ABSTRACT ARCHIVE

Insights into the reasons for discontinuation and changes in the durability of the first line cART over time in Icona (Italian cohort of naive antiretrovirals)

Objectives: Changing treatment strategies over the last 10 years raised the issue of how the first line-treatment discontinuations and their causes have modified according to year of starting cART. We described the time spent on the first-line cART according to the reason of discontinuation and the predictors of discontinuation within 1 year after starting.
Methods: Patients who started cART (>2 drugs) when naïve with ³1 year of follow up on therapy were included. Time to discontinuing ³ 1 drug within the first year of cART for any reason, toxicity, failure, compliance, simplification (as reported in the cohort database) was analyzed by Kaplan-Meier curve; predictors of discontinuation were studied by logistic regression according to demographics, immunovirological parameters, calendar year of starting cART and regimen.
Results: Over a median follow up of 21 months (IQR 19-23) 72% of the 2740 patients enrolled discontinued therapy. 36% of the patients who started therapy in 1997-1999, 29% in 2000-2002 and 24% in 2003-2006 discontinued due to toxicity (the most frequent reason in each period). At one year the probability of discontinuing was 36% for any reason, 24% for toxicity, 20% compliance, 3% simplification, 5% failure. Patients who started cART in 2003-2006 compared to those who started in 1997-1999 had lower risk of discontinuing due to any reason (AOR 0.1 95%CI 0.06-0.1 vs 1997-1999), failure (AOR 0.4, 95%CI 0.2-0.8 vs 1997-1999), toxicity (AOR 0.3 95%CI 0.2-0.5 vs 1997-1999) and compliance (AOR 0.5 95%CI 0.3-0.8) and higer risk due to simplification (AOR 3.7 95%CI 2.2-5.9). Female sex (AOR 1.2 95%CI 0.9-1.5), HCV coinfection (AOR 1.2 95%CI 1.0-1.5), regimen started (2NRTI/bPI AOR 0.6 95%CI 0.4-0.9 and 2NRTI/1NNRTI AOR 0.3 95%CI0.2-0.4 vs 2NRTI/sPI) were predictors of discontinuation for any reason.
Conclusions: Toxicity was the most frequent reason for discontinuation. cART regimens started more recently showed higher durability, efficacy and tolerability.