Methods: Retrospective analysis of treatment-naïve nPHIV youth ages 12-24 followed at 19 US HIV clinical sites in the HIV Research Network from 2006-2014. Cox proportional hazards regression was used to assess time to initial virologic suppression (<400 copies/mL) within the first year. Demographic and clinical factors associated with initiation of 1-pill vs. multi-pill ART and virologic suppression 1 year (± 3months) after initiation were assessed using multivariable logistic regression.
Results: Of 1646 treatment-naïve nPHIV youth, 62% initiated 1-pill ART (72% EFV/TDF/FTC), with increasing proportion yearly (47% in 2006 to 78% in 2014). Male gender (AOR 5.63, 95% CI: 3.63-8.74) and CD4 count >200cells/mm3(AOR 1.79, 95% CI: 1.34-2.37) were independently associated with increased likelihood of 1-pill initiation. Adjusting for other factors (sex, race, baseline CD4 and viral load (VL), adult vs. pediatric site, HIV risk) 1-pill ART was associated with increased likelihood of initial viral suppression within 1 year of initiation compared to multi-pill (HR 1.16, 95% CI: 1.03-1.31). For those with VL data at 9-15 months, adjusting for the same factors, use of 1-pill ART was associated with virologic suppression (AOR 1.80, 95%CI 1.28-2.52). A similar proportion in the 1-pill and multi-pill groups did not have VL data 9-15 months after ART initiation (37% and 39% respectively).
Conclusion: Use of 1-pill ART is associated with greater likelihood of initial virologic suppression as well as sustained suppression 1 year after ART initiation. Over 1/3 of nPHIV youth in both groups had no available VL measurements 1 year after ART initiation, suggesting that a significant proportion are sub-optimally engaged in care. Use of 1-pill ART may improve virologic suppression among youth, however, interventions to sustain engagment in care are critical to ultimately improving overall outcomes in this age group.
R. Rutstein, None
W. C. Mathews, None
R. Beil, None
P. T. Korthuis, None
S. Berry, None
A. E. Nijhawan, Gilead: Investigator , Research support
A. Gaur, None
K. Gebo, None
A. Agwu, None