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

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  • 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
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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 languageEnglish
JournalHIV Medicine
Volume2018 May;19
Issue number5
Pages (from-to)324-338
ISSN1464-2662
DOIs
Publication statusPublished - 2018

    Research areas

  • Journal Article

ID: 52717555