Durability of First-Line Antiretroviral Treatment Regimens in a Cohort of HIV-Infected Patients

Abstract

Aims: In recent years, increasing numbers of studies have been made of the durability of antiretroviral treatments (ART) and reasons for changing this medication, but few have evaluated the most recent therapeutic approaches. In this paper, we analyse the durability of the first-line ART regimen currently employed for patients infected with human immunodeficiency virus (HIV), and examine the reasons for treatment modification. Method: A retrospective multicentre observational study was conducted of patients with HIV infection who started first-line ART between January 2012 and December 2013 in the provinces of Málaga, Granada, Jaén and Almería (Spain). The main study variable is the durability of the first-line ART regimen until its modification, the reasons for which are described. Survival analysis was performed using Kaplan-Meier curves to evaluate durability, and a Cox multiple regression model was constructed to identify associated factors. Results: A total of 664 patients started first-line ART. The average durability was 20 months (95% CI: 17-22); at one year, 29% had abandoned this regimen, while 57% maintained it until the end of follow-up. The greatest durability was achieved with regimens based on rilpivirine (RPV), darunavir (DRV) and raltegravir (RAL). The main reason for change was toxicity (20%), mainly gastrointestinal, associated with the use of protease inhibitors (PI), and neuropsychiatric, associated with the use of efavirenz (EFV). HCV coinfection, AIDS diagnosis and type of ART regimen were all associated with reduced durability. Conclusion: With the regimens currently applied, the durability of first-line ART is 20 months. At one year of treatment, this first-line regimen had been modified for 29% of patients, with toxicity being the main reason for change. Regimens based on RPV, DRV and RAL present greater durability, mainly due to their lower toxicity. Citation: Perez Stachowski J, Gonzalez-Domenech CM, García Vallecillos C, Perez-Camacho I, Vinuesa Garcia D, et al. (2018) Durability of FirstLine Antiretroviral Treatment Regimens in a Cohort of HIV-Infected Patients. J AIDS Clin Res 9: 773. doi: 10.4172/2155-6113.1000773