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Multicenter Study
. 2019 Aug 26;14(8):e0221598.
doi: 10.1371/journal.pone.0221598. eCollection 2019.

Choice of the initial antiretroviral treatment for HIV-positive individuals in the era of integrase inhibitors

Belén Alejos  1 , Inés Suárez-García  2   3 , Otilia Bisbal  4 , José Antonio Iribarren  5 , Víctor Asensi  6 , Miguel Górgolas  7 , Roberto Muga  8 , Santiago Moreno  9 , Inma Jarrín  1 ; CoRIS cohort
Affiliations
Multicenter Study

Choice of the initial antiretroviral treatment for HIV-positive individuals in the era of integrase inhibitors

Belén Alejos et al. PLoS One. .

Abstract

Background: We aimed to describe the most frequently prescribed initial antiretroviral therapy (ART) regimens in recent years in HIV-positive persons in the Cohort of the Spanish HIV/AIDS Research Network (CoRIS) and to investigate factors associated with the choice of each regimen.

Methods: We analyzed initial ART regimens prescribed in adults participating in CoRIS from 2014 to 2017. Only regimens prescribed in >5% of patients were considered. We used multivariable multinomial regression to estimate Relative Risk Ratios (RRRs) for the association between sociodemographic and clinical characteristics and the choice of the initial regimen.

Results: Among 2874 participants, abacavir(ABC)/lamivudine(3TC)/dolutegavir(DTG) was the most frequently prescribed regimen (32.1%), followed by tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC)/elvitegravir(EVG)/cobicistat(COBI) (14.9%), TDF/FTC/rilpivirine (RPV) (14.0%), tenofovir alafenamide (TAF)/FTC/EVG/COBI (13.7%), TDF/FTC+DTG (10.0%), TDF/FTC+darunavir/ritonavir or darunavir/cobicistat (bDRV) (9.8%) and TDF/FTC+raltegravir (RAL) (5.6%). Compared with ABC/3TC/DTG, starting TDF/FTC/RPV was less likely in patients with CD4<200 cells/μL and HIV-RNA>100.000 copies/mL. TDF/FTC+DTG was more frequent in those with CD4<200 cells/μL and HIV-RNA>100.000 copies/mL. TDF/FTC+RAL and TDF/FTC+bDRV were also more frequent among patients with CD4<200 cells//μL and with transmission categories other than men who have sex with men. Compared with ABC/3TC/DTG, the prescription of other initial ART regimens decreased from 2014-2015 to 2016-2017 with the exception of TDF/FTC+DTG. Differences in the choice of the initial ART regimen were observed by hospitals' location.

Conclusions: The choice of initial ART regimens is consistent with Spanish guidelines' recommendations, but is also clearly influenced by physician's perception based on patient's clinical and sociodemographic variables and by the prescribing hospital location.

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Conflict of interest statement

IJ has received teaching fees from ViiV Healthcare and has been an external evaluator of scientific projects for GILEAD. ISG has received conference grants or speaker fees from Bristol-Myers Squibb, ViiV Healthcare, Merck Sharp & Dohme and Gilead. SM has been involved in speaking activities and has received grants for research from Abbott, Boehringer & Ingelheim, Bristol-Myers Squibb, Gilead, Glaxo Smith Kline, Janssen Cilag, Merck Sharp & Dohme, Pfizer, Roche, and Schering Plough. All other authors declare no conflict of interest. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Distribution of the initial antiretroviral treatment by period of ART initiation.
See this image and copyright information in PMC

References

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