TY  - JOUR
A1  - Stecher, Melanie
A1  - Schommers, Philipp Frederik
A1  - Kollan, Christian
A1  - Stoll, Matthias
A1  - Kuhlendahl, Frieder
A1  - Stellbrink, Hans‑Jürgen
A1  - Wasmuth, Jan‑Christian
A1  - Stephan, Christoph
A1  - Hamacher, Laura
A1  - Lehmann, Clara
A1  - Boesecke, Christoph
A1  - Bogner, Johannes
A1  - Esser, Stefan
A1  - Fritzsche, Carlos
A1  - Haberl, Annette
A1  - Hofmann, Christian
A1  - Jensen, Björn
A1  - Schwarze‑Zander, Carolynne
A1  - Platten, Martin
A1  - Fätkenheuer, Gerd
A1  - Schmidt, Daniel
A1  - Gunsenheimer-Bartmeyer, Barbara
A1  - Vehreschild, Jörg Janne
T1  - Treatment modification after starting cART in people living with HIV: retrospective analysis of the German ClinSurv HIV Cohort 2005–2017
T2  - Infection
N2  - Objective: Combination antiretroviral therapy (cART) has markedly increased survival and quality of life in people living with HIV. With the advent of new treatment options, including single-tablet regimens, durability and efficacy of first-line cART regimens are evolving.
Methods: We analyzed data from the prospective multicenter German Clinical Surveillance of HIV Disease (ClinSurv) cohort of the Robert-Koch Institute. Kaplan–Meier and Cox proportional hazards models were run to examine the factors associated with treatment modification. Recovery after treatment initiation was analyzed comparing pre-cART viral load and CD4+ T-cell counts with follow-up data.
Results: We included 8788 patients who initiated cART between 2005 and 2017. The sample population was predominantly male (n = 7040; 80.1%), of whom 4470 (63.5%) were reporting sex with men as the transmission risk factor. Overall, 4210 (47.9%) patients modified their first-line cART after a median time of 63 months (IQR 59–66). Regimens containing integrase strand transfer inhibitors (INSTI) were associated with significantly lower rates of treatment modification (adjusted hazard ratio 0.44; 95% CI 0.39–0.50) compared to protease inhibitor (PI)-based regimens. We found a decreased durability of first-line cART significantly associated with being female, a low CD4+ T-cell count, cART initiation in the later period (2011–2017), being on a multi-tablet regimen (MTR).
Conclusions: Drug class and MTRs are significantly associated with treatment modification. INSTI-based regimens showed to be superior compared to PI-based regimens in terms of durability.
KW  - HIV
KW  - cART
KW  - Treatment modification
KW  - First-line regimen
Y1  - 2020
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/57458
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-574586
SN  - 1439-0973
SN  - 0300-8126
VL  - 48
SP  - 723
EP  - 733
PB  - Springer
CY  - Heidelberg ; Berlin
ER  -