Recent Trends and Effectiveness of Antiretroviral Regimens among Men Who Have Sex with Men Living with HIV in the United States: The Multicenter AIDS Cohort Study (MACS) 2008-2017

Xiuhong Li, Todd T. Brown, Kenneth S. Ho, Mallory D. Witt, John Phair, Lisa P. Jacobson

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Article numberofz333
JournalOpen Forum Infectious Diseases
Volume6
Issue number9
DOIs
StatePublished - Oct 5 2019

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Acquired Immunodeficiency Syndrome
Cohort Studies
HIV
Integrases
Confidence Intervals
Therapeutics
Rilpivirine
Lamivudine
efavirenz
Guidelines
RNA
Ritonavir
Salvage Therapy
Fumarates
Drug Costs
Drug Interactions
Viruses
Population

Keywords

  • cART
  • effectiveness
  • guidelines
  • IPTC weighted model
  • trend

ASJC Scopus subject areas

  • Oncology
  • Clinical Neurology

Cite this

@article{5bc811b913d7484fb74afe1254184389,
title = "Recent Trends and Effectiveness of Antiretroviral Regimens among Men Who Have Sex with Men Living with HIV in the United States: The Multicenter AIDS Cohort Study (MACS) 2008-2017",
abstract = "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.",
keywords = "cART, effectiveness, guidelines, IPTC weighted model, trend",
author = "Xiuhong Li and Brown, {Todd T.} and Ho, {Kenneth S.} and Witt, {Mallory D.} and John Phair and Jacobson, {Lisa P.}",
year = "2019",
month = "10",
day = "5",
doi = "10.1093/ofid/ofz333",
language = "English (US)",
volume = "6",
journal = "Open Forum Infectious Diseases",
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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.

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.

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