TY - JOUR

T1 - Clinical Outcomes of 2-Drug Regimens vs 3-Drug Regimens in Antiretroviral Treatment-Experienced People Living With Human Immunodeficiency Virus

AU - Greenberg, Lauren

AU - Ryom, Lene

AU - Neesgaard, Bastian

AU - Wandeler, Gilles

AU - Staub, Therese

AU - Gisinger, Martin

AU - Skoll, Michael

AU - Günthard, Huldrych F.

AU - Scherrer, Alexandra

AU - Mussini, Cristina

AU - Smith, Colette

AU - Johnson, Margaret

AU - De Wit, Stéphane

AU - Necsoi, Coca

AU - Pradier, Christian

AU - Wit, Ferdinand

AU - Lehmann, Clara

AU - d'Arminio Monforte, Antonella

AU - Miró, Jose M.

AU - Castagna, Antonella

AU - Spagnuolo, Vincenzo

AU - Sönnerborg, Anders

AU - Law, Matthew

AU - Hutchinson, Jolie

AU - Chkhartishvili, Nikoloz

AU - Bolokadze, Natalia

AU - Wasmuth, Jan Christian

AU - Stephan, Christoph

AU - Vannappagari, Vani

AU - Rogatto, Felipe

AU - Llibre, Josep M.

AU - Duvivier, Claudine

AU - Hoy, Jennifer

AU - Bloch, Mark

AU - Bucher, Heiner C.

AU - Calmy, Alexandra

AU - Volny Anne, Alain

AU - Pelchen-Matthews, Annegret

AU - Lundgren, Jens D.

AU - Peters, Lars

AU - Bansi-Matharu, Loveleen

AU - Mocroft, Amanda

AU - RESPOND (International Cohort Consortium of Infectious Diseases) Study Group

N1 - Publisher Copyright: © The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

PY - 2021

Y1 - 2021

N2 - BACKGROUND: Limited data exist that compare clinical outcomes of 2-drug regimens (2DRs) and 3-drug regimens (3DRs) in people living with human immunodeficiency virus. METHODS: Antiretroviral treatment-experienced individuals in the International Cohort Consortium of Infectious Diseases (RESPOND) who switched to a new 2DR or 3DR from 1 January 2012-1 October 2018 were included. The incidence of clinical events (AIDS, non-AIDS cancer, cardiovascular disease, end-stage liver and renal disease, death) was compared between regimens using Poisson regression. RESULTS: Of 9791 individuals included, 1088 (11.1%) started 2DRs and 8703 (88.9%) started 3DRs. The most common 2DRs were dolutegravir plus lamivudine (22.8%) and raltegravir plus boosted darunavir (19.8%); the most common 3DR was dolutegravir plus 2 nucleoside reverse transcriptase inhibitors (46.9%). Individuals on 2DRs were older (median, 52.6 years [interquartile range, 46.7-59.0] vs 47.7 [39.7-54.3]), and a higher proportion had ≥1 comorbidity (81.6% vs 73.9%). There were 619 events during 27 159 person-years of follow-up (PYFU): 540 (incidence rate [IR] 22.5/1000 PYFU; 95% confidence interval [CI]: 20.7-24.5) on 3DRs and 79 (30.9/1000 PYFU; 95% CI: 24.8-38.5) on 2DRs. The most common events were death (7.5/1000 PYFU; 95% CI: 6.5-8.6) and non-AIDS cancer (5.8/1000 PYFU; 95% CI: 4.9-6.8). After adjustment for baseline demographic and clinical characteristics, there was a similar incidence of events on both regimen types (2DRs vs 3DRs IR ratio, 0.92; 95% CI: .72-1.19; P = .53). CONCLUSIONS: This is the first large, international cohort to assess clinical outcomes on 2DRs. After accounting for baseline characteristics, there was a similar incidence of events on 2DRs and 3DRs. 2DRs appear to be a viable treatment option with regard to clinical outcomes. Further research on resistance barriers and long-term durability of 2DRs is needed.

AB - BACKGROUND: Limited data exist that compare clinical outcomes of 2-drug regimens (2DRs) and 3-drug regimens (3DRs) in people living with human immunodeficiency virus. METHODS: Antiretroviral treatment-experienced individuals in the International Cohort Consortium of Infectious Diseases (RESPOND) who switched to a new 2DR or 3DR from 1 January 2012-1 October 2018 were included. The incidence of clinical events (AIDS, non-AIDS cancer, cardiovascular disease, end-stage liver and renal disease, death) was compared between regimens using Poisson regression. RESULTS: Of 9791 individuals included, 1088 (11.1%) started 2DRs and 8703 (88.9%) started 3DRs. The most common 2DRs were dolutegravir plus lamivudine (22.8%) and raltegravir plus boosted darunavir (19.8%); the most common 3DR was dolutegravir plus 2 nucleoside reverse transcriptase inhibitors (46.9%). Individuals on 2DRs were older (median, 52.6 years [interquartile range, 46.7-59.0] vs 47.7 [39.7-54.3]), and a higher proportion had ≥1 comorbidity (81.6% vs 73.9%). There were 619 events during 27 159 person-years of follow-up (PYFU): 540 (incidence rate [IR] 22.5/1000 PYFU; 95% confidence interval [CI]: 20.7-24.5) on 3DRs and 79 (30.9/1000 PYFU; 95% CI: 24.8-38.5) on 2DRs. The most common events were death (7.5/1000 PYFU; 95% CI: 6.5-8.6) and non-AIDS cancer (5.8/1000 PYFU; 95% CI: 4.9-6.8). After adjustment for baseline demographic and clinical characteristics, there was a similar incidence of events on both regimen types (2DRs vs 3DRs IR ratio, 0.92; 95% CI: .72-1.19; P = .53). CONCLUSIONS: This is the first large, international cohort to assess clinical outcomes on 2DRs. After accounting for baseline characteristics, there was a similar incidence of events on 2DRs and 3DRs. 2DRs appear to be a viable treatment option with regard to clinical outcomes. Further research on resistance barriers and long-term durability of 2DRs is needed.

KW - 2-drug regimens

KW - antiretroviral treatment

KW - clinical outcomes

KW - dual therapy

KW - HIV

U2 - 10.1093/cid/ciaa1878

DO - 10.1093/cid/ciaa1878

M3 - Journal article

C2 - 33354721

AN - SCOPUS:85118283290

VL - 73

SP - e2323-e2333

JO - Clinical Infectious Diseases

JF - Clinical Infectious Diseases

SN - 1058-4838

IS - 7

ER -