Assessment of antiretroviral third agent virologic durability after initiation of first antiretroviral regimen

Varriano, Brenda; Sandler, Ina; Loutfy, Mona; Steinberg, Samantha; Smith, Graham; Kovacs, Colin; Brunetta, Jason; Fletcher, David; Knox, David; Merkley, Barry; Chang, Benny; Tilley, David; Acsai, Megan; Crouzat, Frederic

doi:10.1177/0956462418815292

Cited by 6 publications

(6 citation statements)

References 41 publications

(55 reference statements)

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“…12 The majority of patients in the present study who were treated initially with NNRTIs and PIs switched to INSTIs regardless of switching times and/or backbone drugs, with low switch rates thereafter. These ndings and similar ndings reported by other investigators [20][21][22] suggest that INSTIs may be the most durable anchor drug class for PLWH on ART regimens, regardless of backbone drugs in the rst ART regimen. Analysis of a large dataset of HIV-positive patients con rmed that initial INSTI-based regimens combined with TDF, TAF, or ABC were all potent and well tolerated without signi cant virological failure; only a small percentage of patients (12%) discontinued INSTI regimens, and DTG showed the lowest risk of virological failure.…”

Section: Discussionsupporting

confidence: 89%

Antiretroviral Therapy Switch Rates and Switching Patterns in 16,069 People Living With HIV: A Nationwide, Population-Based Study in Japan

et al. 2021

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To report the status of switch rates and time-to-switch of antiretroviral therapy (ART) regimens by evaluating anchor drug classes and common switching patterns in Japanese people living with human immunode ciency virus (HIV, PLWH). This cross-sectional cohort study extracted data of 28,089 PLWH from the National Database of Health Insurance Claims and Speci c Health Checkups of Japan (NDB), which contains data representing the entire population of Japan. PLWH with rst prescription records of ART administered between January 2011 and March 2019 were identi ed (n = 16,069). The median timeto-switch and switch rates of anchor drug classes were estimated by Kaplan-Meier analysis. Brookmeyer-Crowley and Greenwood methods were used to estimate 95% con dence intervals for switch rates and median days, respectively. Switch rates were compared between anchor drug classes by year using logrank tests. A total of 3,108 (19•3%) PLWH switched anchor drug classes from rst to second regimens. Switch rates increased continuously over eight years for non-nucleoside reverse transcriptase inhibitors (NNRTIs) (14•9%-65•5%) and protease inhibitors (PIs) (13•2%-67•7%), with median time-to-switch of 1,826 and 1,583 days, respectively. Integrase strand transfer inhibitors (INSTIs) maintained a low switch rate (3•0%-7•6%), precluding median-days calculation. The majority of patients treated initially with NNRTIs and PIs switched to INSTIs regardless of switching times (< 1 year: 67•3% and 85•9%, respectively; ≥1 year: 95•5% and 93•6%, respectively). The foremost switching strategies for rst-to-second ART regimens are from NNRTI or PI to INSTI regimens that maintain low switch rates long term. INSTI HIV agents may be the most durable anchor drug class for PLWH receiving ART.

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Section: Discussionsupporting

confidence: 89%

Antiretroviral Therapy Switch Rates and Switching Patterns in 16,069 People Living With HIV: A Nationwide, Population-Based Study in Japan

et al. 2021

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“…The informations of percentage of STR uses were lack. They found that being on an INSTI or NNRTI-based regimens versus PI regimen, frequent VL testing and longer duration on of ART were associated with better durability [6].…”

Section: Resultsmentioning

confidence: 99%

“…In another study from Maple Leaf Medical Clinic in Canada, researchers found that being on an integrase strand transfer inhibitor (INSTI) or nonnucleoside reverse transcriptase inhibitor (NNRTI)-based regimens versus protease inhibitors (PI) regimen were associated with better durability. However, the informations of percentage of STR uses were lack [6].…”

Section: Introductionmentioning

confidence: 99%

Durability of Single Tablet Regimen for Patients with HIV infection in Southern Taiwan: data from a real world setting

Chang

Chou

Tsai

2020

Preprint

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Background: A single-tablet regimen (STR) has been associated with better drug adherence. However, the durability of different STRs was unknown in the real world settings. Our aim was to investigate the durability of different initial STR regimens in patients starting STR in southern Taiwan Method: This was a retrospective study of antiretroviral-naive patients that initiated first-line antiretroviral regimens with STRs between May 2016 and December 2017. The primary endpoint was time to virological failure (defined as plasma HIV RNAs≧200 copies/mL after 24 weeks). Secondary endpoints were STR discontinuation due to toxicity/intolerance. Survival analysis was done using Kaplan–Meier and Cox regression. Results: Two hundred and twenty-three patients were included: Over a median (IQR) of 86 (60-112) weeks, 25 patients (11%) experienced virological failure; the 1 year probability of virological failure was 11% (8/70) for Atripla, 7% (4/54) for Complera and 13% (13/99) for Triumeq. Fifty-six patients (25%) discontinued their STRs owing to toxicity/intolerance. When compared to Atripla, treatment with Complera (AHR 8.39, CI 1.98-35.58, p=0.004) and Triumeq (AHR 8.40, CI 2.39-29.54, p=0.001) were more likely to have treatment failure. However, when the risk of treatment failure was compared between two different STRs, treatment with Complera was not found to have higher risk of treatment failure when compared to Atripla (log rank test p=0.116). The predictors for treatment failure included age≦30 years old (AHR 3.73, CI 1.25-11.17, p=0.018), switch between different STR (AHR 2.3, CI 1.18-4.50, p=0.001) and free of active syphilis infection (AHR 0.24, CI 0.08-0.73, p=0.012). The risk factor for treatment discontinuation included younger age≦30 years old (AHR 3.82, CI 1.21-12.37, p=0.023), treatment with Atripla (AHR 8.65 , CI 2.64-28.39 , p<0.001) and free of active syphilis infection (AHR0.16, CI 0.04-0.62, p=0.006). Conclusion: Younger age was associated with treatment failure and drug discontinuation. Active syphilis infection s/p treatment was associated with free from treatment failure and discontinuation. This probably driven by the more frequently sexual health education and counseling when patients had syphilis infection. The STR durability was dependent on the drug toxicity/intolerance, age and syphilis infection

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“…No information on the percentage of STR uses were lack. They found that being on an INSTI or NNRTI-based regimens versus PI regimen, frequent VL testing and longer duration on of ART were associated with better durability [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…In another study from Maple Leaf Medical Clinic in Canada, researchers found that being on an integrase strand transfer inhibitor (INSTI) or nonnucleoside reverse transcriptase inhibitor (NNRTI)-based regimens versus protease inhibitors (PI) regimen were associated with longer time to virologic failure and better virologic durability. However, the information of durability of STR uses was lack [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Durability of single tablet regimen for patients with HIV infection in Southern Taiwan: data from a real-world setting

2022

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Background A single-tablet regimen (STR) has been associated with better drug adherence. However, the durability of different STRs was unknown in the real-world settings. Our aim was to investigate the durability of different initial STR regimens in antiretroviral-naive patients starting STR in southern Taiwan. Method This was a retrospective study of antiretroviral-naive patients that initiated first-line antiretroviral regimens with STRs between May 2016 and December 2017. The primary endpoint was time to virological failure. Secondary endpoints were STR discontinuation due to toxicity/intolerance. Durability was defined as time from the initiation until discontinuation/modification. Kaplan- Meier curves were plotted assessing time to virological suppression, treatment failure and discontinuation for the three STRs and Cox proportional hazards model was used to analyze the factors associated with time to viral suppression, treatment failure or discontinuation. Results Two hundred and twenty-three patients were included: The median follow-up duration (IQR) was 73.9 (48–101.6) weeks, 25 patients (11%) experienced virological failure; the 48 weeks probability of treatment failure was 22.9% (16/70) for Efavirenz/Emtricitabine/Tenofovir Disoproxil Fumarate (EFV/FTC/TDF), 24.1% (13/54) for Emtricitabine/Rilpivirine/Tenofovir Disoproxil Fumarate (FTC/RPV/TDF) and 24.2% (24/99) for Abacavir/Dolutegravir/Lamivudine (ABC/DTG/3TC) (p=0.16). Fifty-six patients (25%) discontinued their STRs owing to toxicity/intolerance. When compared to EFV/FTC/TDF, treatment with FTC/RPV/TDF (aHR 8.39, CI 1.98–35.58, p = 0.004) and ABC/DTG/3TC (aHR 8.40, CI 2.39–29.54, p=0.001) were more likely to have treatment failure. The predictors for treatment failure included age ≦ 30 years old (aHR 3.73, CI 1.25–11.17, p = 0.018), switch between different STR (aHR 2.3, CI 1.18–4.50, p = 0.001) and free of active syphilis infection (aHR 0.24, CI 0.08–0.73, p = 0.012). The risk factor for treatment discontinuation included younger age ≦ 30 years old (aHR 3.82, CI 1.21–12.37, p = 0.023), treatment with EFV/FTC/TDF (aHR 8.65, CI 2.64–28.39, p < 0.001) and free of active syphilis infection (aHR 0.16, CI 0.04–0.62, p = 0.006). Conclusion Younger age was associated with treatment failure and drug discontinuation. Active syphilis infection s/p treatment was associated with free from treatment failure and discontinuation. This probably driven by the more frequently sexual health education and counseling when patients had syphilis infection. Treatment with ABC/DTG/3TC was associated with higher risk of treatment failure. The STR durability was dependent on the drug toxicity/intolerance, age and syphilis infection.

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Assessment of antiretroviral third agent virologic durability after initiation of first antiretroviral regimen

Cited by 6 publications

References 41 publications

Antiretroviral Therapy Switch Rates and Switching Patterns in 16,069 People Living With HIV: A Nationwide, Population-Based Study in Japan

Antiretroviral Therapy Switch Rates and Switching Patterns in 16,069 People Living With HIV: A Nationwide, Population-Based Study in Japan

Durability of Single Tablet Regimen for Patients with HIV infection in Southern Taiwan: data from a real world setting

Durability of single tablet regimen for patients with HIV infection in Southern Taiwan: data from a real-world setting

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