Work

Uptake and Virologic Outcomes of 1-Pill versus Multipill Antiretroviral Therapy Among Treatment-Naive Nonperinatally HIV-Infected Youth (2006–2014)

Year: 2016

Type: article

Abstract: Background. Youth with HIV often struggle with sustaining adherence to antiretroviral therapy (ART). Decreased pill burden may be associated with better ART adherence and several 1-pill regimens are recommended for first-line ART for youth. We evaluated the factors associated with initiation of 1-pill versus multipill ART and the related virologic outcomes in treatment of naive nonperinatally HIV-infected (nPHIV) youth. Methods. Retrospective analysis of treatment-naive nPHIV youth aged 12–24 followed at 19 US HIV clinical sites in the HIV Research Network from 2006 to 2014. Cox proportional hazards regression was used to assess time to initial virologic suppression (<400 copies/mL) within the first year. Demographic and clinical factors associated with initiation of 1-pill versus multi-pill ART and virologic suppression 1 year (± 3 months) after initiation were assessed using multivariable logistic regression. Results. Of 1646 treatment-naive nPHIV youth, 62% initiated 1-pill ART (72% EFV/TDF/FTC), with increasing proportion yearly (47% in 2006 to 78% in 2014). Male gender (AOR 5.63, 95% CI: 3.63–8.74) and CD4 count >200 cells/mm3(AOR 1.79, 95% CI: 1.34–2.37) were independently associated with increased likelihood of 1-pill initiation. Adjusting for other factors (sex, race, baseline CD4 and viral load (VL), adult versus pediatric site, HIV risk) 1-pill ART was associated with increased likelihood of initial viral suppression within 1 year of initiation compared to multipill (HR 1.16, 95% CI: 1.03–1.31). For those with VL data at 9–15 months, adjusting for the same factors, use of 1-pill ART was associated with virologic suppression (AOR 1.80, 95% CI 1.28–2.52). A similar proportion in the 1-pill and multipill groups did not have VL data 9–15 months after ART initiation (37% and 39%, respectively). Conclusion. Use of 1-pill ART is associated with greater likelihood of initial virologic suppression as well as sustained suppression 1 year after ART initiation. More than one-third of nPHIV youth in both groups had no available VL measurements 1 year after ART initiation, suggesting that a significant proportion are suboptimally engaged in care. Use of 1-pill ART may improve virologic suppression among youth; however, interventions to sustain engagement in care are critical to ultimately improving overall outcomes in this age group. Disclosures. A. E. Nijhawan, Gilead: Investigator, Research support

Source: Open Forum Infectious Diseases

DOI: 10.1093/ofid/ofw172.1245