2492. Differences between Individuals Currently Taking Integrase Inhibitor (INSTI)-based Therapy and Those Not Taking INSTIs in the Era of INSTIs as Recommended First-line Therapy

Abstract

BackgroundAgents from the integrase inhibitor (INSTI) therapeutic class only are recommended as initial therapy for most patients with HIV. Clinicians now face a decision when treating ART-experienced patients on non-INSTI regimens: continue current therapy or switch to INSTI. Multiple factors may be considered in this decision: clinician/patient preference, comorbidities, tolerability, and resistance history. The objective of this analysis was to examine patient factors associated with currently taking an INSTI-based regimen.MethodsWe used data from the DC Cohort, a longitudinal observational cohort of patients receiving HIV care at 14 clinics between 2011–2018. Participants in the sample had ≥ 1 encounter between 4/1/17 and 3/1/18, were aged ≥ 18 years and were ART experienced. Participants were classified as currently, previously, or never on an INSTI. Independent variables included demographics, clinical characteristics, alcohol/tobacco use, HBV/HCV status and HIV-related variables (recent CD4 and HIV RNA, presence of resistance mutations). Multivariable multinomial logistic regression was used to identify factors associated with INSTI use status.ResultsAmong 4584 participants (58.2% aged 50+ years; 69.4% male; 2.5% transgender; 80.3% Black; 36% MSM), most (65.0%) were current INSTI users; however, a sizeable proportion (28.3%) were never users and 6.7% were former users. Current and previous INSTI users were more likely to have a major NRTI, NNRTI or PI mutation compared with never users (see Table 1). Transgender participants (compared with males), were less likely to be current (vs. never) users (adjusted odds ratio (aOR) 0.48, 95% CI 0.32, 0.72). Younger participants (18–24 vs 50+ years) were more likely current users (aOR 1.90, 95% CI 1.18, 3.06), as were Hispanic participants (aOR 1.39, 95% CI 1.05, 1.84).ConclusionThe majority of active DC Cohort participants were using INSTI-based therapy. Transgender and older individuals were less likely to be on INSTIs, indicating that they are more likely to be on PI-based or NNRTI-based therapy or not on therapy. Further research should explore whether this is detrimental for long-term HIV outcomes in these patient groups. Additionally, these results suggest resistance history as an important driver of INSTI prescription. Disclosures All authors: No reported disclosures.