Evolution in Real-World Therapeutic Strategies for HIV Treatment: A Retrospective Study in Southern Italy, 2014-2020.

Nunzia Papa,Ugo Trama,Simona Cammarota,Luigi Atripaldi,Micaela Spatarella,Anna Citarella,Francesca F Bernardi,Nello Giugliano,Marianna Fogliasecca

doi:10.3390/jcm11010161

Abstract

Changes in HIV treatment guidelines over the last two decades reflect the evolving challenges in this field. Our study examined treatment change patterns throughout a 7-year period in a large Italian cohort of HIV patients as well as the reasons and direction of changes. Treatment-naïve and -experienced HIV patients managed by Cotugno Hospital of Naples between 2014 and 2020 were analyzed. During the period, the proportion of single-tablet regimen treatment sharply increased for the naïve and experienced patients. Regimens containing integrase strand transfer inhibitors rapidly replaced those containing protease inhibitor and non-nucleoside reverse transcriptase inhibitors. The use of the tenofovir alafenamide fumarate/emtricitabine backbone increased rapidly after its introduction in the Italian pharmaceutical market, making up 63.7 and 54.9% of all treatments in naïve and experienced patients, respectively, in 2020. The main reason for treatment changes was optimization and/or simplification (90.6% in 2018; 85.3% in 2019; 95.5 in 2020) followed by adverse effects and virological failure. Our real-world analysis revealed that the majority of treatment-naïve and treatment-experienced patients received antiretroviral drugs listed as preferred/recommended in current recommendations. Regimen optimization and/or simplification is a leading cause of treatment modification, while virologic failure or adverse effects are less likely reasons for modification in the current treatment landscape.

Highlights

Introduction published maps and institutional affilThe human immunodeficiency virus (HIV) pandemic continues to be a major global public health issue
Switching Antiretroviral therapy (ART) regimens was defined as a treatment change in at least one antiretroviral drug in the regimen excluding dose modifications
This study is a detailed examination of 7 years of temporal trends (2014–2020) in the prescribing pattern of antiretroviral drugs and reasons for ART switches in a large Italian cohort of HIV patients

Summary

Introduction

Introduction published maps and institutional affilThe human immunodeficiency virus (HIV) pandemic continues to be a major global public health issue. In 2020, there were approximately 37.7 million people living with. HIV (PLWH), and around 1.5 million people acquired HIV worldwide [1]. Antiretroviral therapy (ART) has transformed the outlook for PLWH, yielding near-normal life expectancy and better quality of life [2]. ART is recommended for all PLWH, irrespective of their immune status, in order to prevent HIV-related morbidity, mortality, and reduce transmission to others [3,4,5]. Changes in HIV treatment guidelines over the last two decades reflect the evolving challenges in this field. This underscores the importance of considering the content and revisions of treatment recommendations when analyzing time trends of ART, but such studies are rare in the literature

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