Four-Drug-Class-Resistant HIV Linked to Higher Death Risk

TOPLINE:

Individuals with HIV who were resistant to all four antiretroviral drug classes experienced higher mortality than those who were not resistant, a difference primarily due to lower CD4 cell counts.

METHODOLOGY:

• Researchers conducted a retrospective study to determine whether people living with HIV and resistance to four-drug classes (nucleoside reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors, protease inhibitors, and integrase strand transfer inhibitors) faced a higher risk for death than those without such resistance.
• A total of 1097 patients with HIV were analysed, including 228 with four-drug class resistance (median age at baseline, 50 years; 72.4% men; median years of HIV diagnosis, 21.4 years) who were propensity score matched with 869 without such resistance, and followed up until a median of 8.67 years.
• The primary outcome was all-cause mortality.

TAKEAWAY:

• During the follow-up period, 12.3% of patients with HIV and four-drug class resistance vs 7.7% of those without such resistance died (incidence rate ratio, 1.51; P = .063).
• When controlling for comorbidities, patients who were resistant to the four drug classes had a significantly higher risk for mortality than those who were not resistant (adjusted hazard ratio [AHR], 1.68; P = .024).
• In the four-drug-class-resistant group, lower CD4 cell counts had a significant indirect effect on mortality (AHR, 1.62; P < .001); however, the direct effect was not statistically significant.

IN PRACTICE:

“The priority for this vulnerable population is achieving virological control to enable immune recovery,” the authors wrote.

SOURCE:

This study was led by Andrea Giacomelli, MD, Università degli Studi di Milano, Milan, Italy. It was published online on August 01, 2025, in Clinical Infectious Diseases.

LIMITATIONS:

This study was limited by its retrospective design and the small sample size of four-drug-class-resistant patients. Recruiting the control group from a single centre introduced selection and information bias. Moreover, approximately 30% of four-drug-class-resistant participants lacked data on causes of death.

DISCLOSURES:

This study was conducted as a part of routine work of the PRESTIGIO Registry, which received support from ViiV Healthcare, Gilead Sciences, Merck Sharp & Dohme, and Janssen-Cilag. Some authors reported receiving consultancy fees, speaker honoraria, and honoraria for lectures and presentations and having other ties with the registry funders and various pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.