Long-term effectiveness of recommended boosted protease inhibitor-based antiretroviral therapy in Europe

JR Santos, A Cozzi-Lepri, A Phillips, S De Wit, C Pedersen, P Reiss, A Blaxhult, A Lazzarin, M Sluzhynska, C Orkin, C Duvivier, J Bogner, P Gargalianos-Kakolyris, P Schmid, G Hassoun, I Khromova, M Beniowski, V Hadziosmanovic, D Sedlacek, R ParedesJD Lundgren, on behalf of the EuroSIDA study group

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Abstract

Objectives: The aim of the study was to evaluate the long-term response to antiretroviral treatment (ART) based on atazanavir/ritonavir (ATZ/r)-, darunavir/ritonavir (DRV/r)-, and lopinavir/ritonavir (LPV/r)-containing regimens. Methods: Data were analysed for 5678 EuroSIDA-enrolled patients starting a DRV/r-, ATZ/r- or LPV/r-containing regimen between 1 January 2000 and 30 June 2013. Separate analyses were performed for the following subgroups of patients: (1) ART-naïve subjects (8%) at ritonavir-boosted protease inhibitor (PI/r) initiation; (2) ART-experienced individuals (44%) initiating the new PI/r with a viral load (VL) ≤500 HIV-1 RNA copies/mL; and (3) ART-experienced patients (48%) initiating the new PI/r with a VL > 500 copies/mL. Virological failure (VF) was defined as two consecutive VL measurements > 200 copies/mL ≥24 weeks after PI/r initiation. Kaplan–Meier and multivariable Cox models were used to compare risks of failure by PI/r-based regimen. The main analysis was performed with intention-to-treat (ITT) ignoring treatment switches. Results: The time to VF favoured DRV/r over ATZ/r, and both were superior to LPV/r (log-rank test; P < 0.02) in all analyses. Nevertheless, the risk of VF in ART-naïve patients was similar regardless of the PI/r initiated after controlling for potential confounders. The risk of VF in both treatment-experienced groups was lower for DRV/r than for ATZ/r, which, in turn, was lower than for LPV/r-based ART. Conclusions: Although confounding by indication and calendar year cannot be completely ruled out, in ART-experienced subjects the long-term effectiveness of DRV/r-containing regimens appears to be greater than that of ATZ/r and LPV/r. © 2018 British HIV Association
Original languageEnglish
Pages (from-to)324-338
Number of pages15
JournalHIV Medicine
Volume19
Issue number5
DOIs
Publication statusPublished - 2018

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    Santos, JR., Cozzi-Lepri, A., Phillips, A., De Wit, S., Pedersen, C., Reiss, P., Blaxhult, A., Lazzarin, A., Sluzhynska, M., Orkin, C., Duvivier, C., Bogner, J., Gargalianos-Kakolyris, P., Schmid, P., Hassoun, G., Khromova, I., Beniowski, M., Hadziosmanovic, V., Sedlacek, D., ... group, O. B. O. T. EIDA. S. (2018). Long-term effectiveness of recommended boosted protease inhibitor-based antiretroviral therapy in Europe. HIV Medicine, 19(5), 324-338. https://doi.org/10.1111/hiv.12581