Durability of Integrase STrand Inhibitor (InSTI)-based regimen in geriatric people living with HIV in the GEPPO cohort

PLoS One. 2021 Oct 13;16(10):e0258533. doi: 10.1371/journal.pone.0258533. eCollection 2021.

Abstract

Objective: To investigate the durability of the first integrase inhibitor-based regimen in a HIV geriatric multicentric prospective cohort and to explore the reasons of regimen discontinuation.

Design: This is an analysis conducted on the Geriatric Patients Living with HIV/AIDS (GEPPO) cohort, an Italian prospective observational multicentre cohort of people living with HIV with 65 years of age or more.

Methods: The analysis was performed using R (version 4.0.2). The tests performed were two sided assuming a 5% significance level (Kruskal-Wallis test, Chi-squared test, log-rank test and a Cox Proportional Hazard model). The proportion of participants discontinuing the three regimens was displayed using cumulative curves.

Results: Among 1531 patients enrolled between 2017 and 2019 in the GEPPO cohort, we included 822 participants in this analysis. At baseline, median age was 69.8, the immunovirological profile good, multimorbidity was present in 42.3% of participants, while 27.4% were on polypharmacy. Overall, 483, 243 and 96 participants received DTG, RAL and EVG/c respectively as first InSTI. At the end of the follow up 6.4%, 21.1% and 22.9% participants discontinued DTG, RAL and EVG/c respectively. Using a log-rank test, EVG showed a significantly lower durability than DTG (p<0.001) or RAL (p 0.05) or both, DTG and RAL (p<0.001). Among participants who discontinued their regimen we found 0 virological failure and 56.7% simplification/deprescription.

Conclusions: The three integrase inhibitors considered showed a good durability and no virological failures in geriatric patients such as those enrolled in the GEPPO cohort when used in a two or three drug regimen.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Amides / therapeutic use
  • Anti-Retroviral Agents / therapeutic use
  • Drug Therapy, Combination
  • Female
  • HIV Infections / drug therapy*
  • HIV Integrase Inhibitors / therapeutic use*
  • Heterocyclic Compounds, 3-Ring / therapeutic use
  • Humans
  • Longitudinal Studies
  • Male
  • Medication Adherence
  • Oxazines / therapeutic use
  • Piperazines / therapeutic use
  • Polypharmacy
  • Proportional Hazards Models
  • Prospective Studies
  • Pyridones / therapeutic use
  • Quinolones / therapeutic use
  • Raltegravir Potassium / therapeutic use
  • Treatment Outcome

Substances

  • Amides
  • Anti-Retroviral Agents
  • HIV Integrase Inhibitors
  • Heterocyclic Compounds, 3-Ring
  • Oxazines
  • Piperazines
  • Pyridones
  • Quinolones
  • Raltegravir Potassium
  • elvitegravir
  • bictegravir
  • dolutegravir

Grants and funding

The GEPPO project is funded through an independent grant by ViiV Healthcare IT and supported by Penta Foundation. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.