Treatment modification after starting cART in people living with HIV: retrospective analysis of the German ClinSurv HIV
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ORIGINAL PAPER
Treatment modification after starting cART in people living with HIV: retrospective analysis of the German ClinSurv HIV Cohort 2005–2017 Melanie Stecher1,2 · Philipp Schommers1,2 · Christian Kollan3 · Matthias Stoll4 · Frieder Kuhlendahl5 · Hans‑Jürgen Stellbrink6 · Jan‑Christian Wasmuth7,8 · Christoph Stephan9 · Laura Hamacher1 · Clara Lehmann1,2 · Christoph Boesecke7 · Johannes Bogner10 · Stefan Esser11 · Carlos Fritzsche12 · Annette Haberl9 · Christian Hoffmann13 · Björn Jensen14 · Carolynne Schwarze‑Zander7 · Martin Platten15 · Gerd Fätkenheuer1,2 · Daniel Schmidt3,16 · Barbara Gunsenheimer‑Bartmeyer3 · Jörg Janne Vehreschild1,2,17 · On behalf of the ClinSurv Study Group Received: 25 January 2020 / Accepted: 21 June 2020 © The Author(s) 2020
Abstract Objective Combination antiretroviral therapy (cART) has markedly increased survival and quality of life in people living with HIV. With the advent of new treatment options, including single-tablet regimens, durability and efficacy of first-line cART regimens are evolving. Methods We analyzed data from the prospective multicenter German Clinical Surveillance of HIV Disease (ClinSurv) cohort of the Robert-Koch Institute. Kaplan–Meier and Cox proportional hazards models were run to examine the factors associated with treatment modification. Recovery after treatment initiation was analyzed comparing pre-cART viral load and CD4+ T-cell counts with follow-up data. Results We included 8788 patients who initiated cART between 2005 and 2017. The sample population was predominantly male (n = 7040; 80.1%), of whom 4470 (63.5%) were reporting sex with men as the transmission risk factor. Overall, 4210 (47.9%) patients modified their first-line cART after a median time of 63 months (IQR 59–66). Regimens containing integrase strand transfer inhibitors (INSTI) were associated with significantly lower rates of treatment modification (adjusted hazard ratio 0.44; 95% CI 0.39–0.50) compared to protease inhibitor (PI)-based regimens. We found a decreased durability of first-line cART significantly associated with being female, a low CD4+ T-cell count, cART initiation in the later period (2011–2017), being on a multi-tablet regimen (MTR). Conclusions Drug class and MTRs are significantly associated with treatment modification. INSTI-based regimens showed to be superior compared to PI-based regimens in terms of durability. Keywords HIV · cART · Treatment modification · First-line regimen
Introduction Melanie Stecher and Philipp Schommers contributed equally to this work. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s15010-020-01469-6) contains supplementary material, which is available to authorized users. * Melanie Stecher melanie.stecher@uk‑koeln.de * Jörg Janne Vehreschild joerg.vehreschild@uk‑koeln.de Extended author information available on the last page of the article
Combination antiretroviral therapy (cART) has improved markedly over the past decades. Today, people living with HIV (PLWH) can mostly b
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