Two‐drug antiretroviral regimens: an assessment of virologic response and durability among treatment‐experienced persons living with HIV in the OPERA® Observational Database

• Published in: Journal of the International AIDS Society Vol. 22; no. 12; pp. e25418 - n/a
• Main Authors: Pierone, Gerald, Henegar, Cassidy, Fusco, Jennifer, Vannappagari, Vani, Aboud, Michael, Ragone, Leigh, Fusco, Gregory
• Format: Journal Article
• Language: English
• Published: Switzerland International AIDS Society 01.12.2019; John Wiley & Sons, Inc; John Wiley and Sons Inc
• Subjects: Acquired immune deficiency syndrome; AIDS; Analysis; Antiretroviral drugs; antiretroviral therapy‐experience; Antiviral agents; ART‐experience; Atazanavir; Biological products industry; Clinical trials; cohort; Comorbidity; Darunavir; Development and progression; Dolutegravir; Dosage and administration; Drug therapy; Drug therapy, Combination; Failure; Hepatitis; Highly active antiretroviral therapy; HIV; HIV infection; Human immunodeficiency virus; Methods; Patient compliance; Patient outcomes; Patients; Population; Raltegravir; regimens; Rilpivirine; two‐drug; United States; United States > US; two-drug; HIV; antiretroviral therapy-experience; ART-experience; human immunodeficiency virus; cohort; regimens
• ISSN: 1758-2652; 1758-2652
• DOI: 10.1002/jia2.25418

Introduction Two‐drug regimens (2‐DR) have the potential to be a viable solution to the challenges of treatment complexity, cost, adverse effects and contraindications. We sought to describe the real‐world use and effectiveness of 2‐DR among persons living with HIV (PLHIV) in the United States. Methods We analysed data for 10,190 treatment‐experienced patients from the OPERA® Observational Database initiating a new 2‐DR or three‐drug regimen (3‐DR) between 1 January 2010 and 30 June 2016. Multivariate Cox Proportional Hazards models were used to estimate the association among 2‐DR or 3‐DR initiation and virologic suppression (viral load (VL) <50 copies/mL), virologic failure (2 VLs > 200 copies/mL or 1 VL > 200 copies/mL + discontinuation) or regimen discontinuation. Results Patients initiating a 2‐DR (n = 1337, 13%) were older, and more likely to have a lower CD4 count, a history of AIDS and comorbid conditions than patients initiating a 3‐DR. There was no difference between groups in time to virologic suppression (aHR: 1.00 (95% CI: 0.88, 1.13)) among viraemic patients (baseline VL ≥ 50 copies/mL, n = 4180), or time to virologic failure (aHR: 1.15 (95% CI: 0.90, 1.48)) among virologically stable patients (baseline VL < 50 copies/mL, n = 6010). However, time to discontinuation was shorter following 2‐DR than 3‐DR initiation (aHR: 1.51 (95% CI: 1.41, 1.61)). Conclusions In this large cohort of treatment‐experienced patients, 2‐DR prescriptions were common and more frequent among patients with significant comorbidity. Virologic response was similar, but duration of use was shorter with a 2‐DR than a 3‐DR, suggesting that 2‐DRs may be a virologically effective treatment strategy for treatment‐experienced PLHIV with existing comorbidities.