Causes of HIV Treatment Interruption during the Last 20 Years: A Multi-Cohort Real-Life Study

Abstract

In the last years, many antiretroviral drugs (ART) have been developed with increased efficacy. Nowadays, the main reasons for treatment switches are adverse events, proactive strategy or simplification. We conducted a retrospective cohort study to investigate the reason for treatment interruption in the last 20 years. We merged data of eight cohorts of the SCOLTA project: lopinavir/r (LPV), atazanavir/r (ATV), darunavir/r or /c (DRV), rilpivirine (RPV), raltegravir (RAL), elvitegravir/c (EVG), dolutegravir (DTG) and bictegravir (BIC). We included 4405 people with HIV (PWH). Overall, 664 (15.1%), 489 (11.1%), and 271 (6.2%) PWH interrupted the treatment in the first, second, and third years after starting a new ART. Looking at the interruption in the first year, the most frequent causes were adverse events (3.8%), loss to follow-up (3.7%), patients’ decisions (2.6%), treatment failure (1.7%), and simplification (1.3%). In the multivariate analysis regarding experienced patients, treatment with LPV, ATV, RPV or EVG/c, having less than 250 CD4 cells/mL, history of intravenous drug use, and HCV positivity were associated with an increased risk of interruption. In naive people, only LPV/r was associated with an increased risk of interruption, while RPV was associated with a lower risk. In conclusion, our data on more than 4400 PWH show that adverse events have represented the most frequent cause of treatment interruptions in the first year of ART (3.84%). Treatment discontinuations were more frequent during the first year of follow-up and decreased thereafter. First-generation PI in both naïve and experienced PWH, and EVG/c, in experienced PWH, were associated with a higher risk of treatment interruptions.

Living with HIV and Getting Vaccinated: A Narrative Review

“…This implies that PWH are becoming older, with an increase in the comorbidity burden that HIV specialists have to manage [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 ]. However, despite ART, many people do not have a complete CD4 recovery [ 13 , 14 , 15 , 16 ], and PWH with low CD4 cell count have an estimated life expectancy of 30 years lower than the general population [ 1 ].…”

Special Issue “Efficacy and Safety of Antiviral Therapy”

“…Lastly, De Vito et al focus on treatment interruption in individuals who have been living with HIV for over 20 years. By analyzing the reasons behind treatment switches, this study uncovers factors influencing treatment adherence and interruption patterns [ 19 ]. Understanding these factors can inform healthcare providers and policymakers to design interventions to enhance treatment adherence and long-term health outcomes for HIV patients.…”