Abstract
ObjectiveCombination antiretroviral therapy (cART) has markedly increased survival and quality of life in people living with HIV. With the advent of new treatment options, including single-tablet regimens, durability and efficacy of first-line cART regimens are evolving.MethodsWe analyzed data from the prospective multicenter German Clinical Surveillance of HIV Disease (ClinSurv) cohort of the Robert-Koch Institute. Kaplan–Meier and Cox proportional hazards models were run to examine the factors associated with treatment modification. Recovery after treatment initiation was analyzed comparing pre-cART viral load and CD4+ T-cell counts with follow-up data.ResultsWe included 8788 patients who initiated cART between 2005 and 2017. The sample population was predominantly male (n = 7040; 80.1%), of whom 4470 (63.5%) were reporting sex with men as the transmission risk factor. Overall, 4210 (47.9%) patients modified their first-line cART after a median time of 63 months (IQR 59–66). Regimens containing integrase strand transfer inhibitors (INSTI) were associated with significantly lower rates of treatment modification (adjusted hazard ratio 0.44; 95% CI 0.39–0.50) compared to protease inhibitor (PI)-based regimens. We found a decreased durability of first-line cART significantly associated with being female, a low CD4+ T-cell count, cART initiation in the later period (2011–2017), being on a multi-tablet regimen (MTR).ConclusionsDrug class and MTRs are significantly associated with treatment modification. INSTI-based regimens showed to be superior compared to PI-based regimens in terms of durability.
Highlights
Combination antiretroviral therapy has improved markedly over the past decades
We found that being on a nucleotide reverse-transcriptase inhibitor (NRTI)/nucleotide reverse-transcriptase inhibitor (NNRTI) or a NRTI/integrase strand transfer inhibitors (INSTI) first-line regimen was associated with lower rates of modification, compared to being on a NRTI/protease inhibitor (PI)/boosted first-line regimen
We found several factors that were associated with a shorter durability of first-line Combination antiretroviral therapy (cART) in the multivariable analysis including being female, low CD4+ T-cell counts at the beginning of treatment, PI-based cART, multiple-tablet regimens (MTR), cART
Summary
Combination antiretroviral therapy (cART) has improved markedly over the past decades. People living with HIV (PLWH) can mostly be treated with safe and well-tolerated cART leading to a long-term suppression of viremia [1], which results in a significant reduction of morbidity and mortality in PLWH. New drug combinations are available as once-daily or single-tablet regimens (STR) that improve adherence to cART and lead to successful suppression of viremia [2]. Various studies found factors that are believed to lead to an earlier modification of the initial cART, including treatment with a protease inhibitor (PI), a high baseline HIV RNA level, and multiple-tablet regimens (MTR) as well as not receiving a once-daily cART or STR [3, 9, 10]
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