Heavy antiretroviral exposure and exhausted/limited antiretroviral options: predictors and clinical outcomes. AIDS
Mocroft et al. assessed determinants of developing an HIV treatment status with limited antiretroviral treatment options among people with HIV (PWH) in the International Cohort Consortium of Infectious Diseases (RESPOND).
Authors included RESPOND cohort participants with at least 5 years of antiretroviral therapy. Limited and exhausted treatment options were defined as receiving (1) at least two anchor agents together with a third drug from any class, (2) exactly two anchor agents (excluding dual therapies recommended by HIV treatment guidelines such as cabotegravir and rilpivirine), (3) any regimen that included enfuvirtide, or (4) at least three nucleotide reverse transcriptase inhibitors (NRTI). Predictors were assessed using multivariable Poisson regression.
The study included 23’827 PWH, of which 26% were female. The median age was 46 years (IQR 39-53), and the median nadir CD4 cell count was 230 cells/μL (IQR 119-348). Within a median follow-up of 5.5 years, 2’164 persons (9.1%) developed a status of limited or exhausted treatment options. Individuals with follow-up in 2018–2021 had a lower probability of having limited treatment options than those with follow-up in 2015–2017. In addition, individuals with high CD4 cell counts and suppressed HIV viral loads were less likely to have limited treatment options compared with those with ongoing HIV replication. In contrast, individuals who had HIV for more than 15 years were most likely to have limited treatment options.
In summary, the present study shows that PWH are less likely to have limited or exhausted antiretroviral treatment options in recent years. Effective suppression of HIV viral load and successful immune recovery with current medications likely contributed to this improvement.