Temporal Trends and Geographic Variability in the Prescription of Antiretroviral Treatments in People Living with HIV in Spain, 2004-2020

Abstract

Background: The purpose of this study was to describe temporal trends in the use of antiretroviral therapy (ART) among people living with HIV (PLWHIV) from the cohort of the Spanish HIV/AIDS research network (CoRIS), 2004-2020.

Methods: We described the yearly evolution of the proportion of patients receiving ART and the most frequently prescribed antiretroviral drugs among newly recruited treatment-naïve patients and among all patients with active follow-up.

Results: Of 15,539 patients included, 14,618 (94.1%) started ART during their follow-up. Regarding initial regimens, the use of 2NRTI plus 1NNRTI (which were the most frequently prescribed until 2014) and 2NRTI plus 1bPI decreased after 2014, being gradually replaced by INI-based triple therapies. Since 2019, other regimens started to be prescribed, mainly dual therapies. TDF/FTC/EFV was the single-tablet regimen (STR) most frequently prescribed as initial ART until 2012, decreasing thereafter as TDF/FTC/RPV, TDF/FTC/EVG/COBI, and ABC/3TC/DTG became available. TAF/FTC/BIC accounted for 53.6% of initial prescriptions in 2020, followed by DTG/3TC (24%). The percentage of patients on ART increased from 45.7% in 2004 to 98.2% in 2020. Among all patients receiving ART, regimens based on 2NRTI plus 1INI increased from 0.1% in 2007 to 53.3% in 2020. During 2007-2015, most patients were receiving TDF/FTC/EFV, which was replaced after 2017 by ABC/3TC/DTG. In 2020, 13.0% of patients were receiving dual therapies.

Conclusions: Robust real-world data on ART use in PLWHIV over more than 15 years show historical trends in prescriptions with an unprecedented visualization of the contemporary treatment patterns.

Keywords: HIV infection; antiretroviral therapy; cohort studies; trends.

Figure 1

Temporal trends in the percentage of (A) patients initiating ART according to the year of enrollment in CoRIS and (B) patients on ART treatment, 2004–2020.

Figure 2

Temporal trends in the prescription of (A) first-line antiretroviral regimen among treatment-naïve patients and (Dual therapies as initial treatment were DTG/3TC and ETR + RAL). (B) ART regimen among all patients on treatment, by type of regimen, 2004–2020.(Dual therapies among patients on treatment were DTG/RPV, DTG/3TC, DRV/r + 3TC, DRV/r + RPV, DRV/r + ETV, DRV/r + DTG, DRV/r + RAL, CAB + RPV, ATV/r + 3TC, ETR + RAL, and DRVc + 3TC).

Figure 3

Geographic variability among autonomous regions in the prescription of (A) first-line antiretroviral regimen among treatment-naïve patients and (Dual therapies prescribed as initial treatment were DTG/3TC and ETR + RAL. Patients were not enrolled in the cohort in AR 11 in 2018 and 2019, or in AR 8 in 2020. AR 14 was included in the cohort in 2020). (B) ART regimen among all patients on treatment, by type of regimen, 2018–2020. (Dual therapies prescribed among patients on treatment were DTG/RPV, DTG/3TC, DRV/r + 3TC, DRV/r + RPV, DRV/r + ETV, DRV/r + DTG, DRV/r + RAL, CAB + RPV, ATV/r + 3TC, ETR + RAL, and DRVc + 3TC. AR 14 was included in the cohort in 2020). Each autonomous region (AR) is represented with a number.