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Original article

Durability of first-line antiretroviral regimens in the era of integrase inhibitors: a cohort of HIV-positive individuals in Spain, 2014–2015

Inmaculada Jarrin, Ines Suarez-Garcia, Cristina Moreno, Maria Tasias, Jorge Del Romero, Rosario Palacios, Joaquim Peraire, Miguel Gorgolas, Santiago Moreno, Cohort of the Spanish HIV/AIDS Research Network (CoRIS)

Corresponding author name: Inmaculada Jarrin
Corresponding author e-mail: ijarrin@isciii.es

doi: 10.3851/IMP3297

Abstract

Background: We compared time to treatment change (TC), viral suppression (VS) and change in CD4+ T-cell counts of first-line antiretroviral regimens (ART).

Methods: We analyzed HIV treatment-naïve adults from the Cohort of the Spanish HIV/AIDS Research Network (CoRIS) initiating the most commonly used ART regimens from September 2014 to November 2015. We used proportional hazards models on the sub-distribution hazard to estimate sub-distribution hazard ratios (sHR) for time to TC, logistic regression to estimate odds ratios (ORs) for VS (viral load<50 copies/ml), and linear regression to assess mean differences in CD4 changes from ART initiation.

Results: Among 960 individuals, tenofovir (TDF)/emtricitabine (FTC)/rilpivirine (RPV) was the most frequently prescribed regimen (24.2%), followed by elvitegravir (EVG)/cobicistat (COBI)/TDF/FTC (22.8%), abacavir (ABC)/lamivudine (3TC)/dolutegavir (DTG) (17.4%), TDF/FTC+darunavir/ritonavir (DRV/r) or darunavir/cobicistat (DRV/c) (12.1%), TDF/FTC/efavirenz (EFV) (8.8%), TDF/FTC+raltegravir (RAL) (7.7%) and TDF/FTC+DTG (7.0%). Initiating ART with TDF/FTC+DRV/r or DRV/c (adjusted sHR: 2.96; 95% CI: 1.44 – 6.08), TDF/FTC/EFV (2.18; 0.98 – 4.82), TDF/FTC+RAL (2.37; 1.08 – 5.22) and TDF/FTC+DTG (6.34; 3.18 – 12.64) was associated with a higher risk of TC compared to ABC/3TC/DTG. At 24 weeks, VS was lower in TDF/FTC+DRV/r or DRV/c (adjusted OR: 0.37, 95% CI: 0.18; 0.74) compared to ABC/3TC/DTG, and CD4increase was lower in patients initiating with TDF/FTC/RPV (adjusted mean difference: -75.9, 95% CI: -130.6; -21.2) compared to those who did with ABC/3TC/DTG.

Conclusions: Time to TC, VS and change in CD4+ T-cell counts varies by initial regimen. These differences may be useful for making decision when initiating ART.

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