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AIDS. 2019 Nov 1;33(13):2013-2024. doi: 10.1097/QAD.0000000000002320.

Uptake and effectiveness of two-drug compared with three-drug antiretroviral regimens among HIV-positive individuals in Europe.

Author information

1
CHIP, University of Copenhagen, Denmark.
2
University College London, UK.
3
Institute of Tropical Medicine, Antwerp, Belgium.
4
Department of Infectious Diseases, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
5
Royal Sussex County Hospital, Brighton, UK.
6
Hvidovre Hospital, University of Copenhagen, Denmark.
7
Gomel State Medical University, Belarus.
8
Hospital Ramon y Cajal, Madrid, Spain.
9
Szpital Specjalistyczny, Chorzów, Poland.
10
University Hospital of Infectious Diseases, Zagreb, Croatia.
11
Vilnius University, Faculty of Medicine, Vilnius University Hospital Santaros Klinikos.
12
Novgorod Centre for AIDS Prevention and Control, Russia.
13
Kaplan Medical Center, Rehovot, Israel.
14
Hospital JM Ramos Mejia, Buenos Aires, Argentina.
15
Sapienza University of Rome, Rome, Italy.
16
Medizinische Hochschule Hannover, Germany.
17
Centre Hospitalier de Luxembourg, Luxembourg.
18
ViiV Healthcare, RTP, North Carolina, USA.

Abstract

OBJECTIVE:

To assess the use of two-drug antiretroviral regimens (2DR) and virologic and immunologic outcomes compared with three-drug regimens (3DR) in the EuroSIDA cohort.

DESIGN:

Multicentre, prospective cohort study.

METHODS:

Logistic regression was used to analyse the uptake and outcomes among HIV-positive individuals who started or switched to a 2DR compared with those on a 3DR. Virologic outcomes were assessed on-treatment as the proportion of individuals with controlled viral load (<400 copies/ml), or with a composite modified FDA snapshot endpoint (mFDA), with mFDA success defined as controlled viral load at 6 months or 12 months for individuals with a known viral load, no regimen changes, AIDS or death. Immunologic response was defined as a 100 cells/μl or a 25% increase in CD4 cell counts from baseline.

RESULTS:

Between 1 July 2010 and 31 December 2016, 423 individuals started or switched to a 2DR (eight antiretroviral-naive) and 4347 started a 3DR (566 naive). Individuals on 2DR tended to have suppressed viral load, higher CD4 cell counts and more comorbidities at baseline compared with those on 3DR. There were no differences in the proportions of individuals who obtained on-treatment or mFDA success, and no significant differences in the adjusted odds ratios for mFDA success or immunologic responses between the 2DR and 3DR groups at 6 months or 12 months.

CONCLUSION:

In routine clinical practice, 2DR were largely used for virologically suppressed individuals with higher cumulative exposure to antiretrovirals and comorbidities. Virologic and immunologic outcomes were similar among those on 2DR or 3DR, although confounding by indication cannot be fully excluded due to the observational nature of the study.

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