%0 Journal Article
%A Teira, Ramón
%A Diaz-Cuervo, Helena
%A Aragão, Filipa
%A Marguet, Sophie
%A de la Fuente, Belén
%A Muñoz, Maria Jose
%A Abdulghani, Nadia
%A Ribera, Esteban
%A Domingo, Pere
%A Deig, Elisabeth
%A Peraire, Joaquim
%A Roca, Bernardino
%A Montero, Marta
%A Galindo, Maria José
%A Romero, Alberto
%A Espinosa, Nuria
%A Lozano, Fernando
%A Merino, María Dolores
%A Martínez, Elisa
%A Geijo, Paloma
%A Estrada, Vicente
%A García, Josefina
%A Sepúlveda, M Antonia
%A Berenguer, Juan
%T Real world effectiveness of standard of care triple therapy versus two-drug combinations for treatment of people living with HIV.
%D 2021
%U http://hdl.handle.net/10668/17546
%X Since 1996, the standard of care (SOC) therapy for HIV treatment has consisted of a backbone of two nucleoside analogue reverse transcriptase inhibitors (NRTI) paired with a third agent. Use of two-drug combinations (2DC) has been considered for selected patients to avoid toxicities associated with the use of NRTIs. This study aimed to compare the real-world outcomes of integrase strand transfer inhibitor (INSTI)-containing triple therapy (TT) to dolutegravir- (DTG) and/or boosted protease inhibitor (bPI)-based 2DC in a large Spanish cohort of HIV patients. A retrospective analysis was performed using data from the VACH cohort, a prospective multicentre Spanish cohort of adult HIV patients. All treatment experienced patients initiating a TT of an INSTI combined with two NRTIs or a 2DC-containing DTG and/or a bPI between 01/01/2012 and 01/06/2017 were included. The unit of analysis was patient-regimens. The overall sample analysis was complemented with two sub-analyses. The first sub-analysis focused on patients treated with a backbone plus DTG compared to those treated with DTG+ one other antiretroviral. The second sub-analysis focused on patients with HIV RNA Overall 7,481 patients were included in the analysis, contributing to 9,243 patient-regimens. Patient characteristics at baseline differed among groups, with the 2DC group being significantly older and having a higher proportion of women, a longer time on ART and a higher number of previous virologic failures. Median (95% Confidence Interval [C.I.]) time to switch was 2.5 years (2.3, 2.7) in 2DC group versus 2.9 years (2.7, 3.0) in TT. Adjusted hazard ratios (95% C.I.) for discontinuation due to any reason, virologic failure and toxicity in the 2DC vs TT group were 1.29 (1.15; 1.44), 2.06 (1.54; 2.77) and 1.18 (0.94; 1.48), respectively. Results were consistent in the two sub-analyses. In this analysis, time to discontinuation and probability of remaining free of virologic failure were significantly higher in patients on INSTI-based TT compared to DTG- and/or bPI-containing 2DC, with no differences in toxicity.
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