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Clinical Outcomes of 2-Drug Regimens vs 3-Drug Regimens in Antiretroviral Treatment–Experienced People Living With Human Immunodeficiency Virus

2020; Oxford University Press; Volume: 73; Issue: 7 Linguagem: Inglês

10.1093/cid/ciaa1878

1537-6591

Lauren Greenberg, Lene Ryom, Bastian Neesgaard, Gilles Wandeler, Thérèse Staub, Martin Gisinger, Michael Skoll, Huldrych F. Günthard, Alexandra Scherrer, Cristina Mussini, Colette Smith, Margaret Johnson, Stéphane De Wit, Coca Necsoi, Christian Pradier, Ferdinand W.N.M. Wit, Clara Lehmann, Antonella d’Arminio Monforte, José M. Miró, Antonella Castagna, Vincenzo Spagnuolo, Anders Sönnerborg, Matthew Law, Jolie Hutchinson, Nikoloz Chkhartishvili, N Bolokadze, Jan‐Christian Wasmuth, Christoph Stephan, Vani Vannappagari, Felipe Rogatto, Josep M. Llibre, Claudine Duvivier, Jennifer Hoy, Mark Bloch, Heiner C. Bucher, Alexandra Calmy, Alain Volny Anne, Annegret Pelchen‐Matthews, Jens Lundgren, Lars Peters, Loveleen Bansi‐Matharu, Amanda Mocroft, Ferdinand W.N.M. Wit, Peter Reiss, M Hillebregt, Matthew Law, Kathy Petoumenos, Norman Rose, Robert Zangerle, H Appoyer, Stéphane De Wit, M Delforge, Gilles Wandeler, Christoph Stephan, M Bucht, Nikoloz Chkhartishvili, Otar Chokoshvili, Antonella d’Arminio Monforte, A Rodano, Alessandro Tavelli, Iuri Fanti, Cristina Mussini, Vanni Borghi, Christian Pradier, Éric Fontas, K Dollet, C Caissotti, J Casabona, José M. Miró, Josep M. Llibre, Antoni Riéra, J. Uruena, Colette Smith, Fiona Lampe, Antonella Castagna, Adriano Lazzarin, Andrea Poli, A Sönnerborg, Karolin Falconer, V Svedhem, Huldrych F. Günthard, B Ledergerber, Heiner C. Bucher, Alexandra Scherrer, J C Wasmuth, Jörg Janne Vehreschild, Gerd Fätkenheuer, Amanda Mocroft, James F. Rooney, Felipe Rogatto, Vani Vannappagari, H Garges, Gilles Wandeler, Matthew Law, Robert Zangerle, Colette Smith, Stéphane De Wit, Jens Lundgren, Huldrych F. Günthard, Jens Lundgren, Huldrych F. Günthard, J. Kowalska, David Raben, Lene Ryom, Amanda Mocroft, J Rockstroh, Lars Peters, Alain Volny Anne, N Dedes, E. D. Williams, Nikoloz Chkhartishvili, Robert Zangerle, Matthew Law, Ferdinand W.N.M. Wit, Coca Necsoi, Gilles Wandeler, Christoph Stephan, Christian Pradier, Antonella d’Arminio Monforte, Cristina Mussini, Andreu Bruguera, Heiner C. Bucher, A Sönnerborg, Jörg Janne Vehreschild, J C Wasmuth, Colette Smith, Antonella Castagna, Felipe Rogatto, Richard Haubrich, Vani Vannappagari, H Garges, Lene Ryom, Amanda Mocroft, Bastian Neesgaard, Lauren Greenberg, Loveleen Bansi‐Matharu, V Svedhem-Johansson, Ferdinand W.N.M. Wit, Katharina Grabmeier‐Pfistershammer, Robert Zangerle, Jennifer Hoy, Mark Bloch, Dominique L. Braun, Alexandra Calmy, Gundolf Schüttfort, M Youle, Stéphane De Wit, Cristina Mussini, Stefano Zona, Antonella Castagna, Andrea Antinori, Nikoloz Chkhartishvili, N Bolokadze, Éric Fontas, K Dollet, Christian Pradier, José M. Miró, Josep M. Llibre, Jörg Janne Vehreschild, Carolynne Schwarze‐Zander, J.‐C. Wasmuth, J Rockstroh, Kathy Petoumenos, Matthew Law, Claudine Duvivier, Gordana Dragović, Roxana Rădoi, Carmen Oprea, M Vasylyev, J. Kowalska, Raimonda Matulionytė, V Mulabdic, G Marchetti, Elena Kuzovatova, Nicola Coppola, Josip Begovać, Inka Aho, Salvatore Martini, Heiner C. Bucher, Arjan Harxhi, Torgun Wæhre, Anastasia Pharris, Anna Vassilenko, Gerd Fätkenheuer, J. R. Bogner, Anne Maagaard, Elżbieta Jabłonowska, Daniel Elbirt, Gaetano Marrone, Clifford Leen, Christoph Wyen, M Kundro, N Dedes, Emily D. Williams, Joel E. Gallant, David Thorpe, Helena Díaz-Cuervo, Vani Vannappagari, H Garges, Alain Volny‐Anne, N Dedes, Luís Mendão, Emily D. Williams, David Raben, Lars Peters, Lene Ryom, Bastian Neesgaard, Jens Fromholt Larsen, Marie Louise Jakobsen, T Bruun, Anders Bojesen, E V Hansen, T W Elsing, Daniel Tuyet Kristensen, Simon Francis Thomsen, T Weide, Amanda Mocroft, Lauren Greenberg, Amanda Mocroft, Lauren Greenberg, Loveleen Bansi‐Matharu, Annegret Pelchen‐Matthews, Kathy Petoumenos, Norman Rose, D Byonanebye,

HIV/AIDS Research and Interventions

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.