TY - JOUR
T1 - Clinical Outcomes of 2-Drug Regimens vs 3-Drug Regimens in Antiretroviral Treatment-Experienced People Living With Human Immunodeficiency Virus
AU - Greenberg, Lauren
AU - Ryom, Lene
AU - Neesgaard, Bastian
AU - Wandeler, Gilles
AU - Staub, Therese
AU - Gisinger, Martin
AU - Skoll, Michael
AU - Günthard, Huldrych F.
AU - Scherrer, Alexandra
AU - Mussini, Cristina
AU - Smith, Colette
AU - Johnson, Margaret
AU - De Wit, Stéphane
AU - Necsoi, Coca
AU - Pradier, Christian
AU - Wit, Ferdinand
AU - Lehmann, Clara
AU - d'Arminio Monforte, Antonella
AU - Miró, Jose M.
AU - Castagna, Antonella
AU - Spagnuolo, Vincenzo
AU - Sönnerborg, Anders
AU - Law, Matthew
AU - Hutchinson, Jolie
AU - Chkhartishvili, Nikoloz
AU - Bolokadze, Natalia
AU - Wasmuth, Jan Christian
AU - Stephan, Christoph
AU - Vannappagari, Vani
AU - Rogatto, Felipe
AU - Llibre, Josep M.
AU - Duvivier, Claudine
AU - Hoy, Jennifer
AU - Bloch, Mark
AU - Bucher, Heiner C.
AU - Calmy, Alexandra
AU - Volny Anne, Alain
AU - Pelchen-Matthews, Annegret
AU - Lundgren, Jens D.
AU - Peters, Lars
AU - Bansi-Matharu, Loveleen
AU - Mocroft, Amanda
AU - for the RESPOND (International Cohort Consortium of Infectious Diseases) Study Group
N1 - Publisher Copyright:
© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: [email protected].
Copyright:
This record is sourced from MEDLINE/PubMed, a database of the U.S. National Library of Medicine
PY - 2021/10/1
Y1 - 2021/10/1
N2 - 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.
AB - 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.
KW - 2-drug regimens
KW - antiretroviral treatment
KW - clinical outcomes
KW - dual therapy
KW - HIV
UR - http://www.scopus.com/inward/record.url?scp=85118283290&partnerID=8YFLogxK
U2 - 10.1093/cid/ciaa1878
DO - 10.1093/cid/ciaa1878
M3 - Article
C2 - 33354721
AN - SCOPUS:85118283290
SN - 1058-4838
VL - 73
SP - e2323-e2333
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 7
ER -
