Treatment modification after starting cART in people living with HIV: retrospective analysis of the German ClinSurv HIV Cohort 2005–2017

Abstract

Objective Combination 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. Methods We 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. Results We 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). Conclusions Drug 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.

Dolutegravir plus rilpivirine: benefits beyond viral suppression

“…These results correlate with published data from clinical trials and cohort studies. [ 12 , 16 ] This observation is of great interest because toxicity continues to be one of the main reasons for switching antiretrovirals, [ 26 ] although only 2.3% of patients in our cohort discontinued treatment due to mild or moderate issues. The main reasons for withdrawal were physicians’ decisions or clinical conditions other than HIV infection, which prevented continuation of DTG plus RPV.…”

Incidence of hypertension in people with HIV who are treated with integrase inhibitors versus other antiretroviral regimens in the RESPOND cohort consortium

“…First, they suggest that hypertension is common in people living with HIV, even in the era of contemporary ART, and indicates that people living with HIV, especially those receiving INSTIs or PIs, should have regular BP monitoring. This is important given that INSTIs are increasingly the preferred ART option [44–46]. The incidence of hypertension in this study was higher than in other predominantly Caucasian cohorts [15,35] but comparable to that in cohorts with significant CVD risk [47,48].…”

Real-world medication persistence among HIV-1 patients initiating integrase inhibitor-based antiretroviral therapy in Japan

“…This finding suggests that although most INSTI-based regimens already have highly satisfactory efficacy and safety profiles [18], the regimen type remains an important differentiating factor for persistence among INSTI-based regimens. Previous studies from Europe and North America also found that STRs are associated with greater persistence than MTRs, but these studies usually included patients whose regimens contained disparate classes of third agents or no INSTIs [7][8][9][10]19]. Thus, this study including only patients initiating INSTI-based regimens allows for a more reliable evaluation of the effects of regimen type on persistence by excluding potential confounding effects from third agent class.…”

“…Discontinuation includes cessation of therapy altogether or switch to a different regimen. Previous studies from Europe and North America found that regimen types (single-tablet regimen [STR] versus multiple-tablet regimen [MTR]) [7][8][9][10], NRTI backbones [8,10], and third agents [9,11,12] can affect the persistence of initial regimens. However, the persistence of initial regimens has been rarely investigated in Asia.…”