Treatment outcomes of integrase inhibitors, boosted protease inhibitors and non-nucleoside reverse transcriptase inhibitors in antiretroviral naïve persons starting treatment. HIV Medicine
Mocroft et al. on behalf of the RESPOND study-group aimed to compare shorter term virological and immunological outcomes and clinical events of AIDS/death in ART-naïve persons starting antiretroviral therapy (ART) in RESPOND with either an integrase strand transfer inhibitor (INSTI), contemporary boosted protease inhibitors (PI/b) or nonnucleoside reverse transcriptase inhibitors (NNRTIs) in key subgroups.
The International Cohort Consortium of Infectious Diseases (RESPOND) is a collaboration of 17 cohort studies, including 29’432 HIV-1-positive persons from across Europe and Australia. The composite treatment outcome (cTO) defined success as viral load (VL) <200 HIV-1 RNA copies/mL with no regimen change and no AIDS/death events. Immunological success was defined as a CD4 count >750 cells/lL or a 33% increase where the baseline CD4 count was ≥500 cells/lL.
Of 5’198 ART-naıve persons in RESPOND, 45.4% started INSTIs, 26.0% PI/b and 28.7% NNRTIs; 880 (17.4%) were aged >50 years, 2539 (49.4%) had CD4 counts <350 cells/lL and 1891 (36.8%) had VL >100 000 copies/mL. Differences in virological and immunological success and clinical failure among ART classes were similar across age groups (≤40, 40 –50 and >50 years), CD4 count categories (≤350 vs. >350 cells/lL) and VL categories at ART initiation (≤100 000 vs. >100 000 copies/mL), with all investigated interactions being nonsignificant (P >0.05).
In conclusion, differences among ART classes in virological, immunological and clinical outcomes in ART-naïve participants were consistent irrespective of age, immune suppression or VL at ART initiation. While confounding by indication cannot be excluded, this provides reassuring evidence that such subpopulations will equally benefit from modern ART.