14th Annual Conference of the British HIV Association 23-25 April 2008, Belfast

COMPARING THE OUTCOME AND COST OF SECOND-LINE 2NRTIS + PI, 2NRTIS + 2PIS, 2NRTIS + PI-BOOSTED AND 3NRTIS FOR THOSE WHO FAILED ON 2NRTIS + NNRTI AS FIRST-LINE HAART IN THE UK, 1996-2002

HIV Med 2008 Apr 23-25 (Suppl 1);14:12 (abstract no. P10)

EJ Beck, S Mandalia, M Youle, B Gazzard, for the NPMS-HHC Steering Group
NPMS-HHC Coordinating and Analytic Centre, London, UK

BACKGROUND: Recent UK analysis demonstratedthat people living with HIV (PLHIV) and starting on 2NRTIs + NNRTIs had a median time to treatment failure of 13 years compared with other first-line HAART regimens and this regimen was cost-effective compared with PI containing regimens. This study investigated those who failed first- line 2NRTIs + NNRTIs and compared the outcome and cost for 4 second-line HAART regimens.

METHODS: A multi- centre prospective open cohort has been collecting information on the use, cost and outcome of HIV service provision since 1996. Time to regimen failure was adjusted for age, sex, year starting 2nd line therapy, viral load, CD4 and clinical stage.

RESULTS:Between 1996-2002, 103 PLHIV (36 failed). 36 started on 3NRTIs (10 failed), 35 on 2NRTIs + PI (14 failed), 17 on 2NRTIs + 2PIs (5 failed), 16 on 2NRTIs + PIboosted (7 failed). 22 (46%) failed for immunological, virological or clinical reasons. Median failure time [interquartile range] was 385 days [192-577] for 3 NRTIs; 714 days [357-1071] for 2NRTIs + PI; 710 days [350-1062] for 2NRTIs + 2PIs; 455 days [227-682] for 2NRTIs + PIboosted. Annual cost (2002 prices) was ≤12191 for 3NRTIs; ≤14,015 for 2NRTIs + PI; ≤18,628 for 2NRTIs + 2PIs and ≤13,449 for 2NRTIs + PI boosted.

CONCLUSIONS: 2NRTIs + PI and 2NRTIs + 2PI had longer time to treatment failure compared to 3NRTIs. Annual cost for 2NRTIs + PI less than 2NRTIs + 2PIs and similar to 3NRTIs. This suggests 2NRTIs + 1PI acceptable choice for 2nd line HAART. Relatively poor performance of 2NRTIs + PIboosted possibly related to shorter period of follow up compared with other regimens as only introduced in 2000. In addition, sample size was small. Await effect of longer periods of follow up and the introduction of newer antiretrovirals beyond the year 2002.

2008-04-23
P10

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