Rossetti, BarbaraFabbiani, MassimilianoDi Carlo, DomenicoIncardona, FrancescaAbecasis, AnaGomes, PerpetuaGeretti, Anna MariaSeguin-Devaux, CaroleGarcia, FedericoKaiser, RolfModica, SaraShallvari, AdrianSönnerborg, AndersZazzi, MaurizioEuResist Network, INTEGRATE study group2023-02-092023-02-092021http://hdl.handle.net/10668/18143INSTIs have become a pillar of first-line ART. Real-world data are needed to assess their effectiveness in routine care. We analysed ART-naive patients who started INSTI-based regimens in 2012-19 whose data were collected by INTEGRATE, a European collaborative study including seven national cohorts. Kaplan-Meier analyses assessed time to virological failure (VF), defined as one viral load (VL) ≥1000 copies/mL, two consecutive VLs ≥50 copies/mL, or one VL ≥50 copies/mL followed by treatment change after ≥24 weeks of follow-up, and time to INSTIs discontinuation (INSTI-DC) for any reason. Factors associated with VF and INSTI-DC were explored by logistic regression analysis. Of 2976 regimens started, 1901 (63.9%) contained dolutegravir, 631 (21.2%) elvitegravir and 444 (14.9%) raltegravir. The 1 year estimated probabilities of VF and INSTI-DC were 5.6% (95% CI 4.5-6.7) and 16.2% (95% CI 14.9-17.6), respectively, and were higher for raltegravir versus both elvitegravir and dolutegravir. A baseline VL ≥100 000 copies/mL [adjusted HR (aHR) 2.17, 95% CI 1.55-3.04, P 3 drugs versus 3 drugs (aHR 2.73, 95% CI 1.55-4.79, P  This large multi-cohort study indicates high effectiveness of elvitegravir- or dolutegravir-based first-line ART in routine practice across Europe.enCohort StudiesDrug Resistance, ViralHIV InfectionsHIV Integrase InhibitorsHeterocyclic Compounds, 3-RingHumansIntegrasesOxazinesPyridonesRaltegravir Potassiumresearch article34212176open access10.1093/jac/dkab2001460-2091https://academic.oup.com/jac/article-pdf/76/9/2394/39711750/dkab200.pdf