Long-term effectiveness of recommended boosted protease inhibitor-based antiretroviral therapy in Europe

J R Santos; A Cozzi-Lepri; A Phillips; S De Wit; C Pedersen; P Reiss; A Blaxhult; A Lazzarin; M Sluzhynska; C Orkin; C Duvivier; J Bogner; P Gargalianos-Kakolyris; P Schmid; G Hassoun; I Khromova; M Beniowski; V Hadziosmanovic; D Sedlacek; R Paredes; J D Lundgren; EuroSIDA study group

doi:10.1111/hiv.12581

Long-term effectiveness of recommended boosted protease inhibitor-based antiretroviral therapy in Europe

J R Santos, A Cozzi-Lepri, A Phillips, S De Wit, C Pedersen, P Reiss, A Blaxhult, A Lazzarin, M Sluzhynska, C Orkin, C Duvivier, J Bogner, P Gargalianos-Kakolyris, P Schmid, G Hassoun, I Khromova, M Beniowski, V Hadziosmanovic, D Sedlacek, R ParedesJ D Lundgren, EuroSIDA study group

Internal Medicine

4 Citations (Scopus)

Abstract

OBJECTIVES: The aim of the study was to evaluate the long-term response to antiretroviral treatment (ART) based on atazanavir/ritonavir (ATZ/r)-, darunavir/ritonavir (DRV/r)-, and lopinavir/ritonavir (LPV/r)-containing regimens.

METHODS: Data were analysed for 5678 EuroSIDA-enrolled patients starting a DRV/r-, ATZ/r- or LPV/r-containing regimen between 1 January 2000 and 30 June 2013. Separate analyses were performed for the following subgroups of patients: (1) ART-naïve subjects (8%) at ritonavir-boosted protease inhibitor (PI/r) initiation; (2) ART-experienced individuals (44%) initiating the new PI/r with a viral load (VL) ≤500 HIV-1 RNA copies/mL; and (3) ART-experienced patients (48%) initiating the new PI/r with a VL >500 copies/mL. Virological failure (VF) was defined as two consecutive VL measurements >200 copies/mL ≥24 weeks after PI/r initiation. Kaplan-Meier and multivariable Cox models were used to compare risks of failure by PI/r-based regimen. The main analysis was performed with intention-to-treat (ITT) ignoring treatment switches.

RESULTS: The time to VF favoured DRV/r over ATZ/r, and both were superior to LPV/r (log-rank test; P < 0.02) in all analyses. Nevertheless, the risk of VF in ART-naïve patients was similar regardless of the PI/r initiated after controlling for potential confounders. The risk of VF in both treatment-experienced groups was lower for DRV/r than for ATZ/r, which, in turn, was lower than for LPV/r-based ART.

CONCLUSIONS: Although confounding by indication and calendar year cannot be completely ruled out, in ART-experienced subjects the long-term effectiveness of DRV/r-containing regimens appears to be greater than that of ATZ/r and LPV/r.

Original language	English
Journal	HIV Medicine
Volume	2018 May;19
Issue number	5
Pages (from-to)	324-338
ISSN	1464-2662
DOIs	https://doi.org/10.1111/hiv.12581
Publication status	Published - 2018

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Journal Article

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10.1111/hiv.12581

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Santos, J. R., Cozzi-Lepri, A., Phillips, A., De Wit, S., Pedersen, C., Reiss, P., Blaxhult, A., Lazzarin, A., Sluzhynska, M., Orkin, C., Duvivier, C., Bogner, J., Gargalianos-Kakolyris, P., Schmid, P., Hassoun, G., Khromova, I., Beniowski, M., Hadziosmanovic, V., Sedlacek, D., ... EuroSIDA study group (2018). Long-term effectiveness of recommended boosted protease inhibitor-based antiretroviral therapy in Europe. HIV Medicine, 2018 May;19(5), 324-338. https://doi.org/10.1111/hiv.12581

Santos, JR, Cozzi-Lepri, A, Phillips, A, De Wit, S, Pedersen, C, Reiss, P, Blaxhult, A, Lazzarin, A, Sluzhynska, M, Orkin, C, Duvivier, C, Bogner, J, Gargalianos-Kakolyris, P, Schmid, P, Hassoun, G, Khromova, I, Beniowski, M, Hadziosmanovic, V, Sedlacek, D, Paredes, R, Lundgren, JD & EuroSIDA study group 2018, 'Long-term effectiveness of recommended boosted protease inhibitor-based antiretroviral therapy in Europe', HIV Medicine, vol. 2018 May;19, no. 5, pp. 324-338. https://doi.org/10.1111/hiv.12581

@article{38baa32f63f343e08baf2bc80e0468d9,

title = "Long-term effectiveness of recommended boosted protease inhibitor-based antiretroviral therapy in Europe",

abstract = "OBJECTIVES: The aim of the study was to evaluate the long-term response to antiretroviral treatment (ART) based on atazanavir/ritonavir (ATZ/r)-, darunavir/ritonavir (DRV/r)-, and lopinavir/ritonavir (LPV/r)-containing regimens.METHODS: Data were analysed for 5678 EuroSIDA-enrolled patients starting a DRV/r-, ATZ/r- or LPV/r-containing regimen between 1 January 2000 and 30 June 2013. Separate analyses were performed for the following subgroups of patients: (1) ART-na{\"i}ve subjects (8%) at ritonavir-boosted protease inhibitor (PI/r) initiation; (2) ART-experienced individuals (44%) initiating the new PI/r with a viral load (VL) ≤500 HIV-1 RNA copies/mL; and (3) ART-experienced patients (48%) initiating the new PI/r with a VL >500 copies/mL. Virological failure (VF) was defined as two consecutive VL measurements >200 copies/mL ≥24 weeks after PI/r initiation. Kaplan-Meier and multivariable Cox models were used to compare risks of failure by PI/r-based regimen. The main analysis was performed with intention-to-treat (ITT) ignoring treatment switches.RESULTS: The time to VF favoured DRV/r over ATZ/r, and both were superior to LPV/r (log-rank test; P < 0.02) in all analyses. Nevertheless, the risk of VF in ART-na{\"i}ve patients was similar regardless of the PI/r initiated after controlling for potential confounders. The risk of VF in both treatment-experienced groups was lower for DRV/r than for ATZ/r, which, in turn, was lower than for LPV/r-based ART.CONCLUSIONS: Although confounding by indication and calendar year cannot be completely ruled out, in ART-experienced subjects the long-term effectiveness of DRV/r-containing regimens appears to be greater than that of ATZ/r and LPV/r.",

keywords = "Journal Article",

author = "Santos, {J R} and A Cozzi-Lepri and A Phillips and {De Wit}, S and C Pedersen and P Reiss and A Blaxhult and A Lazzarin and M Sluzhynska and C Orkin and C Duvivier and J Bogner and P Gargalianos-Kakolyris and P Schmid and G Hassoun and I Khromova and M Beniowski and V Hadziosmanovic and D Sedlacek and R Paredes and Lundgren, {J D} and {EuroSIDA study group}",

note = "{\textcopyright} 2018 British HIV Association.",

year = "2018",

doi = "10.1111/hiv.12581",

language = "English",

volume = "2018 May;19",

pages = "324--338",

journal = "HIV Medicine",

issn = "1464-2662",

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TY - JOUR

T1 - Long-term effectiveness of recommended boosted protease inhibitor-based antiretroviral therapy in Europe

AU - Santos, J R

AU - Cozzi-Lepri, A

AU - Phillips, A

AU - De Wit, S

AU - Pedersen, C

AU - Reiss, P

AU - Blaxhult, A

AU - Lazzarin, A

AU - Sluzhynska, M

AU - Orkin, C

AU - Duvivier, C

AU - Bogner, J

AU - Gargalianos-Kakolyris, P

AU - Schmid, P

AU - Hassoun, G

AU - Khromova, I

AU - Beniowski, M

AU - Hadziosmanovic, V

AU - Sedlacek, D

AU - Paredes, R

AU - Lundgren, J D

AU - EuroSIDA study group

PY - 2018

Y1 - 2018

N2 - OBJECTIVES: The aim of the study was to evaluate the long-term response to antiretroviral treatment (ART) based on atazanavir/ritonavir (ATZ/r)-, darunavir/ritonavir (DRV/r)-, and lopinavir/ritonavir (LPV/r)-containing regimens.METHODS: Data were analysed for 5678 EuroSIDA-enrolled patients starting a DRV/r-, ATZ/r- or LPV/r-containing regimen between 1 January 2000 and 30 June 2013. Separate analyses were performed for the following subgroups of patients: (1) ART-naïve subjects (8%) at ritonavir-boosted protease inhibitor (PI/r) initiation; (2) ART-experienced individuals (44%) initiating the new PI/r with a viral load (VL) ≤500 HIV-1 RNA copies/mL; and (3) ART-experienced patients (48%) initiating the new PI/r with a VL >500 copies/mL. Virological failure (VF) was defined as two consecutive VL measurements >200 copies/mL ≥24 weeks after PI/r initiation. Kaplan-Meier and multivariable Cox models were used to compare risks of failure by PI/r-based regimen. The main analysis was performed with intention-to-treat (ITT) ignoring treatment switches.RESULTS: The time to VF favoured DRV/r over ATZ/r, and both were superior to LPV/r (log-rank test; P < 0.02) in all analyses. Nevertheless, the risk of VF in ART-naïve patients was similar regardless of the PI/r initiated after controlling for potential confounders. The risk of VF in both treatment-experienced groups was lower for DRV/r than for ATZ/r, which, in turn, was lower than for LPV/r-based ART.CONCLUSIONS: Although confounding by indication and calendar year cannot be completely ruled out, in ART-experienced subjects the long-term effectiveness of DRV/r-containing regimens appears to be greater than that of ATZ/r and LPV/r.

AB - OBJECTIVES: The aim of the study was to evaluate the long-term response to antiretroviral treatment (ART) based on atazanavir/ritonavir (ATZ/r)-, darunavir/ritonavir (DRV/r)-, and lopinavir/ritonavir (LPV/r)-containing regimens.METHODS: Data were analysed for 5678 EuroSIDA-enrolled patients starting a DRV/r-, ATZ/r- or LPV/r-containing regimen between 1 January 2000 and 30 June 2013. Separate analyses were performed for the following subgroups of patients: (1) ART-naïve subjects (8%) at ritonavir-boosted protease inhibitor (PI/r) initiation; (2) ART-experienced individuals (44%) initiating the new PI/r with a viral load (VL) ≤500 HIV-1 RNA copies/mL; and (3) ART-experienced patients (48%) initiating the new PI/r with a VL >500 copies/mL. Virological failure (VF) was defined as two consecutive VL measurements >200 copies/mL ≥24 weeks after PI/r initiation. Kaplan-Meier and multivariable Cox models were used to compare risks of failure by PI/r-based regimen. The main analysis was performed with intention-to-treat (ITT) ignoring treatment switches.RESULTS: The time to VF favoured DRV/r over ATZ/r, and both were superior to LPV/r (log-rank test; P < 0.02) in all analyses. Nevertheless, the risk of VF in ART-naïve patients was similar regardless of the PI/r initiated after controlling for potential confounders. The risk of VF in both treatment-experienced groups was lower for DRV/r than for ATZ/r, which, in turn, was lower than for LPV/r-based ART.CONCLUSIONS: Although confounding by indication and calendar year cannot be completely ruled out, in ART-experienced subjects the long-term effectiveness of DRV/r-containing regimens appears to be greater than that of ATZ/r and LPV/r.

KW - Journal Article

U2 - 10.1111/hiv.12581

DO - 10.1111/hiv.12581

M3 - Journal article

C2 - 29388732

SN - 1464-2662

VL - 2018 May;19

SP - 324

EP - 338

JO - HIV Medicine

JF - HIV Medicine

IS - 5

ER -

Long-term effectiveness of recommended boosted protease inhibitor-based antiretroviral therapy in Europe

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