Objective: To evaluate the clinical impact and cost-effectiveness of HLA-B*5701 testing to guide selection of first-line HIV regimens in the United States.
Design: Cost-effectiveness analysis using a simulation model of HIV disease. The prevalence of HLA-B*5701 and the probabilities of confirmed and unconfirmed severe systemic hypersensitivity reaction among patients taking abacavir testing HLA-B*5701 positive and negative were from the Prospective Randomized Evaluation of DNA Screening in a Clinical Trial study. The monthly costs of abacavir-based and tenofovir-based regimens were $1135 and $1139, respectively; similar virologic efficacy was assumed and this assumption was varied in sensitivity analysis.
Patients: Simulated cohort of patients initiating HIV therapy.
Interventions: The interventions are first-line abacavir, lamivudine, and efavirenz without pretreatment HLA-B*5701 testing; the same regimen with HLA-B*5701 testing; and first-line tenofovir, emtricitabine, and efavirenz.
Main Outcome Measures: Quality-adjusted life years and lifetime medical costs discounted at 3% per annum, cost-effectiveness ratios ($/QALY).
Results: Abacavir-based treatment without HLA-B*5701 testing resulted in a projected 30.93 years life expectancy, 16.23 discounted quality-adjusted life years, and $472,200 discounted lifetime cost per person. HLA-B*5701 testing added 0.04 quality-adjusted months at an incremental cost of $110, resulting in a cost-effectiveness ratio of $36,700/QALY compared with no testing. Initiating treatment with a tenofovir-based regimen increased costs without improving quality-adjusted life expectancy. HLA-B*5701 testing remained the preferred strategy only if abacavir-based treatment had equal efficacy and cost less per month than tenofovir-based treatment. Results were also sensitive to the cost of HLA-B*5701 testing and the prevalence of HLA-B*5701.
Conclusion: Pharmacogenetic testing for HLA-B*5701 is cost-effective only if abacavir-based treatment is as effective and costs less than tenofovir-based treatment.
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| http://dx.doi.org/10.1097/QAD.0b013e3283103ce6 | DOI Listing |
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Article Synopsis
- Early treatment is crucial for effective HIV prevention, but many individuals struggle to connect with care after diagnosis, impacting their outcomes.
- A study in central Poland tracked 232 HIV-positive individuals from 2010-2013, finding that while 62% linked to care, only 81% of those started treatment, but nearly all achieved viral suppression.
- Factors influencing better viral suppression included using non-PI treatment regimens and being HLA B5701-positive, while uncertain syphilis status and higher viral loads negatively impacted outcomes.
Darunavir Stands Up as Preferred HIV Protease Inhibitor.
AIDS Rev
February 2018
HIV/AIDS Unit, Infectious Disease Service, Hospital Clínic, University of Barcelona, Barcelona, Spain.
Current antiretroviral therapy reaches and maintains viral suppression over the years in more than 90% of treated HIV-infected individuals. Although integrase inhibitors are the preferred third agent in antiretroviral therapy in the current guidelines, rilpivirine, a non-nucleoside reverse transcrip- tase inhibitor, and darunavir (DRV), a second-generation protease inhibitor, are the preferred third companion to be used along with a backbone of two nucleos(t)ide reverse transcriptase inhibitors as first-line triple HIV combination treatment. However, rilpivirine is not recommended in patients with plasma HIV-RNA above 100,000 copies/mL.
View Article and Find Full Text PDFObjective: In addition to hypersensitivity reactions to abacavir, HLA B5701 has been associated with slow or nonprogression of HIV infection. We explored the effect of HLA B5701 on CD4 cell count and viral load in untreated patients and on responses to nonabacavir-containing combination antiretroviral therapy (cART) in a large UK-based cohort.
Design: Analysis of a cohort of HIV-infected adults.
Use of patch testing for the diagnosis of abacavir-related hypersensitivity reaction in HIV patients.
Dermatol Ther
August 2012
Division of Clinical, Preventive and Oncologic Dermatology - Department of Critical Care Medicine and Surgery, University of Florence, Florence, Italy.
Background: The use of antiretroviral drug abacavir (ABC) has been often associated with cutaneous hypersensitivity reactions, the majority being severe.
Objective: The present study discusses the issues of patch testing associated with pharmacogenetic screening in light of the development of abacavir hypersensitivity reactions (HSRs).
Methods: The present authors classified 100 patients into three groups: 20 patients (group A) had experienced a hypersensitivity reaction when treated with highly active antiretroviral therapy (HAART) including ABC; 60 HIV-positive patients (group B) were receiving HAART scheme including ABC; 20 HIV-negative patients acted as control group (group C).
[Clinico-epidemiological characteristics of HIV-positive immigrants: study of 371 cases].
Enferm Infecc Microbiol Clin
October 2012
Unidad VIH, Hospital Universitario 12 de Octubre, Madrid, España.
Introduction: The number of HIV-positive immigrants have increased in Spain in the last few years, and now represent a significant proportion of the epidemic. Our objective is to describe the clinico-epidemiological characteristics of HIV-positive immigrants seen in a specialist unit in Madrid.
Material And Methods: Retrospective study.
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