Program Schedule

1568
Use of the Integrase Strand Transfer Inhibitor-Based Antiretroviral Regimen Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Disoproxil Fumarate in a Predominantly African-American HIV Infected Population

Session: Poster Abstract Session: HIV Treatment: Outcomes, Adherence, and Toxicities
Saturday, October 11, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Background: Elvitegravir (EVG) is an integrase strand transfer inhibitor (INSTI) based drug for the treatment of HIV-1 infection, co-formulated with cobicistat (COBI), a CYP3A4 inhibitor, emtricitabine (FTC), and tenofovir disoproxil fumarate (TDF).  The regimen consists of a single tablet, taken once daily.  Two phase 3 clinical trials have established its efficacy and safety.

Methods: A retrospective chart review was conducted in a community HIV clinic for patients receiving treatment with EVG/COBI/FTC/TDF.  Comparison analysis was conducted for African Americans (AA) and non-AA.  Data was abstracted from 225 patient charts (190 AA, 29 non-AA). Six charts did not specify race.   Four charts indicated patients opted not to begin therapy.  Of the remaining 221 patients, there were 145 treatment experienced and 76 treatment naïve.  Data was available for 144 ART experienced patients and 74 treatment naïve patients, and included GFR, HIV-1 RNA viral load, and CD4 cell count at baseline, 2 weeks, 3 and 6 months. 

Results: There was no significant difference between the AA and non-AA groups with regards to GFR and HIV-1 RNA viral load. A higher CD4 cell count in the non AA group (P=0.031, 691.71±373.71 cells per μL vs 491.98±345.55 cells per μL) at the 3 month interval was noted, but was insignificant at 6 months. ART experienced patients who achieved viral suppression prior to initiation of EVG/COBI/FTC/TDF, maintained suppression. Experienced patients, who were not suppressed were able to achieve viral suppression at either the three or six month interval. Viral load suppression was achieved in persons who were treatment na´ve.

Conclusion: EVG/COBI/FTC/TDF is the first INSTI combination regimen approved for the treatment of HIV-1 infection and should be considered a viable treatment option regardless of ethnicity or treatment experience.  This retrospective analysis provides real world data in a predominantly African-American population.  Limitations pertained to patient adherence and difficulty with clinic follow-up. These challenges are inherent in treating a minority population with complicated socioeconomic factors and will be the focus of future quality improvement measures.  However, patients prescribed EVG/COBI/FTC/TDF who were able to continue treatment as recommended, achieved or maintained viral suppression.

Paul Bryant, MD, Internal Medicine, University of Tennessee, Memphis, TN, Malinda Conrad, MSN, FNP-BC, Union University, Jackson, TN, Marye Bernard, DNP, Regional One Health, Memphis, TN and John Norwood, MD, University of Tennessee, Memphis, TN

Disclosures:

P. Bryant, None

M. Conrad, None

M. Bernard, None

J. Norwood, None

Findings in the abstracts are embargoed until 12:01 a.m. EDT, Oct. 8th with the exception of research findings presented at the IDWeek press conferences.

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