Open Access

Melanie Stecher, Philipp Schommers, Christian Kollan, Matthias Stoll, Frieder Kuhlendahl, Hans‑Jürgen Stellbrink, Jan‑Christian Wasmuth, Christoph Stephan, Laura Hamacher, Clara Lehmann, Christoph Boesecke, Johannes Bogner, Stefan Esser, Carlos Fritzsche, Annette Haberl, Christian Hofmann, Björn Jensen, Carolynne Schwarze‑Zander, Martin Platten, Gerd Fätkenheuer, Daniel Schmidt, Barbara Gunsenheimer-Bartmeyer, Jörg Janne Vehreschild

• 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.