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Which antiretrovirals should be prescribed as first-line treatments? Changes over the past 10 years in France
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Which antiretrovirals should be prescribed as first-line treatments? Changes over the past 10 years in France

Pascal Pugliese, Valentin Joly, Marc-Antoine Valantin, Laurent Cotte, Thomas Huleux, Clotilde Allavena, Jacques Reynes, Isabelle Poizot-Martin, Firouzé Bani-Sadr, Lise Cuzin, …
Médecine et Maladies Infectieuses (1971-2020), Vol.49(4), p.264-269
06/2019
DOI: https://doi.org/10.1016/j.medmal.2018.10.005
PMID: 30409541

Résumé

Traitement antirétroviral initial Integrase strand transfer inhibitors Initial HIV therapy Inhibiteurs d’intégrase Infection par le VIH HIV infection
OBJECTIVE:To describe the changes in first-line antiretroviral (ART) regimens in France between 2005 and 2015 and patients' characteristics related to the use of protease inhibitors in 2015.METHODS:We extracted all patients starting ART between 2005 and 2015 from a large prospective cohort. Regimens were classified as three nucleoside reverse transcriptase inhibitors (NRTI), or two NRTIs with a boosted protease inhibitor (bPI), with a non-nucleoside reverse transcriptase inhibitor (NNRTI), or with an INSTI. Patients' characteristics at the time of initiation were collected. A multinomial logit model was fitted to analyze characteristics related to the choice of regimen in 2015.RESULTS:We analyzed data from 15,897 patients. The proportion of patients starting with (i) a bPI decreased from 60% before 2014 to 38.1% in 2015; (ii) an NNRTI decreased from 30% to 17.8% in 2015; (iii) an INSTI gradually increased to 39.4% in 2015. In 2015, patients with an initial viral load ˃5 log copies/mL were less likely to receive NNRTI (OR=0.08) or INSTI regimens (OR=0.69) than bPIs. Patients with initial CD4+ T cell count ˂200/mm3 were less likely to receive an NNRTI (OR=0.28) or an INSTI regimen (OR=0.52) than a bPI. Women were less likely to receive an NNRTI (OR=0.79) or an INSTI regimen (OR=0.71) than a bPI; although this depended on age.CONCLUSION:The use of bPI as first-line ART declined sharply in France from 2005 to 2015. bPI remained of preferential use in patients with high viral load, low CD4+ T cell count, and in women.

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