Real-world persistence with antiretroviral therapy for HIV in the United Kingdom: A multicentre retrospective cohort study

Abstract

SummaryObjectivesPersistence with an antiretroviral therapy (ART) regimen for HIV can be defined as the length of time a patient remains on therapy before stopping or switching. We aimed to describe ART persistence in treatment naïve patients starting therapy in the United Kingdom, and to describe differential persistence by treatment regimen.MethodsWe performed a retrospective cohort study at eight UK centres of ART-naïve adults commencing ART between 2012 and 2015. Aggregate data were extracted from local treatment databases. Time to discontinuation was compared for different third agents and NRTI backbones using incidence rates.Results1949 patients contributed data to the analysis. Rate of third agent change was 28 per 100 person-years of follow up [95% CI 26–31] and NRTI backbone change of 15 per 100 person-years of follow up [95% CI 14–17]). Rilpivirine, as co-formulated rilpivirine/tenofovir/emtricitabine had a significantly lower discontinuation rate than all other third agents and, excluding single tablet regimens, co-formulated tenofovir/emtricitabine had a significantly lower discontinuation rate than co-formulated abacavir/lamivudine. The reasons for discontinuation were not well recorded.ConclusionsTreatment discontinuation is not an uncommon event. Rilpivirine had a significantly lower discontinuation rate than other third agents and tenofovir/emtricitabine a lower rate than co-formulated abacavir/lamivudine.

Real-world adherence and persistence for newly-prescribed HIV treatment: single versus multiple tablet regimen comparison among US medicaid beneficiaries

“…Although outside the scope of the current analysis, future research should investigate reasons for discontinuation and switching of therapy. Past research has reported that factors including pill burden, poor tolerability, risk of resistance due to complexity, toxicity, regimen performance, drug efficacy, and virologic failure could be possible reasons for higher rates of discontinuation among MTR patients [20,37,40]. Furthermore, the current study also showed that among STRs, patients who were treated with EVG/COBI/FTC/TAF had greater persistence compared to those treated with other STRs.…”

“…Amongst third agents, INSTIs are the most preferred as evident in studies that showed it be superior or equivalent to other third agents in safety and efficiency. In addition, it is reported that INSTIs are more tolerable to patients, in turn reducing discontinuation rates [20][21][22][23]. However, for patients that are at higher risk of non-adherence, PIs as the third agent would be most appropriate because of their genetic barrier to resistance [24].…”

“…For backbones, tenofovir-containing nucleoside has shown higher safety and tolerability then abacavir-lamivudine [25]. In addition, tenofovir/ emtricitabine has been found to have a lower rate of discontinuation than co-formulated abacavir/lamivudine [20]. Hence, this retrospective claims-based study was conducted with an aim to assess real world adherence and persistence for newly prescribed HIV treatment comparing STRs versus MTRs, backbones, and third agents using the Truven Health Medicaid database.…”

First‐line antiretroviral therapy with efavirenz plus tenofovir disiproxil fumarate/emtricitabine or rilpivirine plus tenofovir disiproxil fumarate/emtricitabine: a durability comparison

“…Previous analyses of durability have compared people receiving the two NNRTIs without accounting, in the study entry criteria, for the fact that RPV use is restricted to people with an untreated HIV RNA level < 100 000 copies/mL. This makes the interpretation of the comparisons even more difficult [19,20].…”

Durability of Single Tablet Regimen for Patients with HIV infection in Southern Taiwan: data from a real world setting

“…In a retrospective cohort study at eight UK centers, Lewis et. al. found that the rilpivirine based STR (complera) had a significantly lower discontinuation rate than another STR (atripa) and other third agents [5]. In another study from Maple Leaf Medical Clinic in Canada, researchers found that being on an integrase strand transfer inhibitor (INSTI) or nonnucleoside reverse transcriptase inhibitor (NNRTI)-based regimens versus protease inhibitors (PI) regimen were associated with better durability.…”