Table 1. Baseline Patient Characteristics and Time to Discontinuation and Virologic Failure by Initial Antiretroviral Therapy.
| Initial ART Regimen | |||||||
|---|---|---|---|---|---|---|---|
|
|
|||||||
| Total (n = 1624) |
INSTI (n = 173) |
NNRTI (n = 536) |
bPI (n = 331) |
Other (n = 434) |
NRTI (n = 150) |
P valuea | |
| Baseline Characteristics | |||||||
| Age y, Median (IQR) | 37 (29, 46) | 38 (26, 48) | 37 (29, 46) | 37 (29, 47) | 37 (29, 45) | 37 (31, 45) | .90 |
| Women, No (%) | 460 (28%) | 30 (17%) | 124 (23%) | 107 (32%) | 146 (34%) | 53 (35%) | <.001 |
| Raceb, No (%) | .003 | ||||||
| African-American | 979 (60%) | 109 (63%) | 328 (61%) | 174 (53%) | 268 (62%) | 100 (67%) | |
| White | 453 (28%) | 52 (30%) | 129 (24%) | 112 (34%) | 122 (28%) | 38 (25%) | |
| Other | 192 (12%) | 12 (7%) | 79 (15%) | 45 (14%) | 44 (10%) | 12 (8%) | |
| CD4 Cell Count cells/mm3, Median (IQR) | 277 (104, 463) | 403 (246, 579) | 279 (116, 468) | 230 (78, 401) | 237 (69, 442) | 341 (127, 475) | <.001 |
| HIV RNA level log10 copies/mL, Median (IQR) | 4.8 (4.2, 5.3) | 4.4 (3.9, 5.0) | 4.8 (4.2, 5.4) | 4.9 (4.3, 5.5) | 4.9 (4.2, 5.4) | 4.6 (3.9, 5.1) | <.001 |
| Calendar Year,Median (IQR) | 2005 (2000, 2010) | 2013 (2012, 2014) | 2007 (2002, 2010) | 2007 (2005, 2010) | 1999 (1998, 2003) | 1998 (1997, 2001) | <.001 |
| Follow-up years, Median (IQR)c | 5.5 (2.7, 9.7) | 2.3 (1.5, 3.1) | 5.5 (3.2, 8.8) | 5.5 (3.0, 8.7) | 6.6 (3.2, 14.2) | 9.7 (2.7, 14.7) | <.001 |
| Lost to follow-up, No (%) | 594 (37%) | 29 (17%) | 204 (38%) | 121 (37%) | 169 (39%) | 71 (47%) | <.001 |
|
| |||||||
| Time to Discontinuationd | |||||||
| Unadjusted HR single model (95% CI)e | 0.48 (0.35, 0.67) | 1 (Reference) | 1.23 (1.04, 1.46) | 1.59 (1.37, 1.85) | 3.02 (2.48, 3.68) | NA | |
| Adjusted HR single model (95% CI)e | 0.49 (0.35, 0.69) | 1 (Reference) | 1.24 (1.05, 1.47) | 1.47 (1.24, 1.75) | 3.01 (2.40, 3.78) | NA | |
| Unadjusted HR separate models (95% CI)e | 0.56 (0.40, 0.80) | 1 (Reference) | 1.28 (1.08, 1.52) | 1.58 (1.35, 1.85) | 2.61 (1.98, 3.43) | NA | |
| Adjusted HR separate models (95% CI)e | 0.52 (0.34, 0.80) | 1 (Reference) | 1.28 (1.07, 1.53) | 1.39 (1.16, 1.67) | 2.76 (2.00, 3.82) | NA | |
|
| |||||||
| Time to Virologic Failure | |||||||
| Unadjusted HR single model (95% CI)e | 0.46 (0.31, 0.67) | 1 (Reference) | 1.13 (0.92, 1.38) | 1.91 (1.61, 2.27) | 3.06 (2.46, 3.81) | NA | |
| Adjusted HR single model (95% CI)e | 0.70 (0.46, 1.06) | 1 (Reference) | 1.23 (1.00, 1.51) | 1.23 (1.02, 1.50) | 1.83 (1.44, 2.34) | NA | |
| Unadjusted HR separate models (95% CI)e | 0.74 (0.48, 1.13) | 1 (Reference) | 1.20 (0.97, 1.47) | 1.86 (1.55, 2.23) | 1.49 (1.10, 2.01) | NA | |
| Adjusted HR separate models (95% CI)e | 0.59 (0.34, 1.03) | 1 (Reference) | 1.25 (1.01, 1.55) | 1.28 (1.04, 1.57) | 1.39 (1.00, 1.94) | NA | |
Abbreviations: ART, antiretroviral therapy; INSTI, integrase strand transfer inhibitor; NNRTI, non-nucleoside reverse transcriptase inhibitor; bPI, boosted protease inhibitor; NRTI, nucleoside reverse transcriptase inhibitor; IQR, interquartile range; CI, confidence interval; NA, not applicable; HR, hazard ratio.
P values from Chi-square and Kruskal-Wallis Tests.
Race for this study was based on medical record reviews and categorized by the investigators. We assessed race in this study given prior evidence of an association with HIV clinical outcomes.
Follow-up years defined as time from ART initiation until the first of death, loss to follow-up (last clinic visit plus 12 months), or administrative censoring (November 2015).
Reasons for discontinuation included virologic failure and stopping ART for more than 2 weeks (23%, 37%, respectively) overall, and for INSTI (5%, 54%), NNRTI (18%, 42%), bPI (20%, 35%), Other (29%, 35%), NRTI (29%, 26%).
Estimates from Cox proportional hazards models. Single model estimates based on one model including all patients initiating: INSTI (raltegravir 53, dolutegravir 12, elvitegravir 108); NNRTI (efavirenz 499, rilpivirine 37); bPI (lopinavir 160, atazanavir 98, darunavir 73); Other (434); and NRTI (150). Separate model estimates based on fitting four separate models for patients initiating: (i) INSTI and NNRTI between 2007 and 2014 (raltegravir 53, dolutegravir 12, elvitegravir 108, efavirenz 240, rilpivirine 37); (ii) bPI and NNRTI between 2000 and 2014 (lopinavir 154, atazanavir 98, darunavir 73, efavirenz 467, rilpivirine 37); (iii) Other and NNRTI between 1998 and 2014 (Other 359, efavirenz 499, rilpivirine 37); and (iv) NRTI and NNRTI between 1998 and 2005 (NRTI 83, efavirenz 221). Adjusted models included age, sex, race, CD4 cell count, HIV RNA level and calendar year, all measured at ART initiation.