Duration of first-line antiretroviral therapy with tenofovir and emtricitabine combined with atazanavir/ritonavir, efavirenz or lopinavir/ritonavir in the Italian ARCA cohort.
OBJECTIVE
To explore the durability of three first-line tenofovir/emtricitabine-based regimens in combination with atazanavir/ritonavir, efavirenz or lopinavir/ritonavir in HIV-1-infected patients.


METHODS
A retrospective, longitudinal, multicentre analysis of adult patients enrolled in the Antiretroviral Resistance Cohort Analysis (ARCA), a national prospective observational cohort of HIV-1-infected patients followed up at more than 100 clinical and laboratory units in Italy. Patients eligible were those starting first-line antiretroviral therapy between 1 June 2004 and 15 April 2011 and who were followed up for at least 6 months. The primary endpoint was durability, defined as the time from antiretroviral therapy initiation to first treatment modification. Time-dependent events were analysed by the Kaplan-Meier approach and the Cox proportional hazard model.


RESULTS
There are 26,000 HIV-infected patients in the ARCA database, of whom 1654 met study inclusion criteria. Six hundred and thirty-nine (38.6%) received efavirenz, 321 (19.4%) received atazanavir/ritonavir and 694 (41.9%) received lopinavir/ritonavir as a first-line regimen. Over a total observation period of 88 months, equivalent to more than 2805 person-years of follow-up, 618 patients underwent treatment modification. Lopinavir/ritonavir, given twice daily, was associated with a higher discontinuation rate than efavirenz- and atazanavir-based regimens [hazard ratio (HR) 1.83, 95% confidence interval (CI) 1.56-2.15, P = 0.001]. Comparing the once-daily regimens, the rate of discontinuation of efavirenz was higher than that of atazanavir/ritonavir (HR 1.39, 95% CI 1.06-1.83, P = 0.016).


CONCLUSIONS
Significant differences in treatment duration were observed among the three studied regimens. Once-daily regimens exhibited greater durability than the twice-daily regimen. Among the specific regimens examined, tenofovir/emtricitabine plus atazanavir/ritonavir showed the greatest durability.
Infectious Diseases, IRCCS San Martino Hospital-IST, Genoa, Italy. antonio.dibiagio@hsanmartino.it
Antonio
A
Di Biagio
Roberta
R
Prinapori
Diana
D
Giannarelli
Franco
F
Maggiolo
Simona
S
Di Giambenedetto
Vanni
V
Borghi
Giovanni
G
Penco
Paola
P
Cicconi
Daniela
D
Francisci
Gaetana
G
Sterrantino
Alessia
A
Zoncada
Laura
L
Monno
Amedeo
A
Capetti
Andrea
A
Giacometti
D000225:Adenine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D000480:Alkynes; D044966:Anti-Retroviral Agents / Q000008:administration & dosage; D000069446:Atazanavir Sulfate; D048588:Benzoxazines / Q000008:administration & dosage*; D015331:Cohort Studies; D003521:Cyclopropanes; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D024882:Drug Resistance, Viral / Q000187:drug effects / Q000502:physiology; D004359:Drug Therapy, Combination; D000068679:Emtricitabine; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology; D015497:HIV-1 / Q000187:drug effects; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008137:Longitudinal Studies; D061466:Lopinavir / Q000008:administration & dosage*; D009842:Oligopeptides / Q000008:administration & dosage*; D063065:Organophosphonates / Q000008:administration & dosage*; D011446:Prospective Studies; D011725:Pyridines / Q000008:administration & dosage*; D012189:Retrospective Studies; D019438:Ritonavir / Q000008:administration & dosage*; D000068698:Tenofovir; D013997:Time Factors
D000480:Alkynes; D044966:Anti-Retroviral Agents; D048588:Benzoxazines; D003521:Cyclopropanes; D009842:Oligopeptides; D063065:Organophosphonates; D011725:Pyridines; D003841:Deoxycytidine; D061466:Lopinavir; D000069446:Atazanavir Sulfate; D000068698:Tenofovir; D000068679:Emtricitabine; D000225:Adenine; C098320:efavirenz; D019438:Ritonavir