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First-line HIV treatment outcomes following the introduction of integrase inhibitors in UK guidelines: a cohort study.

Bouzidi, KEL; Jose, S; Phillips, AN; Pozniak, A; Ustianowski, A; Gompels, M; Winston, A; ... UK CHIC Study, ; + view all (2020) First-line HIV treatment outcomes following the introduction of integrase inhibitors in UK guidelines: a cohort study. AIDS 10.1097/QAD.0000000000002603. (In press). Green open access

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Abstract

OBJECTIVE: To investigate the characteristics and outcomes of people who initiated different antiretroviral therapy (ART) regimens during the era of integrase strand transfer inhibitors (INSTIs). DESIGN: UK-based observational cohort study. METHODS: UK Collaborative HIV Cohort study participants were included if they had started ART between 1 January 2012 and 30 June 2017. Virological failure (VF) was defined as the first of two consecutive plasma HIV RNA > 50 copies/mL, at least six months after starting ART. Follow-up was censored at ART discontinuation, class switch or death. The risk of VF among those on INSTI, protease inhibitor (PI) or nonnucleoside reverse transcriptase inhibitor (NNRTI) regimens was compared using Kaplan-Meier and Cox regression methods. RESULTS: Of 12,585 participants, 45.6% started a NNRTI, 29.0% a PI and 25.4% an INSTI regimen. Over a median follow-up of 20.3 months (interquartile range 7.9-389), 7.5% of participants experienced VF. Compared to those starting an NNRTI regimen, people receiving INSTIs or PIs were more likely to experience VF: INSTI group adjusted hazard ratio [aHR] 1.52, 95% confidence interval [CI] 1.19-1.95, p = 0.0009; PI group aHR 2.70, 95% CI 2.27-3.21, p < 0.0001, likelihood ratio test p < 0.0001. CONCLUSIONS: First-line INSTI regimens were associated with a lower risk of VF than PI regimens but both groups were more likely to experience VF than those initiating treatment with a NNRTI. There is likely to be residual channelling bias resulting from selected use of INSTIs and PIs in specific clinical contexts, including in those with a perceived risk of poor adherence.

Type: Article
Title: First-line HIV treatment outcomes following the introduction of integrase inhibitors in UK guidelines: a cohort study.
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1097/QAD.0000000000002603
Publisher version: https://doi.org/10.1097/QAD.0000000000002603
Language: English
Additional information: This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Keywords: First-line ART; virological failure; INSTI; integrase inhibitors
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology > MRC Clinical Trials Unit at UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health > Infection and Population Health
URI: https://discovery.ucl.ac.uk/id/eprint/10101467
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