In order to validate the accuracy of the reason for discontinuati

In order to validate the accuracy of the reason for discontinuation determined by the clinician, we repeated the analysis with the immunovirological and clinical endpoint,

defining discontinuation as a consequence of failure on the basis of the following: discontinuation Ibrutinib purchase of ≥1 drug in the original regimen concomitant with (i) a single viral load >500 HIV-1 RNA copies/mL, or (ii) an increase in CD4 cell count <10% from the patient's pre-therapy value, or (iii) the occurrence of an AIDS-defining illness. A total of 3291 patients were included in the study: 28.2% were female and 39.9% were HCV antibody-positive; their median age was 36 years [interquartile range (IQR) 32–41 years]. Median

CD4 cell count at HAART initiation was 263 cells/μL (IQR 114–402 cells/μL), and median HIV RNA was 4.8 log10 copies/mL (IQR 4.2–5.3 log10 copies/mL). One hundred and thirty-eight patients (4.2%) initiated therapy with three NRTIs (of whom 117 initiated regimens including abacavir and 21 initiated regimens including tenofovir as the third drug), Nutlin-3a cell line 894 (27.2%) with an NNRTI-based regimen, 366 (11.1%) with a boosted PI, 1786 (54.3%) with a single PI, five (0.1%) with a combination of three other drugs (one NRTI+two PIs) and 102 (3.1%) with CYTH4 four or more drugs. Most patients

(52.6%) started HAART in the early period (1997–1999), 925 (28.1%) in the intermediate period (2000–2002) and 635 (19.3%) in the recent period (2003–2007) (Table 1). The median time of follow-up of patients was 12 (IQR 3–12) months; 288 patients (8.7% of the population) dropped out during the first year of follow-up; 14 of these died. During the first 12 months, 1189 (36.1%) patients discontinued ≥1 drug in their initial HAART. The main causes of discontinuation were intolerance/toxicity (696 of 1189 patients; 58.5%) and poor adherence (285 of 1189 patients; 24%); 126 patients (10.6%) discontinued because of immunovirological or clinical failure and 62 (5.2%) because of simplification strategies. Twenty patients (1.7%) interrupted temporarily or permanently all the ongoing drugs by clinician choice or patient wish. The Kaplan–Meier estimates of drug discontinuation for any reason in the first year were 39.5% (95% CI 37.1–41.9%) in those who initiated in 1997–1999, 35.6% (95% CI 32.3–38.9%) in those who initiated in 2000–2002, and 41.2% (95% CI 37.1–45.3%) in those who initiated in 2003–2007 (log-rank test P=0.06) (Fig. 1).

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