Long-term virological suppression on first-line efavirenz + tenofovir + emtricitabine/lamivudine for HIV-1

The Long-Term Virological Suppression Working Group for the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) in EuroCoord

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Abstract

Objectives: Evaluate long-term rates of virological failure (VF) and treatment interruption for people living with HIV (PLWHIV) with viral suppression on first-line efavirenz+tenofovir disoproxilfumarate+emtricitabine/lamivudine (EFV+TDF+FTC/3TC), and compare these according topatient characteristics. 
Methods: PLWHIV enrolled in the COHERE cohort collaboration, who started first-line EFV+TDF+FTC/3TCat age ≥16 years and had viral suppression (<200 copies/mL) within 9 months were included.Rates of VF (≥200 copies/mL) and (complete) treatment interruption were estimated according to years since initial suppression. We used Poisson regression to examine associations of baseline characteristics with rates of VF or treatment interruption. 
Results: Among 19,527 eligible PLWHIV with median (IQR) follow-up 3.7 (2.0–5.6) years after initial viral suppression, the estimated rate of the combined incidence of VF or treatment interruption fell from 9.0/100 person-years in the first year to <4/100 person-years beyond 3 years from suppression; considering only those remaining on EFV+TDF+FTC/3TC, the combined rate dropped from 8.2/100 person-years in the first year to <3.5/100 person-years beyond 3 years. PLWHIV with injecting drug-related or heterosexual transmission were at higher risk ofVF or treatment interruption, as were those of Black ethnicity. PLWHIV aged <35 years were at higher risk of VF and treatment interruption. 
Conclusions: PLWHIV starting first-line EFV+TDF+FTC/3TC had low rates of VF and treatment interruption up to 10 years from initial suppression. Demographic characteristics can be used to identify subpopulations with higher risks of these outcomes.
Original languageEnglish
Pages (from-to)745-751
Number of pages22
JournalAIDS
Volume33
Issue number4
Early online date1 Mar 2019
DOIs
Publication statusPublished - Mar 2019

Keywords

  • antiretroviral therapy
  • virological control
  • viral suppression
  • viral rebound
  • viral failure

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    The Long-Term Virological Suppression Working Group for the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) in EuroCoord (2019). Long-term virological suppression on first-line efavirenz + tenofovir + emtricitabine/lamivudine for HIV-1. AIDS, 33(4), 745-751. https://doi.org/10.1097/QAD.0000000000002126