TY - JOUR
T1 - Recent Trends and Effectiveness of Antiretroviral Regimens among Men Who Have Sex with Men Living with HIV in the United States
T2 - The Multicenter AIDS Cohort Study (MACS) 2008-2017
AU - Li, Xiuhong
AU - Brown, Todd T.
AU - Ho, Kenneth S.
AU - Witt, Mallory D.
AU - Phair, John
AU - Jacobson, Lisa P.
N1 - Funding Information:
Data in this manuscript were collected by the Multicenter AIDS Cohort Study (MACS). MACS (Principal Investigators): Johns Hopkins University Bloomberg School of Public Health (Joseph Margolick, Todd Brown), U01-AI35042; Northwestern University (Steven Wolinsky), U01-AI35039; University of California, Los Angeles (Roger Detels, Otoniel Martinez-Maza, Otto Yang), U01-AI35040; University of Pittsburgh (Charles Rinaldo, Lawrence Kingsley, Jeremy Martinson), U01-AI35041; the Center for Analysis and Management of MACS, Johns Hopkins University Bloomberg School of Public Health (Lisa Jacobson, Gypsyamber D’Souza), UM1-AI35043. The MACS is funded primarily by the National Institute of Allergy and Infectious Diseases, with additional cofunding from the National Cancer Institute, the National Institute on Drug Abuse, and the National Institute of Mental Health. Targeted supplemental funding for specific projects also was provided by the National Heart, Lung, and Blood Institute and the National Institute on Deafness and Communication Disorders. MACS data collection is supported also by UL1-TR001079 (JHU Institute for Clinical and Translational Research [ICTR]) from the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health (NIH), and the NIH Roadmap for Medical Research. The contents of this publication are solely the responsibility of the authors and do not represent the official views of the NIH, JHU ICTR, or NCATS. The MACS website is located at http://aidscohortstudy.org/.
Funding Information:
Financial support. This work was supported by the National Institute of Allergy and Infectious Diseases at the National Institutes of Health (NIH), with additional cofunding from the National Cancer Institute, the National Institute on Drug Abuse, and the National Institute of Mental Health (grant numbers U01-AI35042, U01-AI35039, U01-AI35040, U01-AI35041, and UM1-AI35043). Targeted supplemental funding for specific projects also was provided by the National Heart, Lung, and Blood Institute, and the National Institute on Deafness and Communication Disorders. MACS data collection is supported by UL1-TR001079 (Johns Hopkins Institute for Clinical and Translational Research) from the National Center for Advancing Translational Sciences, a component of the NIH, and the NIH Roadmap for Medical Research. It was also supported by a CTSI grant at LA Biomed Harbor-UCLA (UL1TR000124).
Funding Information:
This work was supported by the National Institute of Allergy and Infectious Diseases at the National Institutes of Health (NIH), with additional cofunding from the National Cancer Institute, the National Institute on Drug Abuse, and the National Institute of Mental Health (grant numbers U01-AI35042, U01-AI35039, U01-AI35040, U01-AI35041, and UM1-AI35043). Targeted supplemental funding for specific projects also was provided by the National Heart, Lung, and Blood Institute, and the National Institute on Deafness and Communication Disorders. MACS data collection is supported by UL1-TR001079 (Johns Hopkins Institute for Clinical and Translational Research) from the National Center for Advancing Translational Sciences, a component of the NIH, and the NIH Roadmap for Medical Research. It was also supported by a CTSI grant at LA Biomed Harbor-UCLA (UL1TR000124).
Publisher Copyright:
© 2019 The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America.
PY - 2019/10/5
Y1 - 2019/10/5
N2 - Objective: We evaluated trends and population effectiveness (tolerability, HIV suppression) of current combination antiretroviral therapy (cART) regimens mindful of treatment guidelines. Method: Trend analyses included 18 017 person-visits (1457 men) on cART during 2008-2017 in the Multicenter AIDS Cohort Study. Effectiveness analyses of current regimens used 3598 person-visit-pairs (745 men) on cART in 2014-2017. Inverse-probability-of-treatment-and-censoring weighted Poisson regression with robust variances was used to evaluate the association between regimens and switching, adherence and HIV RNA <20 copies/mL. Results: Integrase strand transfer inhibitor (INSTI)-based regimen usage has increased since 2008. Almost 90% of cART initiators started with INSTI-cART in 2016-2017; cART adherence was stable around 90% and 83%-85% suppressed virus (<20 cp/mL). Commonly used regimens in 2014-2017 contained disoproxil fumarate/emtricitabine (TDF/FTC) backbone with efavirenz (EFV, n = 1161 person-visits), elvitegravir/cobicistat (EVG/c, n = 551), rilpivirine (RPV, n = 492), darunavir/ritonavir (DRV/r, n = 351), or atazanavir (ATV)/r (n = 333). Others were dolutegravir/abacavir/lamivudine (DTG/ABC/3TC, n = 401) and EVG/c/tenofovir alafenamide/FTC (EVG/c/TAF/FTC, n = 309). Compared to EFV/TDF/FTC users, ATV/r+TDF/FTC users switched more (rate ratio [RR] = 1.80, 95% confidence interval (CI), 1.17-2.76), while those on DTG/ABC/3TC (RR [95% CI] = 0.16 [0.08-0.31]) or EVG/c/TAF/FTC (RR [95% CI] = 0.12 [0.06-0.27]) switched less. The rate of suppressed HIV RNA was 15% (95% CI, 2%-26%) lower among younger EVG/c/TDF/FTC users and 18% (95% CI, 3%-34%) higher in older DRV/r+TDF/FTC users; adherence did not differ by regimen. Conclusions: Consistent with guidelines, recent cART initiators started with INSTI-cART, which was associated with less switching early after initiation. Factors beyond those studied here, such as need for salvage therapy, unique personal characteristics, drug interactions, and cost may influence treatment decisions.
AB - Objective: We evaluated trends and population effectiveness (tolerability, HIV suppression) of current combination antiretroviral therapy (cART) regimens mindful of treatment guidelines. Method: Trend analyses included 18 017 person-visits (1457 men) on cART during 2008-2017 in the Multicenter AIDS Cohort Study. Effectiveness analyses of current regimens used 3598 person-visit-pairs (745 men) on cART in 2014-2017. Inverse-probability-of-treatment-and-censoring weighted Poisson regression with robust variances was used to evaluate the association between regimens and switching, adherence and HIV RNA <20 copies/mL. Results: Integrase strand transfer inhibitor (INSTI)-based regimen usage has increased since 2008. Almost 90% of cART initiators started with INSTI-cART in 2016-2017; cART adherence was stable around 90% and 83%-85% suppressed virus (<20 cp/mL). Commonly used regimens in 2014-2017 contained disoproxil fumarate/emtricitabine (TDF/FTC) backbone with efavirenz (EFV, n = 1161 person-visits), elvitegravir/cobicistat (EVG/c, n = 551), rilpivirine (RPV, n = 492), darunavir/ritonavir (DRV/r, n = 351), or atazanavir (ATV)/r (n = 333). Others were dolutegravir/abacavir/lamivudine (DTG/ABC/3TC, n = 401) and EVG/c/tenofovir alafenamide/FTC (EVG/c/TAF/FTC, n = 309). Compared to EFV/TDF/FTC users, ATV/r+TDF/FTC users switched more (rate ratio [RR] = 1.80, 95% confidence interval (CI), 1.17-2.76), while those on DTG/ABC/3TC (RR [95% CI] = 0.16 [0.08-0.31]) or EVG/c/TAF/FTC (RR [95% CI] = 0.12 [0.06-0.27]) switched less. The rate of suppressed HIV RNA was 15% (95% CI, 2%-26%) lower among younger EVG/c/TDF/FTC users and 18% (95% CI, 3%-34%) higher in older DRV/r+TDF/FTC users; adherence did not differ by regimen. Conclusions: Consistent with guidelines, recent cART initiators started with INSTI-cART, which was associated with less switching early after initiation. Factors beyond those studied here, such as need for salvage therapy, unique personal characteristics, drug interactions, and cost may influence treatment decisions.
KW - IPTC weighted model
KW - cART
KW - effectiveness
KW - guidelines
KW - trend
UR - http://www.scopus.com/inward/record.url?scp=85073566074&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85073566074&partnerID=8YFLogxK
U2 - 10.1093/ofid/ofz333
DO - 10.1093/ofid/ofz333
M3 - Article
C2 - 31660409
AN - SCOPUS:85073566074
SN - 2328-8957
VL - 6
JO - Open Forum Infectious Diseases
JF - Open Forum Infectious Diseases
IS - 9
M1 - ofz333
ER -
