Eaton EF, et al. - The real world durability of contemporary ART was evaluated for treatment-naïve people living with HIV (PLWH). In this study, NNRTI and InSTI-based ART were most durable, relative to protease inhibitor and InSTI/protease inhibitor-based ART among treatment-naive PLWH, and were least frequently modified/discontinued.

Methods

• Researchers undertook a retrospective follow-up study in a multisite cohort.
• Data from eight Center for AIDS Research (CFARs) was integrated in this study of the CNICS (CFAR Network of Integrated Clinical Systems) cohort.
• Inclusion of PLWH initiating ART between 2007 and 2014 was performed.
• For this study, durability was defined as time from the initiation until discontinuation/modification using Kaplan–Meier survival curves.
• They used Cox Proportional Hazards to measure associations with various sociodemographic and clinical characteristics.

Results

• In 2285 (43%) of 5373 PLWH, the initial regimen was modified.
• The most commonly prescribed initial ART regimen was efavirenz/emtricitabine/tenofovir (n = 2173, 40%); After 2012, elvitegravir/cobicistat/emtricitabine/tenofovir became more common.
• For all regimens, median durability of 48.6 months was observed.
• For NNRTI, InSTI, and protease inhibitor-based regimens, statistically significant differences in median durability were observed, which lasted 61, 44, and 32 months, respectively.
• Regimen modification was observed in significant association with female sex (aHR = 1.4; 95% CI 1.2–1.6), intravenous drug use (aHR = 1.6; 95% CI 1.3–1.9), and CD4+ cell count less than 200 cells/μl (aHR = 1.2; 95% CI 1.1–1.3).
• Compared with InSTI, InSTI/protease inhibitor (aHR = 2.7; 95% CI 2.0–3.7) or protease inhibitor-based ART (aHR = 1.9; 95% CI 1.6–2.2) receiving patients were significantly more likely to be modified; however, those receiving NNRTI (aHR = 1.1; 95% CI 0.9–1.3) were not.