Effectiveness of dolutegravir-based regimens compared to raltegravir-, elvitegravir-, bictegravir, and darunavir-based regimens among older adults with HIV in the Veterans Aging Cohort Study (VACS).
| Title: | Effectiveness of dolutegravir-based regimens compared to raltegravir-, elvitegravir-, bictegravir, and darunavir-based regimens among older adults with HIV in the Veterans Aging Cohort Study (VACS). |
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| Authors: | Yan, Lei, Henegar, Cassidy E., Marconi, Vincent C., Gordon, Kirsha S., Hicks, Charles, Vannappagari, Vani, Justice, Amy C., Aslan, Mihaela |
| Source: | AIDS Research & Therapy; 12/21/2024, Vol. 21 Issue 1, p1-13, 13p |
| Subject Terms: | HIV integrase inhibitors, DARUNAVIR, RESEARCH funding, ANTIRETROVIRAL agents, HIV-positive persons, RALTEGRAVIR, LOGISTIC regression analysis, HIV infections, DESCRIPTIVE statistics, DRUG approval, LONGITUDINAL method, VETERANS, NUCLEOSIDE reverse transcriptase inhibitors |
| Abstract: | Background: Real-world data on treatment patterns and clinical outcomes for newer drugs, including integrase strand transfer inhibitors, among older people with human immunodeficiency virus (PWH) are limited. Methods: This cohort study included PWH enrolled in the Veterans Aging Cohort Study (VACS) who were prescribed a standard 3-drug antiretroviral therapy (ART) regimen containing dolutegravir (DTG), bictegravir (BIC), cobicistat boosted elvitegravir (EVG), raltegravir (RAL), or darunavir/ritonavir (DRV) plus 2 nucleoside reverse transcriptase inhibitors between January 1, 2014, and March 31, 2020, and who were ≥50 years at regimen initiation. The association between regimen and virologic effectiveness or discontinuation was assessed using logistic regression models with inverse probability of treatment weights. Pairwise comparisons were made between DTG-based regimen and each of the other 3-drug regimens, stratified by ART experience. Results: Among 15,702 PWH (across treatment groups, median age 58–62 years; 94–98% male; 5–11% Hispanic; 44–60% Black; 29–42% White), 5,800 received DTG-based regimens, 2,081 BIC-based regimens, 4,159 EVG-based regimens, 1,607 RAL-based regimens, and 2,055 received DRV-based regimens. Among ART-naïve PWH, there were no statistical differences in the odds of virologic suppression, and 6- and 12-month discontinuations were higher in those on DRV. Among ART-experienced PWH, compared to DTG, those on RAL and DRV were less likely to be suppressed at 6 months (RAL vs DTG: aOR 0.64, 95% CI 0.51–0.81; DRV vs DTG: aOR 0.63, 95% CI 0.51–0.76) and those on EVG and DRV were less likely suppressed at 12 months (EVG vs DTG: aOR 0.82, 95% CI 0.68–0.99; DRV vs DTG: aOR 0.64, 95% CI 0.52–0.80). Those on DRV were more likely to have virologic failure within 12 months (aOR 1.96, 95% CI 1.30–2.97). Six- and 12-month discontinuations were higher in those on RAL and DRV, but less likely for BIC-based regimens. Conclusions: DTG-based regimens demonstrated higher levels of effectiveness and durability compared to DRV- or RAL-based regimens and had similar treatment responses as BIC- and EVG-based regimens among ART-experienced older PWH. [ABSTRACT FROM AUTHOR] |
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| Database: | Complementary Index |
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| Items | – Name: Title Label: Title Group: Ti Data: Effectiveness of dolutegravir-based regimens compared to raltegravir-, elvitegravir-, bictegravir, and darunavir-based regimens among older adults with HIV in the Veterans Aging Cohort Study (VACS). – Name: Author Label: Authors Group: Au Data: <searchLink fieldCode="AR" term="%22Yan%2C+Lei%22">Yan, Lei</searchLink><br /><searchLink fieldCode="AR" term="%22Henegar%2C+Cassidy+E%2E%22">Henegar, Cassidy E.</searchLink><br /><searchLink fieldCode="AR" term="%22Marconi%2C+Vincent+C%2E%22">Marconi, Vincent C.</searchLink><br /><searchLink fieldCode="AR" term="%22Gordon%2C+Kirsha+S%2E%22">Gordon, Kirsha S.</searchLink><br /><searchLink fieldCode="AR" term="%22Hicks%2C+Charles%22">Hicks, Charles</searchLink><br /><searchLink fieldCode="AR" term="%22Vannappagari%2C+Vani%22">Vannappagari, Vani</searchLink><br /><searchLink fieldCode="AR" term="%22Justice%2C+Amy+C%2E%22">Justice, Amy C.</searchLink><br /><searchLink fieldCode="AR" term="%22Aslan%2C+Mihaela%22">Aslan, Mihaela</searchLink> – Name: TitleSource Label: Source Group: Src Data: AIDS Research & Therapy; 12/21/2024, Vol. 21 Issue 1, p1-13, 13p – Name: Subject Label: Subject Terms Group: Su Data: <searchLink fieldCode="DE" term="%22HIV+integrase+inhibitors%22">HIV integrase inhibitors</searchLink><br /><searchLink fieldCode="DE" term="%22DARUNAVIR%22">DARUNAVIR</searchLink><br /><searchLink fieldCode="DE" term="%22RESEARCH+funding%22">RESEARCH funding</searchLink><br /><searchLink fieldCode="DE" term="%22ANTIRETROVIRAL+agents%22">ANTIRETROVIRAL agents</searchLink><br /><searchLink fieldCode="DE" term="%22HIV-positive+persons%22">HIV-positive persons</searchLink><br /><searchLink fieldCode="DE" term="%22RALTEGRAVIR%22">RALTEGRAVIR</searchLink><br /><searchLink fieldCode="DE" term="%22LOGISTIC+regression+analysis%22">LOGISTIC regression analysis</searchLink><br /><searchLink fieldCode="DE" term="%22HIV+infections%22">HIV infections</searchLink><br /><searchLink fieldCode="DE" term="%22DESCRIPTIVE+statistics%22">DESCRIPTIVE statistics</searchLink><br /><searchLink fieldCode="DE" term="%22DRUG+approval%22">DRUG approval</searchLink><br /><searchLink fieldCode="DE" term="%22LONGITUDINAL+method%22">LONGITUDINAL method</searchLink><br /><searchLink fieldCode="DE" term="%22VETERANS%22">VETERANS</searchLink><br /><searchLink fieldCode="DE" term="%22NUCLEOSIDE+reverse+transcriptase+inhibitors%22">NUCLEOSIDE reverse transcriptase inhibitors</searchLink> – Name: Abstract Label: Abstract Group: Ab Data: Background: Real-world data on treatment patterns and clinical outcomes for newer drugs, including integrase strand transfer inhibitors, among older people with human immunodeficiency virus (PWH) are limited. Methods: This cohort study included PWH enrolled in the Veterans Aging Cohort Study (VACS) who were prescribed a standard 3-drug antiretroviral therapy (ART) regimen containing dolutegravir (DTG), bictegravir (BIC), cobicistat boosted elvitegravir (EVG), raltegravir (RAL), or darunavir/ritonavir (DRV) plus 2 nucleoside reverse transcriptase inhibitors between January 1, 2014, and March 31, 2020, and who were ≥50 years at regimen initiation. The association between regimen and virologic effectiveness or discontinuation was assessed using logistic regression models with inverse probability of treatment weights. Pairwise comparisons were made between DTG-based regimen and each of the other 3-drug regimens, stratified by ART experience. Results: Among 15,702 PWH (across treatment groups, median age 58–62 years; 94–98% male; 5–11% Hispanic; 44–60% Black; 29–42% White), 5,800 received DTG-based regimens, 2,081 BIC-based regimens, 4,159 EVG-based regimens, 1,607 RAL-based regimens, and 2,055 received DRV-based regimens. Among ART-naïve PWH, there were no statistical differences in the odds of virologic suppression, and 6- and 12-month discontinuations were higher in those on DRV. Among ART-experienced PWH, compared to DTG, those on RAL and DRV were less likely to be suppressed at 6 months (RAL vs DTG: aOR 0.64, 95% CI 0.51–0.81; DRV vs DTG: aOR 0.63, 95% CI 0.51–0.76) and those on EVG and DRV were less likely suppressed at 12 months (EVG vs DTG: aOR 0.82, 95% CI 0.68–0.99; DRV vs DTG: aOR 0.64, 95% CI 0.52–0.80). Those on DRV were more likely to have virologic failure within 12 months (aOR 1.96, 95% CI 1.30–2.97). Six- and 12-month discontinuations were higher in those on RAL and DRV, but less likely for BIC-based regimens. Conclusions: DTG-based regimens demonstrated higher levels of effectiveness and durability compared to DRV- or RAL-based regimens and had similar treatment responses as BIC- and EVG-based regimens among ART-experienced older PWH. [ABSTRACT FROM AUTHOR] – Name: Abstract Label: Group: Ab Data: <i>Copyright of AIDS Research & Therapy is the property of BioMed Central and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.) |
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| RecordInfo | BibRecord: BibEntity: Identifiers: – Type: doi Value: 10.1186/s12981-024-00681-w Languages: – Code: eng Text: English PhysicalDescription: Pagination: PageCount: 13 StartPage: 1 Subjects: – SubjectFull: HIV integrase inhibitors Type: general – SubjectFull: DARUNAVIR Type: general – SubjectFull: RESEARCH funding Type: general – SubjectFull: ANTIRETROVIRAL agents Type: general – SubjectFull: HIV-positive persons Type: general – SubjectFull: RALTEGRAVIR Type: general – SubjectFull: LOGISTIC regression analysis Type: general – SubjectFull: HIV infections Type: general – SubjectFull: DESCRIPTIVE statistics Type: general – SubjectFull: DRUG approval Type: general – SubjectFull: LONGITUDINAL method Type: general – SubjectFull: VETERANS Type: general – SubjectFull: NUCLEOSIDE reverse transcriptase inhibitors Type: general Titles: – TitleFull: Effectiveness of dolutegravir-based regimens compared to raltegravir-, elvitegravir-, bictegravir, and darunavir-based regimens among older adults with HIV in the Veterans Aging Cohort Study (VACS). Type: main BibRelationships: HasContributorRelationships: – PersonEntity: Name: NameFull: Yan, Lei – PersonEntity: Name: NameFull: Henegar, Cassidy E. – PersonEntity: Name: NameFull: Marconi, Vincent C. – PersonEntity: Name: NameFull: Gordon, Kirsha S. – PersonEntity: Name: NameFull: Hicks, Charles – PersonEntity: Name: NameFull: Vannappagari, Vani – PersonEntity: Name: NameFull: Justice, Amy C. – PersonEntity: Name: NameFull: Aslan, Mihaela IsPartOfRelationships: – BibEntity: Dates: – D: 21 M: 12 Text: 12/21/2024 Type: published Y: 2024 Identifiers: – Type: issn-print Value: 17426405 Numbering: – Type: volume Value: 21 – Type: issue Value: 1 Titles: – TitleFull: AIDS Research & Therapy Type: main |
| ResultId | 1 |