Rossetti, Barbara, Fabbiani, Massimiliano ORCID: 0000-0002-1343-812X, Di Carlo, Domenico, Incardona, Francesca, Abecasis, Ana ORCID: 0000-0002-3903-5265, Gomes, Perpetua ORCID: 0000-0003-3271-8255, Geretti, Anna Maria, Seguin-Devaux, Carole ORCID: 0000-0003-0636-5222, Garcia, Federico, Kaiser, Rolf, Modica, Sara, Shallvari, Adrian, Sonnerborg, Anders and Zazzi, Maurizio (2021). Effectiveness of integrase strand transfer inhibitor-based regimens in HIV-infected treatment-naive individuals: results from a European multi-cohort study. J. Antimicrob. Chemother., 76 (9). S. 2394 - 2400. OXFORD: OXFORD UNIV PRESS. ISSN 1460-2091

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Abstract

Background: INSTIs have become a pillar of first-line ART. Real-world data are needed to assess their effectiveness in routine care. Objectives: We analysed ART-naive patients who started INSTI-based regimens in 2012-19 whose data were collected by INTEGRATE, a European collaborative study including seven national cohorts. Methods: Kaplan-Meier analyses assessed time to virological failure (VF), defined as one viral Load (VL) >= 1000 copies/mL, two consecutive VLs >= 50 copies/mL, or one VL >= 50 copies/mL followed by treatment change after >= 24 weeks of follow-up, and time to INSTIs discontinuation (INSTI-DC) for any reason. Factors associated with VF and INSTI-DC were explored by Logistic regression analysis. Results: Of 2976 regimens started, 1901 (63.9%) contained dolutegravir, 631 (21.2%) elvitegravir and 444 (14.9%) raltegravir. The 1 year estimated probabilities of VF and INSTI-DC were 5.6% (95% CI 4.5-6.7) and 16.2% (95% CI 14.9-17.6), respectively, and were higher for raltegravir versus both elvitegravir and dolutegravir. A baseline VL >= 100 000 copies/mL [adjusted HR (aHR) 2.17, 95% CI 1.55-3.04, P< 0.001] increased the risk of VF, while a pre-treatment CD4 count >= 200 cells/mm(3) reduced the risk (aHR 0.52, 95% CI 0.37-0.74, P< 0.001). Predictors of INSTI-DC included use of raltegravir versus dolutegravir (aHR 3.03, 95% CI 2.34-3.92, P< 0.001), use of >3 drugs versus 3 drugs (aHR 2.73, 95% CI 1.55-4.79, P< 0.001) and starting ART following availability of dolutegravir (aHR 0.64, 95% CI 0.48-0.83, P= 0.001). Major INSTI mutations indicative of transmitted drug resistance occurred in 2/1114 (0.2%) individuals. Conclusions: This large multi-cohort study indicates high effectiveness of elvitegravir- or dolutegravir-based first-line ART in routine practice across Europe.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Rossetti, BarbaraUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Fabbiani, MassimilianoUNSPECIFIEDorcid.org/0000-0002-1343-812XUNSPECIFIED
Di Carlo, DomenicoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Incardona, FrancescaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Abecasis, AnaUNSPECIFIEDorcid.org/0000-0002-3903-5265UNSPECIFIED
Gomes, PerpetuaUNSPECIFIEDorcid.org/0000-0003-3271-8255UNSPECIFIED
Geretti, Anna MariaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Seguin-Devaux, CaroleUNSPECIFIEDorcid.org/0000-0003-0636-5222UNSPECIFIED
Garcia, FedericoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kaiser, RolfUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Modica, SaraUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Shallvari, AdrianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Sonnerborg, AndersUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Zazzi, MaurizioUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-601772
DOI: 10.1093/jac/dkab200
Journal or Publication Title: J. Antimicrob. Chemother.
Volume: 76
Number: 9
Page Range: S. 2394 - 2400
Date: 2021
Publisher: OXFORD UNIV PRESS
Place of Publication: OXFORD
ISSN: 1460-2091
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
ANTIRETROVIRAL THERAPYMultiple languages
Infectious Diseases; Microbiology; Pharmacology & PharmacyMultiple languages
URI: http://kups.ub.uni-koeln.de/id/eprint/60177

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