Antiretroviral Regimen Durability and Success in Treatment-Naive and Treatment-Experienced Patients by Year of Treatment Initiation, United States, 1996-2011

• Type of Material: Article
• Authors: Anandi Sheth, Emory University; Ighoverha Ofotokun, Emory University; Kate Buchacz, Emory University; Carl Armon, Cerner Corporation; Joan S. Chmiel, Northwestern University; Rachel L.D. Hart, Cerner Corporation; Rose Baker, Cerner Corporation; John T. Brooks, Emory University; Frank J. Palella, Northwestern University
• Language: English
• Date: 2016-01-01
• Publisher: Lippincott, Williams & Wilkins
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2015 Wolters Kluwer Health, Inc. All rights reserved.
• Final Published Version (URL): http://dx.doi.org/10.1097/QAI.0000000000000813
• Title of Journal or Parent Work: Journal of Acquired Immune Deficiency Syndromes
• ISSN: 1525-4135
• Volume: 71
• Issue: 1
• Start Page: 47
• End Page: 56
• Grant/Funding Information: Financial support was received from the Centers for Disease Control and Prevention (contracts 200-2001-00133, 200-2006-18797, and 200-2011-41872) and the National Center for Advancing Translational Sciences of the National Institutes of Health (KL2TR000455 and UL1TR000454).
• Keywords: Life Sciences & Biomedicine; DURATION; Infectious Diseases; Immunology; antiretroviral therapy; INFECTION; ADHERENCE; DISCONTINUATION; REASONS; THERAPY REGIMENS; cohort study; Science & Technology; durability
• Research Categories: Health Sciences, Immunology; Health Sciences, Pharmacology; Health Sciences, Medicine and Surgery

Abstract

Background: Although modern combination antiretroviral therapy (cART) regimens are better tolerated and less complex than earlier treatments, regimen modification or discontinuation remains a concern. Methods: We studied HIV Outpatient Study (HOPS) participants who initiated first or second cART regimens during: 1996–1999, 2000–2003, 2004–2007 and 2008–2011. We analyzed regimen durability (time to regimen modification) and success (achieving undetectable plasma HIV RNA) for first and second cART regimens using Kaplan-Meier curves and log-rank tests, and examined factors associated with durability and success of first cART regimen using proportional hazards models. Results: Durability of cART was progressively longer for cART regimens initiated in more recent periods: median first cART regimen durations were 1.0, 1.1, 2.1 and 4.6 years in 1996–1999, 2000–2003, 2004–2007 and 2008–2011, and median second cART durations were 0.9, 1.2, 2.8 and 3.9 years, respectively (both p<0.001). Comparing 1996–1999 and 2008–2011, the percentage of patients who achieved an undetectable HIV RNA within 6 months of first cART initiation increased from 65% to 81%, and from 63% to 80% on second cART (both p<0.001). Among patients initiating first cART during 2008–2011, black non-Hispanic/Latino race/ethnicity and ≥twice daily dosing were significantly associated with higher rates of regimen modification (p<0.05), and higher baseline HIV RNA levels were associated with failure to achieve an undetectable HIV RNA (p<0.001). Conclusions: Among HIV-infected U.S. adults in routine HIV care, durability of first and second cART regimens and the likelihood of prompt virologic suppression increased during 1996–2011, coincident with the availability of more tolerable, less complex cART options.