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Scientific article
Open access
English

Clinical outcomes of 2-drug regimens vs 3-drug regimens in antiretroviral treatment-experienced people living with Human Immunodeficiency Virus

Published inClinical infectious diseases, vol. 73, no. 7, p. e2323-e2333
Publication date2021-10-05
Abstract

Background: Limited data exist that compare clinical outcomes of 2-drug regimens (2DRs) and 3-drug regimens (3DRs) in people living with human immunodeficiency virus.

Methods: Antiretroviral treatment-experienced individuals in the International Cohort Consortium of Infectious Diseases (RESPOND) who switched to a new 2DR or 3DR from 1 January 2012-1 October 2018 were included. The incidence of clinical events (AIDS, non-AIDS cancer, cardiovascular disease, end-stage liver and renal disease, death) was compared between regimens using Poisson regression.

Results: Of 9791 individuals included, 1088 (11.1%) started 2DRs and 8703 (88.9%) started 3DRs. The most common 2DRs were dolutegravir plus lamivudine (22.8%) and raltegravir plus boosted darunavir (19.8%); the most common 3DR was dolutegravir plus 2 nucleoside reverse transcriptase inhibitors (46.9%). Individuals on 2DRs were older (median, 52.6 years [interquartile range, 46.7-59.0] vs 47.7 [39.7-54.3]), and a higher proportion had ≥1 comorbidity (81.6% vs 73.9%). There were 619 events during 27 159 person-years of follow-up (PYFU): 540 (incidence rate [IR] 22.5/1000 PYFU; 95% confidence interval [CI]: 20.7-24.5) on 3DRs and 79 (30.9/1000 PYFU; 95% CI: 24.8-38.5) on 2DRs. The most common events were death (7.5/1000 PYFU; 95% CI: 6.5-8.6) and non-AIDS cancer (5.8/1000 PYFU; 95% CI: 4.9-6.8). After adjustment for baseline demographic and clinical characteristics, there was a similar incidence of events on both regimen types (2DRs vs 3DRs IR ratio, 0.92; 95% CI: .72-1.19; P = .53).

Conclusions: This is the first large, international cohort to assess clinical outcomes on 2DRs. After accounting for baseline characteristics, there was a similar incidence of events on 2DRs and 3DRs. 2DRs appear to be a viable treatment option with regard to clinical outcomes. Further research on resistance barriers and long-term durability of 2DRs is needed.

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Keywords
  • 2-drug regimens
  • HIV
  • Antiretroviral treatment
  • Clinical outcomes
  • Dual therapy
  • Anti-HIV Agents / therapeutic use
  • Anti-Retroviral Agents / therapeutic use
  • HIV
  • HIV Infections / drug therapy
  • HIV Infections / epidemiology
  • Humans
  • Pharmaceutical Preparations
Research group
Funding
  • ViiV Healthcare LLC - [207709]
  • Gilead Sciences - [CO-EU-311-4339]
Citation (ISO format)
GREENBERG, Lauren et al. Clinical outcomes of 2-drug regimens vs 3-drug regimens in antiretroviral treatment-experienced people living with Human Immunodeficiency Virus. In: Clinical infectious diseases, 2021, vol. 73, n° 7, p. e2323–e2333. doi: 10.1093/cid/ciaa1878
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Article (Accepted version)
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Identifiers
ISSN of the journal1058-4838
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