Abstract
BackgroundWe aimed to describe the most frequently prescribed initial antiretroviral therapy (ART) regimens in recent years in HIV-positive persons in the Cohort of the Spanish HIV/AIDS Research Network (CoRIS) and to investigate factors associated with the choice of each regimen.MethodsWe analyzed initial ART regimens prescribed in adults participating in CoRIS from 2014 to 2017. Only regimens prescribed in >5% of patients were considered. We used multivariable multinomial regression to estimate Relative Risk Ratios (RRRs) for the association between sociodemographic and clinical characteristics and the choice of the initial regimen.ResultsAmong 2874 participants, abacavir(ABC)/lamivudine(3TC)/dolutegavir(DTG) was the most frequently prescribed regimen (32.1%), followed by tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC)/elvitegravir(EVG)/cobicistat(COBI) (14.9%), TDF/FTC/rilpivirine (RPV) (14.0%), tenofovir alafenamide (TAF)/FTC/EVG/COBI (13.7%), TDF/FTC+DTG (10.0%), TDF/FTC+darunavir/ritonavir or darunavir/cobicistat (bDRV) (9.8%) and TDF/FTC+raltegravir (RAL) (5.6%).Compared with ABC/3TC/DTG, starting TDF/FTC/RPV was less likely in patients with CD4<200 cells/μL and HIV-RNA>100.000 copies/mL. TDF/FTC+DTG was more frequent in those with CD4<200 cells/μL and HIV-RNA>100.000 copies/mL. TDF/FTC+RAL and TDF/FTC+bDRV were also more frequent among patients with CD4<200 cells//μL and with transmission categories other than men who have sex with men. Compared with ABC/3TC/DTG, the prescription of other initial ART regimens decreased from 2014–2015 to 2016–2017 with the exception of TDF/FTC+DTG. Differences in the choice of the initial ART regimen were observed by hospitals’ location.ConclusionsThe choice of initial ART regimens is consistent with Spanish guidelines’ recommendations, but is also clearly influenced by physician’s perception based on patient’s clinical and sociodemographic variables and by the prescribing hospital location.
Highlights
International and local guidelines for the treatment of HIV-infection provide recommendations on the preferred drug combinations for initial antiretroviral therapy (ART) of treatmentnaïve patients [1,2]
Compared with ABC/3TC/DTG, starting tenofovir disoproxil fumarate (TDF)/fumarate (TDF)/ emtricitabine (FTC)/RPV was less likely in patients with CD4100.000 copies/mL
The few studies that have investigated the factors influencing the choice of initial ART were published before newer drugs such as rilpivirine and integrase inhibitors were widely used [5,7,8,9], and there is no evidence on the factors that could influence the choice of ART with the more recent treatment regimens, and with those including an integrase inhibitor
Summary
International and local guidelines for the treatment of HIV-infection provide recommendations on the preferred drug combinations for initial antiretroviral therapy (ART) of treatmentnaïve patients [1,2]. There is a wide range of highly effective and well tolerated therapies, most recent guidelines in Spain and the United States have limited preferred options to integrase inhibitor-based regimens based on the results of clinical trials as well as on the advantages of individual drugs [3,4]. Other guidelines such as the ones from the European AIDS Clinical Society include regimens based on rilpivirine and boosted darunavir as preferred [2]. We aimed to describe the most frequently prescribed initial antiretroviral therapy (ART) regimens in recent years in HIV-positive persons in the Cohort of the Spanish HIV/AIDS Research Network (CoRIS) and to investigate factors associated with the choice of each regimen
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