Treatment modification after starting cART in people living with HIV: retrospective analysis of the German ClinSurv HIV Cohort 2005-2017

Stecher, Melanie; Schommers, Philipp; Kollan, Christian; Stoll, Matthias; Kuhlendahr, Frieder; Stellbrink, Hans-Jürgen; Wasmuth, Jan-Christian; Stephan, Christoph; Hamacher, Laura; Lehmann, Clara; Boesecke, Christoph; Bogner, Johannes; Esser, Stefan; Fritzsche, Carlos; Haberl, Annette; Hoffmann, Christian; Jensen, Björn; Schwarze-Zander, Carolynne; Platten, Martin; Faetkenheuer, Gerd; Schmidt, Daniel; Gunsenheimer-Bartmeyer, Barbara und Vehreschild, Jörg Janne (2020): Treatment modification after starting cART in people living with HIV: retrospective analysis of the German ClinSurv HIV Cohort 2005-2017. In: Infection, Bd. 48, Nr. 5: S. 723-733

Abstract

Objective: Combination antiretroviral therapy (cART) has markedly increased survival and quality of life in people living with HIV. With the advent of new treatment options, including single-tablet regimens, durability and efficacy of first-line cART regimens are evolving. Methods We analyzed data from the prospective multicenter German Clinical Surveillance of HIV Disease (ClinSurv) cohort of the Robert-Koch Institute. Kaplan-Meier and Cox proportional hazards models were run to examine the factors associated with treatment modification. Recovery after treatment initiation was analyzed comparing pre-cART viral load and CD4+ T-cell counts with follow-up data. Results We included 8788 patients who initiated cART between 2005 and 2017. The sample population was predominantly male (n = 7040;80.1%), of whom 4470 (63.5%) were reporting sex with men as the transmission risk factor. Overall, 4210 (47.9%) patients modified their first-line cART after a median time of 63 months (IQR 59-66). Regimens containing integrase strand transfer inhibitors (INSTI) were associated with significantly lower rates of treatment modification (adjusted hazard ratio 0.44;95% CI 0.39-0.50) compared to protease inhibitor (PI)-based regimens. We found a decreased durability of first-line cART significantly associated with being female, a low CD4+ T-cell count, cART initiation in the later period (2011-2017), being on a multi-tablet regimen (MTR). Conclusions: Drug class and MTRs are significantly associated with treatment modification. INSTI-based regimens showed to be superior compared to PI-based regimens in terms of durability.

• Dokumententyp: Zeitschriftenartikel
• Fakultät: Medizin
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• ISSN: 0300-8126
• Sprache: Englisch