Clinical Outcomes of 2-Drug Regimens vs 3-Drug Regimens in Antiretroviral Treatment–Experienced People Living With Human Immunodeficiency Virus. (23rd December 2020)

• Record Type: Journal Article
• Authors: Greenberg, Lauren; Ryom, Lene; Neesgaard, Bastian; Wandeler, Gilles; Staub, Therese; Gisinger, Martin; Skoll, Michael; Günthard, Huldrych F; Scherrer, Alexandra; Mussini, Cristina; Smith, Colette; Johnson, Margaret; De Wit, Stéphane; Necsoi, Coca; Pradier, Christian; Wit, Ferdinand; Lehmann, Clara; d'Arminio Monforte, Antonella; Miró, Jose M; Castagna, Antonella; Spagnuolo, Vincenzo; Sönnerborg, Anders; Law, Matthew; Hutchinson, Jolie; Chkhartishvili, Nikoloz; Bolokadze, Natalia; Wasmuth, Jan-Christian; Stephan, Christoph; Vannappagari, Vani; Rogatto, Felipe; Llibre, Josep M; Duvivier, Claudine; Hoy, Jennifer; Bloch, Mark; Bucher, Heiner C; Calmy, Alexandra; Volny Anne, Alain; Pelchen-Matthews, Annegret; Lundgren, Jens D; Peters, Lars; Bansi-Matharu, Loveleen; Mocroft, Amanda;
• Is Part Of: Clinical infectious diseases. Volume 73:Number 7(2021)
• Page Start: e2323
• Page End: e2333
• Publication Date: 2020-12-23
• Subjects: HIV -- dual therapy -- 2-drug regimens -- antiretroviral treatment -- clinical outcomes; Communicable diseases -- Periodicals; 616.905
• DOI: 10.1093/cid/ciaa1878
• Languages: English
• ISSNs: 1058-4838

Abstract

Abstract: Background: Limited data exist that compare clinical outcomes of 2-drug regimens (2DRs) and 3-drug regimens (3DRs) in people living with human immunodeficiency virus. Methods: Antiretroviral treatment–experienced individuals in the International Cohort Consortium of Infectious Diseases (RESPOND) who switched to a new 2DR or 3DR from 1 January 2012–1 October 2018 were included. The incidence of clinical events (AIDS, non-AIDS cancer, cardiovascular disease, end-stage liver and renal disease, death) was compared between regimens using Poisson regression. Results: Of 9791 individuals included, 1088 (11.1%) started 2DRs and 8703 (88.9%) started 3DRs. The most common 2DRs were dolutegravir plus lamivudine (22.8%) and raltegravir plus boosted darunavir (19.8%); the most common 3DR was dolutegravir plus 2 nucleoside reverse transcriptase inhibitors (46.9%). Individuals on 2DRs were older (median, 52.6 years [interquartile range, 46.7–59.0] vs 47.7 [39.7–54.3]), and a higher proportion had ≥1 comorbidity (81.6% vs 73.9%). There were 619 events during 27 159 person-years of follow-up (PYFU): 540 (incidence rate [IR] 22.5/1000 PYFU; 95% confidence interval [CI]: 20.7–24.5) on 3DRs and 79 (30.9/1000 PYFU; 95% CI: 24.8–38.5) on 2DRs. The most common events were death (7.5/1000 PYFU; 95% CI: 6.5–8.6) and non-AIDS cancer (5.8/1000 PYFU; 95% CI: 4.9–6.8). After adjustment for baseline demographic and clinical characteristics, there was a similar incidence of events on both regimen types (2DRs vs 3DRs IR ratio, 0.92; 95% CI: .72–1.19; P = .53). Conclusions: This is the first large, international cohort to assess clinical outcomes on 2DRs. After accounting for baseline characteristics, there was a similar incidence of events on 2DRs and 3DRs. 2DRs appear to be a viable treatment option with regard to clinical outcomes. Further research on resistance barriers and long-term durability of 2DRs is needed. Abstract : In this analysis of 9791 antiretroviral-experienced individuals in the International Cohort Consortium of Infectious Diseases (RESPOND) (1088 on 2-drug regimens, 8703 on 3-drug regimens), there was a similar short-term incidence of severe clinical events after adjusting for baseline characteristics (incidence rate ratio, 0.92; 95% confidence interval, .72–1.19; P = .53).