA reduction in patients receiving raltegravir plus etravirine compared with patients receiving raltegravir (mean reduction of 2.1 versus 1.8 log 10 copies/ml). However, survival methods adjusted for both censoring, due to the limit of quantification, and confounding factors lead to a non-significant difference between the two treatment groups (mean reduction of 2.8 versus 2.7 log 10 copies/ml).. Conclusion: Taking into account censoring and confounding factors, our study did not demonstrate a higher early reduction of HIV-1 RNA in patients receiving raltegravir with versus without etravirine.

Mots clés: Antiretroviral therapy; Propensity score; Kaplan-Meier estimates; HIV-1 RNA reduction; limits of quantification

Domaines: Applications [stat.AP]

Philippe Flandre, Anne-Geneviève Marcelin, Vincent Calvez. Addition of Etravirine Does Not Enhance the Initial Decline of HIV-1 RNA in Treatment-Experienced Patients Receiving Raltegravir. Journal of Acquired Immune Deficiency Syndromes - JAIDS, 2017, 75 (4), pp.448-454. ⟨10.1097/QAI.0000000000001435⟩. ⟨hal-03817378⟩