Haidong Lu1, Stephen R Cole2, Daniel Westreich2, Michael G Hudgens3, Adaora A Adimora2,4, Keri N Althoff5, Michael J Silverberg6, Kate Buchacz7, Jun Li7, Jessie K Edwards2, Peter F Rebeiro8, Viviane D Lima9, Vincent C Marconi10,11, Timothy R Sterling8, Michael A Horberg12, M John Gill13, Mari M Kitahata14, Joseph J Eron2,4, Richard D Moore15. 1. Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Connecticut. 2. Department of Epidemiology. 3. Department of Biostatistics, Gillings School of Global Public Health. 4. Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, North Carolina. 5. Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland. 6. Division of Research, Kaiser Permanente Northern California, Oakland, California. 7. Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia. 8. Vanderbilt University Medical Center, Nashville, Tennessee, USA. 9. Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. 10. Division of Infectious Diseases, Emory University School of Medicine, Atlanta. 11. Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, USA. 12. Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, Maryland, USA. 13. Department of Medicine, University of Calgary, Calgary, Alberta, Canada. 14. Department of Medicine, University of Washington, Seattle, Washington. 15. Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Abstract
BACKGROUND: Integrase strand transfer inhibitor (InSTI)-based regimens have been recommended as first-line antiretroviral therapy (ART) for adults with HIV. But data on long-term effects of InSTI-based regimens on virologic outcomes remain limited. Here we examined whether InSTI improved long-term virologic outcomes compared with efavirenz (EFV). METHODS: We included adults from the North American AIDS Cohort Collaboration on Research and Design who initiated their first ART regimen containing either InSTI or EFV between 2009 and 2016. We estimated differences in the proportion virologically suppressed up to 7 years of follow-up in observational intention-to-treat and per-protocol analyses. RESULTS: Of 15 318 participants, 5519 (36%) initiated an InSTI-based regimen and 9799 (64%) initiated the EFV-based regimen. In observational intention-to-treat analysis, 81.3% of patients in the InSTI group and 67.3% in the EFV group experienced virologic suppression at 3 months after ART initiation, corresponding to a difference of 14.0% (95% CI 12.4-15.6). At 1 year after ART initiation, the proportion virologically suppressed was 89.5% in the InSTI group and 90.2% in the EFV group, corresponding to a difference of -0.7% (95% CI -2.1 to 0.8). At 7 years, the proportion virologically suppressed was 94.5% in the InSTI group and 92.5% in the EFV group, corresponding to a difference of 2.0% (95% CI -7.3 to 11.3). The observational per-protocol results were similar to intention-to-treat analyses. CONCLUSIONS: Although InSTI-based initial ART regimens had more rapid virologic response than EFV-based regimens, the long-term virologic effect was similar. Our findings may inform guidelines regarding preferred initial regimens for HIV treatment.
BACKGROUND: Integrase strand transfer inhibitor (InSTI)-based regimens have been recommended as first-line antiretroviral therapy (ART) for adults with HIV. But data on long-term effects of InSTI-based regimens on virologic outcomes remain limited. Here we examined whether InSTI improved long-term virologic outcomes compared with efavirenz (EFV). METHODS: We included adults from the North American AIDS Cohort Collaboration on Research and Design who initiated their first ART regimen containing either InSTI or EFV between 2009 and 2016. We estimated differences in the proportion virologically suppressed up to 7 years of follow-up in observational intention-to-treat and per-protocol analyses. RESULTS: Of 15 318 participants, 5519 (36%) initiated an InSTI-based regimen and 9799 (64%) initiated the EFV-based regimen. In observational intention-to-treat analysis, 81.3% of patients in the InSTI group and 67.3% in the EFV group experienced virologic suppression at 3 months after ART initiation, corresponding to a difference of 14.0% (95% CI 12.4-15.6). At 1 year after ART initiation, the proportion virologically suppressed was 89.5% in the InSTI group and 90.2% in the EFV group, corresponding to a difference of -0.7% (95% CI -2.1 to 0.8). At 7 years, the proportion virologically suppressed was 94.5% in the InSTI group and 92.5% in the EFV group, corresponding to a difference of 2.0% (95% CI -7.3 to 11.3). The observational per-protocol results were similar to intention-to-treat analyses. CONCLUSIONS: Although InSTI-based initial ART regimens had more rapid virologic response than EFV-based regimens, the long-term virologic effect was similar. Our findings may inform guidelines regarding preferred initial regimens for HIV treatment.
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