1387. Impact of Tablet Burden and Antiretroviral Therapy (ART) Choice on Virologic Outcomes in Treatment Naive HIV+ Individuals Attending an Inner City Clinic
Session: Poster Abstract Session: HIV: Antiretroviral Therapy
Friday, October 6, 2017
Room: Poster Hall CD
Posters
  • IDWeek poser_final_7626_Impact of tablet burden (Markowitz)_L3-2 (003).pdf (458.6 kB)
  • Background:

    The durability and effectiveness of single tablet regimens (STR) in treating ART naïve patients in real world, inner city settings, has not been well established.

    Methods:

    Data was abstracted from administrative/medical records at Henry Ford Health System, serving metropolitan Detroit, for HIV+ patients initiating ART (1/1/2007-9/30/2015), who were enrolled in the Health Alliance Plan (HAP) or had ≥1 clinician contact per year and ≥1 viral load (VL)/CD4 test result ≤90 days prior to ART initiation. Patients were followed from initiation to first of: change in ART, death, HAP disenrollment, study end (03/31/2016), or lost to follow-up. Cox regression estimated impact of tablet burden on ART regimen duration, achievement of viral suppression (VS) and viral failure - (VF) failure to suppress plasma HIV RNA to <50 copies/mL or rebound after VS.

    Results:

    Among 390 eligible patients, 79% were male, 74% African-American. Median (IQR) age was 37 years (27-47), 49% MSM and 22% presented with AIDS. The majority (65%) initiated on an STR; 35% on multiple tablet regimens (MTR). The majority of STR initiators (63%) began with EFV/FTC/TDF; 24% with EVG/c/FTC/TDF; and 8% with DTG/ABC/3TC. The most frequent MTR were DRV+RTV+TDF/FTC (26%) and ATV+RTV+TDF/FTC (20%). Median (IQR) log10 VL at baseline was 4.8 (4.3-5.2) in STR; 4.8 (4.4-5.4) in MTR cohorts. Median CD4 cells/µL (IQR) was 277 (115-407) in STR; 231 (37-371) in MTR.

    VL suppression occurred in 81% (85% STR, 74% MTR, p< 0.01) of patients and in 91% of INSTI regimens (91% STR, 90% MTR, p=0.757).VF occurred in 19% (15% STR, 25% MTR, p=0.015) and in 10% of INSTI regimens (9% STR, 13% MTR, p=0.459). Resistance occurred in 15% of VF patients, predominantly with NNRTI mutations. A total of 22% of STR and 60% of MTR initiators experienced a change in their initial ART regimen (p<0.0001). Cox model results suggest STR initiators were 59% less likely to experience regimen change (p<0.0001), 46% less likely to experience VF (p<0.05) and 30% more likely to achieve viral suppression (p<0.05) compared with MTR initiators.

    Conclusion:

    Inner city, HIV treatment naïve patients, initiating ART with a STR are significantly more likely to achieve viral suppression and less likely to experience a change in ART regimen.

    Norman Markowitz, MD1, Beni Tidwell, BS2, Lois Lamerato, PhD1, Susan Zelt, DrPH, MBA3, Ronald D'Amico, DO, MSc3 and Kathy Schulman, MA2, (1)Henry Ford Health System, Detroit, MI, (2)Outcomes Research Solutions, Inc., Waltham, MA, (3)ViiV Healthcare, Research Triangle Park, NC

    Disclosures:

    N. Markowitz, None

    B. Tidwell, ViiV Healthcare: Research Contractor , Research support

    L. Lamerato, ViiV Healthcare: Collaborator , Research support

    S. Zelt, ViiV Healthcare: Employee and Shareholder , Salary and Stock

    R. D'Amico, ViiV Healthcare: Employee and Shareholder , Salary and Stock

    K. Schulman, ViiV Healthcare: Research Contractor , Research support

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 4th with the exception of research findings presented at the IDWeek press conferences.