Real-life evaluation of intermittent triple antiretroviral therapy maintenance strategies

Abstract

Introduction: Intermittent antiretroviral therapy (ART) is commonly prescribed in France, but this strategy is not recommended internationally. The objective of this study was to evaluate real-life efficacy of intermittent ART in virologically suppressed individuals.

Methods: We conducted a retrospective non-comparative cohort study at Strasbourg University Hospital and included all people living with HIV (PLWH) on intermittent ART between 2017 and 2024. The primary outcome was virological success at W48 after initiation of intermittent ART.

Results: We included 160 PLWH. They were mainly males (80 %), with 59.4 % reporting sex with men and 75 % were born in France. Mean CD4 count was 672/mm³, and mean duration of viral suppression was 7.9 years. The third agent was a non-nucleoside reverse transcriptase inhibitor in 87/160 (54.3 %) participants, an integrase strand transfer inhibitor in 72/160 (45.0 %) participants, and one participant had a protease inhibitor. Three participants discontinued the intermittent ART strategy before W48, and five were lost to follow-up before W48, without virological failure at the time of the last update. We did not observe any virological failure at W48 for the remaining 152 participants, nor during longer follow-up (median 131 weeks). A blip occurred in five participants. Throughout the study period, 21/160 (13.1 %) PLWH discontinued intermittent ART strategy, mainly to switch for injectable ART (12/21, 57 %).

Conclusions: Our findings in real-life setting support intermittent triple ART as a safe, cost-effective, and well-tolerated maintenance option in selected compliant PLWH, including regimens with a lower genetic barrier to resistance.

Keywords: Antiretroviral therapy; HIV; intermittent triple HIV treatment.