Background: Initiation of combined antiretroviral therapy (cART) has markedly increased survival and quality of life in HIV-infected patients. With the advent of new treatment options, including an increasing number of single-tablets, the durability of first-line ART regimes is developing.
Methods: We used data from the prospective multicenter German Clinical Surveillance of HIV Disease (ClinSurv) cohort of the Robert-Koch-Institute. Time to event was calculated as time between initiation of first-line cART and therapy change. We used a Cox model to assess predictors of treatment change one year after starting cART.
Results: We included 6,894 patients who initiated ART between 2005 and 2014. The sample population was predominantly men (79%) with German origin (69.8%), of which 49.6% were reporting sex with men (MSM) as main risk factor. Median age (IQR) was 38 (31-46) years. The most frequently treatment combinations were 2NRTI/PIr (48.1%) and 2NRTI/1NNRTI (42.2%), 2NRTI/1II (5.2%). 22.6% patients changed their first-line treatment within one year. Median (IQR) length between first intake and stop of the regime was 105 (35-214) days, which did not change significantly between 2005 (108; 38-217) and 2014 (128; 74-200) (p= .28). Most common documented causes were side effects of drugs 418 (44.0%) and non-adherence 173 (18.2%). In the Cox model (Fig.1), we identified numerous covariates associated with discontinuation of the first-line regime. A 2NRTI/1NNRTI regime was associated with higher rates (Hazard Ratio (HR) 1.28, 95 % CI 1.06-1.55) and a 2NRTI/1II regime with lower rates (HR 0.34, 95% CI 0.23-0.51) of treatment modification (ref.: 2NRTI/1PIr). The HR increased markedly with the amount of daily-administered tablets from HR 2.15, 95% CI 1.48-3.11 (2-3 tablets) to HR 3.98, 95% CI 2.16-7.31 (10 tablets) (ref.: one tablet). We observed an association with a baseline viral load (VL) of >100 copies/ml (HR 0.65, 95%CI 0.53-0.81) and >100.000 copies/ml (HR 0.68, 95% CI 0.54-0.85) (ref.: VL > 1 Mio. copies/ml).
Conclusion: Our analysis revealed, that side effects of drugs, the number of tablets per day and the VL at baseline are significantly associated with treatment change within the first year. A first line regime with 2NRTI/1II seems to improve the adherence to the initial regime significantly.
M. Platten, None
P. Schommers, None
C. Lehmann, None
L. Dold, None
C. Kollan, None
D. Schmidt, None
B. Gunsenheimer-Bartmeyer, None
J. Vehreschild, None