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. 2025 Apr 7:15:100645.
doi: 10.1016/j.ijregi.2025.100645. eCollection 2025 Jun.

Experience of a Nationwide implementation of single-tablet second-generation integrase inhibitors-based treatment in Mexico

Alicia Piñeirúa-Menéndez  1 , Yanink Caro-Vega  2 , Juan Luis Mosqueda-Gómez  3 , Santiago Ávila Ríos  4 , Florentino Badial-Hernández  5 , Alethse De la Torre-Rosas  3 , Juan Sierra-Madero  2
Affiliations

Experience of a Nationwide implementation of single-tablet second-generation integrase inhibitors-based treatment in Mexico

Alicia Piñeirúa-Menéndez et al. IJID Reg. .

Abstract

Objectives: In Mexico, until 2018, antiretroviral therapy (ART) primarily relied on efavirenz-containing regimens or other options suitable for optimization, with ART costs among the highest in the region. This study evaluated the impact of a national strategy using single-tablet, second-generation integrase inhibitors (STSGII)-either bictegravir, emtricitabine, and tenofovir alafenamide or abacavir/lamivudine/dolutegravir-for ART initiation or switch.

Methods: Adults initiating or switching to STSGII between June 1, 2019, and June 30, 2021, at clinics for individuals without social security, were categorized into three groups: G1 (initiated with STSGII), G2 (initiated with non-STSGII), and G3 (switched to STSGII). The switch was defined as individuals changing ART in the presence of virological suppression. Viral suppression (VS) at 6 months post-initiation or switch was reported. A Cox model evaluated VS and regimen durability, defined as maintaining VS without ART change, loss to follow-up, or death.

Results: A total of 70,732 individuals were included; 24,133 (34.1%) on G1, 4605 (6.5%) on G2, and 41,994 (59.4%) on G3. VS was achieved in 85.7%, 52.7%, and 82.7% of individuals in G1, G2, and G3, respectively. Durability was met in 85.1%, 41.3%, and 90.8% of individuals in G1, G2, and G3.

Conclusions: Second-generation INSTIs are effective and durable in this 2-year follow-up analysis, both for ART initiation and optimization in Mexico's population, offering a valuable strategy for improving ART outcomes.

Keywords: HIV; Mexico; Second-generation single-tablet integrase inhibitors.

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Conflict of interest statement

AP reports a relationship with Gilead Sciences that includes consulting or advisory and funding grants. AP reports a relationship with ViiV Healthcare that includes consulting or advisory and funding grants. All other authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Figure 1
Figure 1
Percentage of individuals by ARV regimen from 2017-2020 in Mexico. 3TC, lamivudine; ABC, abacavir; ATV/r, atazanavir plus ritonavir; DRV/r, darunavir plus ritonavir; DRV/c, darunavir plus cobicistat; DTG, dolutegravir; EVG, elvitegravir; EFV, efavirenz; FTC, emtricitabine; NVP, nevirapine; LPVr, lopinavir plus ritonavir; RAL: raltegravir; TDF, tenofovir disoproxil fumarate; ZDV, zidovudine; ARV, antiretroviral. Notes: The combination could also be *FTC/TDF or ZDV/3TC, **FTC/3TC or TDF/FTC.
Figure 2
Figure 2
Distribution of the three analyzed groups. 3TC/ABC/DTG, lamivudine/abacavir/dolutegravir; B/F/TAF, bictegravir/emtricitabine/tenofovir alafenamide; EVG, elvitegravir; EFV, efavirenz; II, integrase inhibitors; NNRTI, non-nucleoside reverse transcriptase inhibitors; PLWH, people living with HIV; PI, protease inhibitors; RAL, raltegravir; STR, single-tablet regimen; TDF, tenofovir disoproxil fumarate.
Figure 3
Figure 3
Cox model addressing loss of durability, adjusted for age, sex, and clusters of differentiation 4+ cell count. STSGII, second-generation integrase inhibitor.
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