The choice between a ritonavir-boosted protease inhibitor- and a non-nucleoside reverse transcriptase inhibitor-based regimen for initiation of antiretroviral treatment – results from an observational study in Germany

Abstract

BackgroundThis study aims at identifying predictors of the treatment decision of German physicians with regard to a non-nucleoside reverse transcriptase inhibitor (NNRTI) or a ritonavir-boosted protease inhibitor (PI/r) -based initial treatment regimen.MethodsThe study is based on a sub analysis of a nation-wide multi-centre, non-interventional, prospective cohort study. 133 patients were identified, who received antiretroviral first-line therapy. By means of a logistic regression, factors that determine the treatment strategy for treatment-naïve patients were analysed.ResultsCompared to patients receiving a NNRTI-based initial regimen, patients treated with PI/r are slightly younger, less educated, in a later stage of HIV and have more concomitant diseases. Regression analysis revealed that being in a later stage of HIV (CDC-C) is significantly associated with a PI/r-based treatment decision.ConclusionsOur analysis is the first study in Germany investigating sociodemographic and disease-specific parameters associated with a NNRTI- or a PI/r-based initial treatment decision. The results confirm that the treatment decision for a PI/r strategy is associated with disease severity.

A week-48 randomized phase-3 trial of darunavir/cobicistat/emtricitabine/tenofovir alafenamide in treatment-naive HIV-1 patients

“…Since its initial approval in 2006, substantial clinical trial data and clinical experience with darunavir have accumulated, demonstrating the potent and durable virologic response, high genetic barrier to resistance, and favorable safety profile in ART-naive, HIV-1-infected patients [ 4 , 5 ]. A substantial proportion of newly diagnosed patients in the United States and Europe are treated with a boosted protease inhibitor [ 6 , 7 ], and darunavir is the recommended protease inhibitor in treatment guidelines [ 8 – 10 ]. United States guidelines recommend two nucleoside or nucleotide analogue reverse transcriptase inhibitors (NRTIs) combined with an integrase strand transfer inhibitor (INSTI), or in certain clinical situations boosted darunavir 800 mg once daily or a nonnucleoside reverse transcriptase inhibitor (NNRTI) [ 8 , 9 ].…”

Estimation of Health-State Utility Values and Factors Driving Health-Related Quality of Life in People Living with HIV and AIDS and Receiving cART in Germany: Baseline Analysis of a Cohort Study

“…An administrative database analysis of approximately four million beneficiaries showed that German physicians use this flexibility and are more likely to prescribe patients who are in a more advanced disease state (CDC class C) with a PI/r-based regimen than with an NNRTI-based regimen (Mahlich et al, 2015). The same result was obtained in another observational study in Germany (Mahlich et al, 2016).…”

A Case Report of Multiclass HIV Drug-Resistance After an Inappropriate Switch of ARVs with Persistent Unsuppressed Viral Load

“…5 PI combined with two NRTIs in patients initiating ART is standard in certain regions like Germany. 6 However, this patient started ART in Namibia before the scale up of ART in Sub-Saharan Africa. She has commenced ART with dual therapy, including a PI and an NNRTI.…”