Simplifying is the main reason for discontinuing ART

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One of the main reasons individuals living with HIV discontinue their first antiretroviral therapy regimen is a desire to simplify their regimen, according to a new study.

BodyPro reports that the study analysed data from 4,052 individuals in Italy who started antiretroviral therapy between 2008 and 2014, and subsequently discontinued their regimen, which was defined as stopping or switching at least one of the drugs in a regimen. The study population was mostly male (78.9%) with a median age of 39.

About 29% discontinued because of simplification, defined by the researchers as either reducing the number of drugs in the regimen or reducing the number of daily doses or pills. Unsurprisingly, this included a preference for a single-tablet regimen. About 21% discontinued because of intolerance, defined as the patient’s general unwillingness or refusal to tolerate the drug, but not because of any clinical signs of the drug’s harmfulness. About 19% discontinued because of toxicity, which was defined as adverse effects related to drug exposure.

Looking further, 18% discontinued because of other causes, including personal choice, pregnancy, enrolling in or ending of a clinical trial, and drug-drug interactions.

Finally, 8% discontinued because of failure, 4% because of a planned discontinuation, and 2% because of non-adherence. Also, based on patient data available on viral load status, 98.9% of participants had an undetectable viral load after two years of starting treatment.

Although there was a variety of initial treatment regimens, the choice of simplification – particularly to a single-tablet regimen – was the leading reason for discontinuation, so the researchers concluded there is a clear trend toward tailoring treatment regimens, the researchers concluded.

Abstract
Background: Study aim was to estimate the rate and identify predictors of discontinuation of first combination antiretroviral therapy (cART) in recent years.
Methods: Patients who initiated first cART between January 2008 and October 2014 were included. Discontinuation was defined as stop of at least 1 drug of the regimen, regardless of the reason. All causes of discontinuation were evaluated and 3 main endpoints were considered: toxicity, intolerance, and simplification. Predictors of discontinuation were examined separately for all 3 endpoints. Kaplan–Meier analysis was used for the outcome discontinuation of ≥1 drug regardless of the reason. Cox regression analysis was used to identify factors associated with treatment discontinuation because of the 3 reasons considered.
Results: A total of 4052 patients were included. Main reason for stopping at least 1 drug were simplification (29%), intolerance (21%), toxicity (19%), other causes (18%), failure (8%), planned discontinuation (4%), and nonadherence (2%). In a multivariable Cox model, predictors of discontinuation for simplification were heterosexual transmission (P = 0.007), being immigrant (P = 0.017), higher nadir lymphocyte T CD4+ cell (P = 0.011), and higher lymphocyte T CD8+ cell count (P = 0.025); for discontinuation due to intolerance: the use of statins (P = 0.029), higher blood glucose levels (P = 0.050). About toxicity: higher blood glucose levels (P = 0.010) and the use of zidovudine/lamivudine as backbone (P = 0.044).
Conclusions: In the late cART era, the main reason for stopping the initial regimen is simplification. This scenario reflects the changes in recommendations aimed to enhance adherence and quality of life, and minimize drug toxicity.

Full report in The BodyPro
Journal of Acquired Immune Deficiency Syndromes material


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