Program Schedule

1555
Factors Associated with the Selection of Initial Antiretroviral Therapy: Real-world Channeling

Session: Poster Abstract Session: HIV Treatment: Outcomes, Adherence, and Toxicities
Saturday, October 11, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Background:

Over the last decade antiretroviral (ARV) regimens have become more effective and better tolerated yielding many options for use in first line therapy.  Using data from the CNICS cohort, we explored factors associated with selection of the class of initial ARV regimen.

Methods: CNICS is a network of 8 HIV clinics situated at academic centers in the US. We classified all patients initiating HAART (3 or more drugs) between Jul-2009 and Dec-2012 as NNRTI, boosted-PI (PI/r), or raltegravir (InSTI).  Measured factors suspected of being associated with regimen choice were explored individually and in 3 separate multivariable logistic regression models with regimen classification as the outcome variable. For each model the referent group was all patients whose initial HAART regimen was not in the classification being modeled.

Results: 1215 patients initiated HAART in the observation period. 650 regimens contained an NNRTI, 455 regimens contained a boosted-PI and 110 regimens contained raltegravir. Median age was 38 yrs; 34% Black, 57% White, 9% other; 19% Hispanic; 88% male; 67% MSM; 14% IVDU; 25% VL >100K; 16% HCV infected; and 65% had > 2 co-morbid conditions.

 

Model 1: NNRTI

Model 2:
PI/r

Model 3: InSTI

Age 37-47 vs 19-36

1.0 (0.7-1.3)

0.9 (0.7-1.2)

1.3 (0.8-2.2)

Age 48-75 vs 19-36

1.0 (0.7-1.4)

0.9 (0.6-1.2)

1.4 (0.8-2.4)

Female vs MSM

0.5 (0.3-0.7)

2.1 (1.5-3.0)

1.1 (0.7-2.0)

Heterosexual Male vs MSM

0.9 (0.6-1.3)

1.1 (0.8-1.6)

1.3 (0.8-2.3)

Prior ART Exposure

0.5 (0.2-1.2)

1.3 (0.6-2.9)

1.7 (0.6-4.7)

Liver-HCV Dx

0.6 (0.4-0.9)

1.3 (0.9-1.8)

1.4 (0.8-2.3)

Psych Depression Dx

0.6 (0.5-0.8)

1.5 (1.2-1.9)

1.9 (1.2-3.0)

Cardiovascular/Cerebrovascular Dx

0.9 (0.5-1.6)

0.8 (0.4-1.6)

2.7 (1.2-5.7)

Diabetes Dx

0.9 (0.5-1.6)

0.9 (0.5-1.7)

1.7 (0.8-3.5)

Hypertension Dx

0.9 (0.7-1.2)

1.0 (0.7-1.4)

1.5 (0.9-2.4)

Conclusion: The choice of initial regimen is associated with several demographic and clinical factors, which is sometimes referred to as ‘channeling.’  In this study, patients with underlying psychiatric conditions were less likely to receive an NNRTI, while those with CVD were more likely to receive raltegravir. As more choices for HIV therapy become available, factors that impact initial regimen selection will likely become even more heterogeneous over time.

Michael Saag, MD, FIDSA, Medicine, University of Alabama At Birmingham, Birmingham, AL; University of Alabama At Birmingham, Birmingham, AL, Andy Westfall, Masters of Statistics, University of Alabama at Birmingham, Birmingham, AL, Stephen Cole, PhD, University of North Carolina at Chapel Hill, Chapel Hill, NC, Mari Kitahata, MD, MPH, Medicine, Center for AIDS Research, University of Washington, Seattle, WA, Richard Moore, MD, MHS, Johns Hopkins University School of Medicine, Baltimore, MD, W. Christopher Mathews, MD, MSPH, University of San Diego, San Diego, CA, Elvin Genge, MD, MSPH, University of California at San Francisco, San Francisco, CA, Stephen Boswell, MD, Fenway CommunityHealth Center, Boston, MA, Sonia Napravnik, PhD, University of North Carolina, Chapel Hill, NC, Benigno Rodriguez, MD, Case Western Reserve University/University Hospitals of Cleveland Center for AIDS Research, Cleveland, OH, Richard Haubrich, MD, University of California, San Diego, CA and Eric Maiese, PhD, Merck, Whitehouse Station, NJ

Disclosures:

M. Saag, Merck: Grant Investigator, Research grant
ViiV: Grant Investigator, Research grant
Gilead: Grant Investigator, Research grant
Janssen: Grant Investigator, Research grant
BMS: Grant Investigator, Research grant

A. Westfall, None

S. Cole, None

M. Kitahata, None

R. Moore, None

W. C. Mathews, None

E. Genge, None

S. Boswell, None

S. Napravnik, None

B. Rodriguez, None

R. Haubrich, None

E. Maiese, Merck : Employee, Salary

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