In the report by Guardiola and colleagues,1 a switch in protease inhibitor (PI) therapy for reasons other than therapeutic failure occurred in 74% of patients who were treated with PI-based regimens. The therapeutic strategy in these patients needs careful assessment before PI changes, since the patients may be put at greater risk for therapeutic failure after therapy change.
Figure 1 shows the virologic response in 14 patients who had a switch in PI after having achieved viral RNA suppression (viral RNA load <400 copies per milliliter) compared with 28 patients who continued to receive a successful regimen. Patients from 2 clinics were included in this retrospective chart review if they were treated with an indinavir sulfate regimen for at least 6 months and had 2 viral RNA measures below detection while receiving indinavir-combination therapy.2 From this group, patients were further identified for the switch group if their PI therapy had changed from indinavir to nelfinavir mesylate and if they had at least 1 viral RNA measurement after the PI switch (t0). Patients who continued to receive indinavir regimens constituted the comparison group. Two comparison patients per nelfinavir switch patient were randomly selected and matched for status of PI use prior to indinavir treatment and start date of indinavir treatment. Each comparison patient was assigned a date that allowed a time receiving indinavir equal to the time receiving indinavir of the matched patient who switched to nelfinavir. Patients in both groups had to have evidence of viral RNA suppression in the 3 months prior to t0. In the nelfinavir switch patients without a documented reason for PI change, the patients also had to have documented undetectable viral RNA (viral RNA load <400 copies per milliliter) within 4 weeks after the switch, indicating that the PI change was not a result of therapeutic failure. In Kaplan-Meier analysis, the last viral RNA measure available for each patient was defined as censored if viral RNA was undetectable and no further observations were available or as indicative of failure if the viral RNA load was greater than 400 copies per milliliter.
Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more
Subscribe for full-text access to content from 1998 forward and a host of useful features
Activate your current subscription (AMA members and current subscribers)
Purchase Online Access to this article for 24 hours
Kaplan-Meier plot of the proportion of 14 patients with viral RNA loads less than 400 copies per milliliter after a switch in protease inhibitor therapy compared with 28 patients who continued to receive a successful regimen. t0 indicates the time protease inhibitor therapy was switched.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
Thank you for submitting a comment on this article. It will be reviewed by JAMA Internal Medicine editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 4
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
and access these and other features:
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.