Evolution in Real-World Therapeutic Strategies for HIV Treatment: A Retrospective Study in Southern Italy, 2014–2020

Changes in HIV treatment guidelines over the last two decades reflect the evolving challenges in this field. Our study examined treatment change patterns throughout a 7-year period in a large Italian cohort of HIV patients as well as the reasons and direction of changes. Treatment-naïve and -experienced HIV patients managed by Cotugno Hospital of Naples between 2014 and 2020 were analyzed. During the period, the proportion of single-tablet regimen treatment sharply increased for the naïve and experienced patients. Regimens containing integrase strand transfer inhibitors rapidly replaced those containing protease inhibitor and non-nucleoside reverse transcriptase inhibitors. The use of the tenofovir alafenamide fumarate/emtricitabine backbone increased rapidly after its introduction in the Italian pharmaceutical market, making up 63.7 and 54.9% of all treatments in naïve and experienced patients, respectively, in 2020. The main reason for treatment changes was optimization and/or simplification (90.6% in 2018; 85.3% in 2019; 95.5 in 2020) followed by adverse effects and virological failure. Our real-world analysis revealed that the majority of treatment-naïve and treatment-experienced patients received antiretroviral drugs listed as preferred/recommended in current recommendations. Regimen optimization and/or simplification is a leading cause of treatment modification, while virologic failure or adverse effects are less likely reasons for modification in the current treatment landscape.

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Trends and factors associated with modification or discontinuation of the initial antiretroviral regimen during the first year of treatment in the Turkish HIV-TR Cohort, 2011–2017

AIDS Research and Therapy ◽

10.1186/s12981-020-00328-6 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Volkan Korten ◽

◽

Deniz Gökengin ◽

Gülhan Eren ◽

Taner Yıldırmak ◽

...

Keyword(s):

Proportional Hazards ◽

Virologic Failure ◽

Risk Function ◽

Transcriptase Inhibitor ◽

Cox Proportional Hazards ◽

Antiretroviral Drugs ◽

Competing Risk ◽

First Year ◽

Strand Transfer ◽

Factors Associated

Abstract Background There is limited evidence on the modification or stopping of antiretroviral therapy (ART) regimens, including novel antiretroviral drugs. The aim of this study was to evaluate the discontinuation of first ART before and after the availability of better tolerated and less complex regimens by comparing the frequency, reasons and associations with patient characteristics. Methods A total of 3019 ART-naive patients registered in the HIV-TR cohort who started ART between Jan 2011 and Feb 2017 were studied. Only the first modification within the first year of treatment for each patient was included in the analyses. Reasons were classified as listed in the coded form in the web-based database. Cumulative incidences were analysed using competing risk function and factors associated with discontinuation of the ART regimen were examined using Cox proportional hazards models and Fine-Gray competing risk regression models. Results The initial ART regimen was discontinued in 351 out of 3019 eligible patients (11.6%) within the first year. The main reason for discontinuation was intolerance/toxicity (45.0%), followed by treatment simplification (9.7%), patient willingness (7.4%), poor compliance (7.1%), prevention of future toxicities (6.0%), virologic failure (5.4%), and provider preference (5.4%). Non-nucleoside reverse transcriptase inhibitor (NNRTI)-based (aHR = 4.4, [95% CI 3.0–6.4]; p < 0.0001) or protease inhibitor (PI)-based regimens (aHR = 4.3, [95% CI 3.1–6.0]; p < 0.0001) relative to integrase strand transfer inhibitor (InSTI)-based regimens were significantly associated with ART discontinuation. ART initiated at a later period (2015-Feb 2017) (aHR = 0.6, [95% CI 0.4–0.9]; p < 0.0001) was less likely to be discontinued. A lower rate of treatment discontinuation for intolerance/toxicity was observed with InSTI-based regimens (2.0%) than with NNRTI- (6.6%) and PI-based regimens (7.5%) (p < 0.001). The percentage of patients who achieved HIV RNA < 200 copies/mL within 12 months of ART initiation was 91% in the ART discontinued group vs. 94% in the continued group (p > 0.05). Conclusion ART discontinuation due to intolerance/toxicity and virologic failure decreased over time. InSTI-based regimens were less likely to be discontinued than PI- and NNRTI-based ART.

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Hematologic Abnormalities in Treatment-naïve HIV Patients

Infectious Diseases Research and Treatment ◽

10.4137/idrt.s6033 ◽

2010 ◽

Vol 3 ◽

pp. IDRT.S6033 ◽

Cited By ~ 2

Author(s):

Akinsegun Akinbami ◽

Olajumoke Oshinaike ◽

Titilope Adeyemo ◽

Adewunmi Adediran ◽

Owolabi Dosunmu ◽

...

Keyword(s):

Blood Count ◽

Demographic Data ◽

Cross Sectional Study ◽

Hiv Treatment ◽

University Teaching ◽

Full Blood Count ◽

Hiv Patients ◽

Cross Sectional ◽

Treatment Naïve ◽

Pre Treatment

Objectives Hematologic abnormalities, indicated by a deranged full blood count, are common manifestations and important prognostic tools for human immunodeficiency virus (HIV) infection and AIDS. This study aimed to determine the prevalence of cytopenia and its relationship to the degree of immunosupression in HIV treatment-naïve patients. Methods This was a cross-sectional study of treatment-naïve HIV-infected clients who enrolled at the HIV clinic of Lagos State University Teaching Hospital (LASUTH) between December 2009 and June 2010. Participants had samples taken for full blood count and CD4 counts, which are free routine pre-requisite and pre-treatment evaluations done for all registered HIV patients at LASUTH. They were asked to fill the structured questionnaires to obtain demographic data, with assistance if necessary. Results A total of 205 cases were reviewed: 24.2% had anemia (PCV < 30%), 26.8% had leucopenia (white blood cell <4,000/L) and 16.1% had thrombocytopenia (platelet count <150,000/L) at enrollment. The degree of cytopenia was directly related to the degree of immunosupression. Conclusion About one-fifth of HIV treatment-naïve patients were cytopenic at enrollment and the degree of cytopenia was directly related to the degree of immunosupression. It is necessary to investigate various causes of cytopenia in these patients so as to administer a specific intervention.

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Adoption of evidence-informed guidelines in prescribing protease inhibitors for HIV-Tuberculosis co-infected patients on rifampicin and effects on HIV treatment outcomes in Uganda

BMC Infectious Diseases ◽

10.1186/s12879-021-06533-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Frank Mulindwa ◽

Barbara Castelnuovo ◽

Bruce Kirenga ◽

Dennis Kalibbala ◽

Priscilla Haguma ◽

...

Keyword(s):

Treatment Outcomes ◽

Protease Inhibitors ◽

Virologic Failure ◽

Standard Dose ◽

Hiv Treatment ◽

Hiv Patients ◽

Tb Treatment ◽

One Year ◽

Hiv Treatment Outcomes ◽

Clinical Records

Abstract Background We aimed to determine how emerging evidence over the past decade informed how Ugandan HIV clinicians prescribed protease inhibitors (PIs) in HIV patients on rifampicin-based tuberculosis (TB) treatment and how this affected HIV treatment outcomes. Methods We reviewed clinical records of HIV patients aged 13 years and above, treated with rifampicin-based TB treatment while on PIs between1st—January -2013 and 30th—September—2018 from twelve public HIV clinics in Uganda. Appropriate PI prescription during rifampicin-based TB treatment was defined as; prescribing doubled dose lopinavir/ritonavir- (LPV/r 800/200 mg twice daily) and inappropriate PI prescription as prescribing standard dose LPV/r or atazanavir/ritonavir (ATV/r). Results Of the 602 patients who were on both PIs and rifampicin, 103 patients (17.1% (95% CI: 14.3–20.34)) received an appropriate PI prescription. There were no significant differences in the two-year mortality (4.8 vs. 5.7%, P = 0.318), loss to follow up (23.8 vs. 18.9%, P = 0.318) and one-year post TB treatment virologic failure rates (31.6 vs. 30.7%, P = 0.471) between patients that had an appropriate PI prescription and those that did not. However, more patients on double dose LPV/r had missed anti-retroviral therapy (ART) days (35.9 vs 21%, P = 0.001). Conclusion We conclude that despite availability of clinical evidence, double dosing LPV/r in patients receiving rifampicin-based TB treatment is low in Uganda’s public HIV clinics but this does not seem to affect patient survival and viral suppression.

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Computational models as predictors of HIV treatment outcomes for the Phidisa cohort in South Africa

Southern African Journal of HIV Medicine ◽

10.4102/sajhivmed.v17i1.450 ◽

2016 ◽

Vol 17 (1) ◽

Cited By ~ 3

Author(s):

Andrew Revell ◽

Paul Khabo ◽

Lotty Ledwaba ◽

Sean Emery ◽

Dechao Wang ◽

...

Keyword(s):

Viral Load ◽

Computational Models ◽

Predictive Accuracy ◽

Characteristic Curve ◽

Antiretroviral Drugs ◽

Hiv Treatment ◽

Response To Therapy ◽

Treatment Change ◽

Global Test

Background: Selecting the optimal combination of HIV drugs for an individual in resourcelimited settings is challenging because of the limited availability of drugs and genotyping.Objective: The evaluation as a potential treatment support tool of computational models that predict response to therapy without a genotype, using cases from the Phidisa cohort in South Africa.Methods: Cases from Phidisa of treatment change following failure were identified that had the following data available: baseline CD4 count and viral load, details of failing and previous antiretroviral drugs, drugs in new regimen and time to follow-up. The HIV Resistance Response Database Initiative’s (RDI’s) models used these data to predict the probability of a viral load < 50 copies/mL at follow-up. The models were also used to identify effective alternative combinations of three locally available drugs.Results: The models achieved accuracy (area under the receiver–operator characteristic curve) of 0.72 when predicting response to therapy, which is less accurate than for an independent global test set (0.80) but at least comparable to that of genotyping with rules-based interpretation. The models were able to identify alternative locally available three-drug regimens that were predicted to be effective in 69% of all cases and 62% of those whose new treatment failed in the clinic.Conclusion: The predictive accuracy of the models for these South African patients together with the results of previous studies suggest that the RDI’s models have the potential to optimise treatment selection and reduce virological failure in different patient populations, without the use of a genotype.Keywords: HIV therapy; mathematical modelling; treatment; genotype

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A Review on Pharmacokinetics properties of antiretroviral drugs to treat HIV-1 infections

Current Computer - Aided Drug Design ◽

10.2174/1573409916666201006143007 ◽

2020 ◽

Vol 16 ◽

Author(s):

Sanjeev Kumar Singh ◽

Mohd. Aqueel Khan ◽

Krishna Kant Gupta

Keyword(s):

Reverse Transcriptase ◽

Antiretroviral Drugs ◽

Hiv Treatment ◽

Strand Transfer ◽

Reverse Transcriptase Inhibitors ◽

Hiv Replication ◽

Health Crisis ◽

Pharmacokinetic Properties ◽

Approved Drugs ◽

Hiv 1

Background: The HIV-1 pandemic is undoubtedly the major public-health crisis of our time. The extensive research on HIV has deepened our understanding of its pathogenesis and transmission dynamics. Some new entity molecules have been approved by the FDA for HIV treatment but till now protective vaccine remains elusive. Scientists are targeting many important proteins of HIV-1; gp41, gp120, CCR5 coreceptor, integrase, reverse transcriptase and protease. Few compounds are used as nucleotide analogues to stop HIV replication. Altogether, these compounds and their derivatives specifically block HIV entry and DNA replication. Using ADMET studies, people are working on these compounds to reduce toxicity and increase potency. Objective: Our main aim is to discuss the Pharmacokinetics properties of 23 important FDA antiretroviral drugs used for the treatment of HIV-1 infections. Methods: We have searched literature related to pharmacokinetics properties in PubMed, Google Scholar search engine. Conclusion: Here, we have reviewed the pharmacokinetic properties such as absorption, bioavailability, distribution, metabolism, and excretion, of important 23 FDA approved drugs. The drugs namely Fuzeon, Selzentry, Complera, Epivir, Retrovir, Emtriva, Ziagen, Edurant, Intelence, Pifeltro, Sustiva, Viramune, Isentress, Genvoya, Tivicay, Reyataz, Prezista, Lexiva, Invirase, Aptivus etc. are classified into five major classes: fusion inhibitors, Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTIs), Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs), Integrase Strand transfer inhibitors (INSTIs) and Protease inhibitors (PIs). This Review may helpful for the future development of potent antiretroviral drugs with improved pharmacokinetic properties.

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301. Risk of Virologic Failure with Antiretroviral Switches in HIV/HCV Co-infections

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.2506 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S162-S162

Author(s):

Diana M Mosquera ◽

Julius Wilder ◽

Alicia Ellis ◽

Susanna Naggie

Keyword(s):

Treatment Failure ◽

Virologic Failure ◽

Sustained Viral Response ◽

Composite Endpoint ◽

Hiv Treatment ◽

Transmission Risk ◽

Research Network ◽

Strand Transfer ◽

Hcv Transmission ◽

Switch Group

Abstract Background Direct-acting antivirals (DAA) and antiretroviral (ARV) medications pose treatment challenges in HIV/HCV co-infection. Management of contraindicated combinations varies across practices. ARV switches may increase the risk of HIV virologic and treatment failure, and has been reported to increase the risk of DAA treatment failure. This analysis assesses how switches in ARV regimen impacts treatment outcomes in HIV/HCV co-infection. Methods This retrospective cohort study includes patients 18 years and older with stable HIV/HCV co-infection (HIV RNA<50 for ≥6 months) who received DAA HCV therapy. Data were obtained using the Centers for AIDS Research Network of Integrated Clinical Systems. The “ARV switch” cohort is defined as patients undergoing a switch in ARV regimen within 6 months prior to DAA treatment. The “no ARV switch” cohort was defined as patients without a change in ARV during the same time period. The primary outcome is HIV treatment failure which is a composite endpoint including HIV virologic failure (defined as confirmed loss of HIV viral suppression), discontinuation/change of ARV regimen, progression to AIDS, or death. We compared baseline characteristics, the proportion of patients free of HIV treatment failure, free of HIV virologic failure, and that achieved sustained viral response (SVR) at 12 and 24 weeks after DAA treatment among ARV switch and no ARV switch groups. Results Of the 256 patients, 63/256 (25%) underwent an ARV switch (Table 1). At baseline, the most common regimen in the ARV switch group was protease inhibitor (PI)-based while for the no ARV switch group, it was an integrase strand transfer inhibitor (INSTI)-based regimen. HIV/HCV transmission risk factors, HCV genotype, and AST/ALT were similar among the two groups (Table 1). The proportion with HIV treatment and virologic failure, and the proportion achieving SVR12/24 were similar among the ARV switch and no ARV switch groups. Conclusion HIV treatment and virologic failure, and SVR12/24 were not different among patients who did or did not undergo a switch in their ARV regimen prior to DAA treatment. This suggests that switches in the ARV regimen for DAA treatment of HCV do not negatively impact HIV or HCV outcomes among patients with HIV/HCV Coinfection. Disclosures All authors: No reported disclosures.

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Antiretroviral Therapy Prescribing Practices and Virologic Response in HIV-Infected Individuals with the M184V Mutation: Results from the 550 Clinic Cohort Study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.1068 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S424-S424

Author(s):

Lauren Kirkpatrick ◽

Paula Peyrani ◽

Anupama Raghuram ◽

Cathy Spencer ◽

Mary Bishop ◽

...

Keyword(s):

Treatment Guidelines ◽

Retrospective Chart Review ◽

Drug Regimen ◽

Virologic Response ◽

Hiv Treatment ◽

Strand Transfer ◽

Resistance Mutations ◽

Prescribing Practices ◽

Chi Square ◽

M184v Mutation

Abstract Background Human immunodeficiency virus (HIV) treatment guidelines recommend using a regimen that contains three fully active antiretroviral agents in patients with drug resistance mutations. However, some evidence suggests that protease inhibitor (PI) based regimens containing less than three fully active drugs may be as efficacious in achieving viral suppression (VS) as a three-drug regimen in the presence of a M184V mutation. The purpose of this study was to identify current prescribing practices and determine if VS can be achieved with regimens containing less than three fully active agents in patients with a M184V mutation. Methods A single-center retrospective chart review was conducted on patients receiving treatment at the 550 Clinic from January 2003 to July 2016. Patients were screened for a M184V mutation. Patients were excluded for lack of a genotype and inadequate documentation of viral load (VL) prior to initiating or changing therapy. Regimens were characterized as containing three fully active agents or less and evaluated for VS success (VL less than 200 copies/mL). Data was analyzed using descriptive statistics, Chi-square tests, and Fischer’s exact tests. Results A M184V mutation was identified in 100 of the 754 patients screened for inclusion. 90% of the 167 regimens evaluated contained less than three fully active drugs. PI-based regimens (n = 86) and integrase strand transfer inhibitor (INSTI)-based regimens (n = 25) were the most commonly prescribed regimens containing less than three fully active drugs. VS was achieved with 72% of regimens containing less than three fully active agents compared with 69% of those containing three fully active agents (P = 0.108). In patients with a baseline VL greater than 100,000 copies/mL, VS was achieved with 80% of INSTI-based regimens compared with 21% of PI-based regimens (P = 0.040). VS was achieved with 85% of INSTI-based regimens and 78% of PI-based regimens in those with a baseline VL less than 100,000 copies/mL (P = 0.513). Conclusion Regimens containing less than three fully active drugs may be as efficacious as regimens containing three fully active drugs in those with a M184V mutation. In those with a high baseline VL, INSTI-based regimens may have better efficacy compared with PI-based regimens. Disclosures All authors: No reported disclosures.

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Dual Antiretroviral Therapy—All Quiet Beneath the Surface?

Frontiers in Immunology ◽

10.3389/fimmu.2021.637910 ◽

2021 ◽

Vol 12 ◽

Author(s):

Berend J. van Welzen ◽

Patrick G. A. Oomen ◽

Andy I. M. Hoepelman

Keyword(s):

Antiretroviral Therapy ◽

Bone Disease ◽

Immune Activation ◽

Opportunistic Infections ◽

Treatment Guidelines ◽

Dual Therapy ◽

Antiretroviral Drugs ◽

Hiv Treatment ◽

Drug Induced ◽

Virological Outcomes

Infection with the human immunodeficiency virus (HIV) is characterized by progressive depletion of CD4+ lymphocytes cells as a result of chronic immune activation. Next to the decreases in the number of CD4+ cells which leads to opportunistic infections, HIV-related immune activation is associated with several prevalent comorbidities in the HIV-positive population such as cardiovascular and bone disease. Traditionally, combination antiretroviral therapy (cART) consists of three drugs with activity against HIV and is highly effective in diminishing the degree of immune activation. Over the years, questions were raised whether virological suppression could also be achieved with fewer antiretroviral drugs, i.e., dual- or even monotherapy. This is an intriguing question considering the fact that antiretroviral drugs should be used lifelong and their use could also induce cardiovascular and bone disease. Therefore, the equilibrium between drug-induced toxicity and immune activation related comorbidity is delicate. Recently, two large clinical trials evaluating two-drug cART showed non-inferiority with respect to virological outcomes when compared to triple-drug regimens. This led to adoption of dual antiretroviral therapy in current HIV treatment guidelines. However, it is largely unknown whether dual therapy is also able to suppress immune activation to the same degree as triple therapy. This poses a risk for an imbalance in the delicate equilibrium. This mini review gives an overview of the current available evidence concerning immune activation in the setting of cART with less than three antiretroviral drugs.

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Impact of the US Food and Drug Administration registration of antiretroviral drugs on global access to HIV treatment

BMJ Global Health ◽

10.1136/bmjgh-2017-000651 ◽

2018 ◽

Vol 3 (3) ◽

pp. e000651 ◽

Cited By ~ 3

Author(s):

Harinder Singh Chahal ◽

Peter Capella ◽

Ryan Presto ◽

Jeffrey S Murray ◽

Martin Shimer ◽

...

Keyword(s):

Global Fund ◽

Treatment Guidelines ◽

Treatment Options ◽

Cross Sectional Study ◽

Antiretroviral Drugs ◽

Hiv Treatment ◽

Emergency Plan ◽

Cross Sectional ◽

The Us ◽

Drug Review

BackgroundSince 2004, the US Food and Drug Administration’s (USFDA) dedicated drug review process in support of President’s Emergency Plan for AIDS Relief (PEPFAR) has made safe, effective and quality antiretrovirals (ARVs) available for millions of patients. Furthermore, the WHO and Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) can add the USFDA-reviewed products to their respective formularies, through a novel process of ‘one-way reliance’. We assessed the number of ARVs made available through WHO and Global Fund based on the USFDA review.MethodsWe conducted a cross-sectional study of all the USFDA-reviewed PEPFAR drugs between 1 December 2014 and 20 March 2017 to determine 1) the percentage that are included on the WHO and Global Fund formularies; 2) the number of the USFDA ARVs supporting the WHO HIV treatment guidelines, and their uptake by WHO and Global Fund and 3) time between the USFDA review and WHO review of the same ARVs.FindingsOverall, 91% (204/224) of the USFDA products appeared on either the WHO/Prequalification of Medicines Programme (PQP) or the Global Fund ARV lists. Forty-five per cent (100/224) and 83% (184/224) appear on WHO/PQP and Global Fund formularies through one-way reliance, respectively. Forty-one per cent (91/224) of the USFDA products support the WHO-preferred first-line HIV treatment options. Of these 91 products, 38% and 85% of products were adopted by WHO/PQP and Global Fund through one-way reliance, respectively. Sixty-six products that were fully reviewed and registered by WHO (vs one-way reliance) had also undergone the USFDA review; 46 of these were registered by WHO after the USFDA review was complete (median delay of 559 days (IQR 233–798 days)).ConclusionsThe USFDA’s PEPFAR process is making safe and effective ARVs available worldwide, in part because the major global ARV procurement organisations rely on the USFDA registration as proof of quality. There is room for improved information sharing and collaboration to reduce duplication of effort, save resources and further expedite access to ARVs.

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Integrase Inhibitor-Based Antiretroviral Therapy Among Women Living with HIV: Data from the OPERA Cohort

Current HIV Research ◽

10.2174/1570162x17666190927161537 ◽

2019 ◽

Vol 17 (4) ◽

pp. 266-276

Author(s):

Jennifer Fusco ◽

Cassidy Henegar ◽

Evelyn Byrd Quinlivan ◽

Vani Vannappagari ◽

Michael Aboud ◽

...

Keyword(s):

Antiretroviral Therapy ◽

Cox Regression ◽

Integrase Inhibitor ◽

Virologic Response ◽

Hiv Treatment ◽

Strand Transfer ◽

Women Living With Hiv ◽

Treatment Naïve ◽

Hiv Women ◽

Living With Hiv

Background: Women face unique complexities in HIV treatment yet are underrepresented in antiretroviral therapy (ART) studies. Objective: This analysis assessed the one-year durability of the first integrase strand transfer inhibitor (INSTI)-based regimens prescribed to women in a large cohort of patients living with HIV in care. Methods: Women with HIV who initiated their first INSTI-containing regimen between 08/12/2013 and 11/30/2015 were identified in the OPERA cohort, a collaboration of 79 US outpatient clinics. Discontinuation within the first year of treatment with an INSTI was compared between dolutegravir (DTG), raltegravir (RAL) and elvitegravir (EVG), using multivariable Cox regression and Kaplan- Meier estimates. Virologic response and regimen modifications were described and compared across INSTIs. Results: A total of 537 treatment-naïve (DTG: 39%, EVG: 48%, RAL: 13%) and 878 treatmentexperienced (DTG: 57%, EVG: 29%, RAL: 13%) women were analyzed. In the first twelve months after initiation, women taking EVG or RAL were more likely to discontinue their initial INSTI than those taking DTG among both treatment-naïve (adjusted hazard ratio EVG vs. DTG: 1.59 (95% CI: 1.09, 2.39); RAL vs. DTG: 2.46 (1.49, 4.05)) and treatment-experienced women (EVG vs. DTG: 1.39 (1.02, 1.88); RAL vs. DTG: 2.17 (1.51, 3.12)). Following discontinuation of the initial INSTI, women commonly switched to a regimen containing a different drug from the INSTI class (treatment-naïve DTG: 34%, RAL: 33% EVG: 41%; treatment-experienced DTG: 23%, RAL: 19% EVG: 41%). Conclusion: In treatment-naïve and treatment-experienced women living with HIV, women taking DTG had the lowest risk for early (≤1 year) discontinuation.

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