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

Abstract

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.

Durability of first-line antiretroviral treatment in the Russian Federation: retrospective study

“…Частота прекращения/изменения терапии по схемам по причине неэффективности или побочных эффектов выглядела следующим образом: EFV/FTC/TDF -22,9% (16/70) и 50,0% (35/70), FTC/RPV/TDF -24,1% (13/54) и 10% (7/54), ABC/DTG/3TC -24,2% (24/99) и 14,1% (14/99) соответственно. По данным этого исследования, с отменой/изменением терапии ассоциировались возраст ≤30 лет и лечение по схеме EFV/FTC/TDF [6]. Эти наблюдения отличаются от результатов нашего исследования, что говорит о необходимости дальнейших исследований в области продолжительности АРТ.…”

“…Известно, что продолжительность жизни людей, живущих с ВИЧ, значительно увеличилась благодаря комплексу мер по оказанию специализированной медицинской помощи и имеющимся лекарственным препаратам [2]. Несмотря на это, в популяции пациентов нередки случаи изменения и прерывания курса терапии по ряду причин, в том числе по причине отсутствия вирусологического ответа, нежелательных явлений или несоблюдения режима терапии [3][4][5][6][7][8][9]. Изменение или отмена терапии могут повлечь за собой неблагоприятные клинические исходы заболевания и увеличение прямых и непрямых расходов системы здравоохранения.…”

Self-Reported Health-Related Quality of Life and Residual Symptoms among Virologically Suppressed People Living with HIV in the Era of Single-Tablet Regimens in Taiwan: A Cross-Sectional Study

“…STRs have been associated with higher patient adherence, translating to viral suppression, lower hospitalization rates, and better patient-reported outcomes as compared with multi-tablet regimens [ 20 , 21 , 22 ]. However, studies assessing the HRQoL of virologically suppressed PLWH were limited in the era of STRs, with most evaluating the impact of initiating STRs or switching to STRs [ 20 , 22 , 23 , 24 ], with one study showing a significantly lower symptom burden 24 weeks after switching to STRs [ 23 ].…”

“…The HIV incidence in Taiwan has decreased from 10.7 per 100,000 persons in 2017 to 4.6 per 100,000 persons in 2022 [ 27 , 28 ], with fewer newly diagnosed HIV cases recorded in 2022 (1075 cases) than in 2021 (1247 cases) [ 29 ], suggesting a favourable outcome of Taiwan’s policies on HIV care. STRs were recommended as first-line treatment for treatment-naive PLWH and included in the Taiwanese reimbursement regulation since 2016 [ 24 ], but little is known about the HRQoL and if there remained any residual symptom burden of virologically suppressed PLWH on STRs. Therefore, this study aimed to assess the HRQoL and the associated factors that might impact HRQoL, such as residual HIV symptom burden, by patient self-reported questionnaires in virologically suppressed PLWH in the era of STR in Taiwan.…”