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Observational Study
. 2017 Oct 1;76(2):111-115.
doi: 10.1097/QAI.0000000000001481.

Increased Persistence of Initial Treatment for HIV Infection With Modern Antiretroviral Therapy

Thibaut Davy-Mendez  1 , Joseph J Eron, Oksana Zakharova, David A Wohl, Sonia Napravnik
Affiliations
Observational Study

Increased Persistence of Initial Treatment for HIV Infection With Modern Antiretroviral Therapy

Thibaut Davy-Mendez et al. J Acquir Immune Defic Syndr. .

Abstract

Background: Initiating antiretroviral therapy (ART) early improves clinical outcomes and prevents transmission. Guidelines for first-line therapy have changed with the availability of newer ART agents. In this study, we compared persistence and virologic responses with initial ART according to the class of anchor agent used.

Setting: An observational clinical cohort study in the Southeastern United States.

Methods: All HIV-infected patients participating in the UNC Center for AIDS Research Clinical Cohort (UCHCC) and initiating ART between 1996 and 2014 were included. Separate time-to-event analyses with regimen discontinuation and virologic failure as outcomes were used, including Kaplan-Meier survival curves and adjusted Cox proportional hazards models.

Results: One thousand six hundred twenty-four patients were included (median age of 37 years at baseline, 28% women, 60% African American, and 28% white). Eleven percent initiated integrase strand transfer inhibitor (INSTI), 33% non-nucleoside reverse transcriptase inhibitor (NNRTI), 20% boosted protease inhibitor, 27% other, and 9% NRTI only regimens. Compared with NNRTI-containing regimens, INSTI-containing regimens had an adjusted hazard ratio of 0.49 (95% confidence interval, 0.35 to 0.69) for discontinuation and 0.70 (95% confidence interval, 0.46 to 1.06) for virologic failure. All other regimen types were associated with increased rates of discontinuation and failure compared with NNRTI.

Conclusions: Initiating ART with an INSTI-containing regimen was associated with lower rates of regimen discontinuation and virologic failure.

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Figures

Figure 1
Figure 1. Primary End Points
Shown are unadjusted Kaplan-Meier estimates of time to discontinuation of first antiretroviral therapy (Panel A), and time to virologic failure of initial antiretroviral therapy (Panel B), by antiretroviral therapy regimen type. Panels C and D show unadjusted Kaplan-Meier estimates of time to discontinuation and time to virologic failure, respectively, restricting to patients initiating INSTI and NNRTI regimens 2007 and later.
See this image and copyright information in PMC

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