Factors associated with the number of drugs in darunavir/cobicistat regimens. (5th October 2019)

• Record Type: Journal Article
• Authors: Martinez, Esteban; Negredo, Eugenia; Knobel, Hernando; Ocampo, Antonio; Sanz, Jose; Garcia-Fraile, Lucio; Martin-Carbonero, Luz; Lozano, Fernando; Gonzalez-Domenech, Carmen M; Gutierrez, Mar; Montero, Marta; Boix, Vicente; Payeras, Antoni; Torralba, Miguel; Gonzalez-Cordon, Ana; Moreno, Ana; Alejos, Belen; Perez-Elias, Maria J
• Is Part Of: Journal of antimicrobial chemotherapy. Volume 75:Number 1(2020)
• Page Start: 208
• Page End: 214
• Publication Date: 2019-10-05
• Subjects: Anti-infective agents -- Periodicals; Chemotherapy -- Periodicals; 615.58
• DOI: 10.1093/jac/dkz399
• Languages: English
• ISSNs: 0305-7453

Abstract

Abstract: Background: Darunavir/cobicistat can be used as mono, dual, triple or more than triple therapy. Objectives: To assess factors associated with the number of drugs in darunavir/cobicistat regimens. Methods: A nationwide retrospective cohort study of consecutive HIV-infected patients initiating darunavir/cobicistat in Spain from July 2015 to May 2017. Baseline characteristics, efficacy and safety at 48 weeks were compared according to the number of drugs used. Results: There were 761 patients (75% men, 98% were antiretroviral-experienced, 32% had prior AIDS, 84% had HIV RNA <50 copies/mL and 88% had ≥200 CD4 cells/mm 3 ) who initiated darunavir/cobicistat as mono ( n =308, 40%), dual ( n =173, 23%), triple ( n =253, 33%) or four-drug ( n =27, 4%) therapy. Relative to monotherapy, triple therapy was more common in men aged <50 years, with prior AIDS and darunavir plus ritonavir use, and with CD4 cells <200/mm 3 and with detectable viral load at initiation of darunavir/cobicistat; dual therapy was more common with previous intravenous drug use, detectable viral load at initiation of darunavir/cobicistat and no prior darunavir plus ritonavir; and four-drug therapy was more common with prior AIDS and detectable viral load at initiation of darunavir/cobicistat. Monotherapy and dual therapy showed a trend to better virological responses than triple therapy. CD4 responses and adverse effects did not differ among regimens. Discussion: Darunavir/cobicistat use in Spain has been tailored according to clinical characteristics of HIV-infected patients. Monotherapy and dual therapy have been common and preferentially addressed to older patients with a better HIV status, suggesting that health issues other than HIV infection may have been strong determinants of its prescription.