Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults: 2020 Recommendations of the International Antiviral Society–USA Panel

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Abstract

<p class="first" id="d4982081e289">Data on the use of antiretroviral drugs, including new drugs and formulations, for the treatment and prevention of HIV infection continue to guide optimal practices. </p>

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Most cited references 62

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Dolutegravir plus Two Different Prodrugs of Tenofovir to Treat HIV

Willem Venter, Michelle Moorhouse, Simiso Sokhela … (2019)

Two drugs under consideration for inclusion in antiretroviral therapy (ART) regimens for human immunodeficiency virus (HIV) infection are dolutegravir (DTG) and tenofovir alafenamide fumarate (TAF). There are limited data on their use in low- and middle-income countries.

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Weight Gain Following Initiation of Antiretroviral Therapy: Risk Factors in Randomized Comparative Clinical Trials

Paul Sax, Kristine Erlandson, Jordan Lake … (2019)

Abstract Background Initiation of antiretroviral therapy (ART) often leads to weight gain. While some of this weight gain may be an appropriate return-to-health effect, excessive increases in weight may lead to obesity. We sought to explore factors associated with weight gain in several randomized comparative clinical trials of ART initiation. Methods We performed a pooled analysis of weight gain in 8 randomized controlled clinical trials of treatment-naive people living with human immunodeficiency virus (HIV) initiating ART between 2003 and 2015, comprising >5000 participants and 10 000 person-years of follow-up. We used multivariate modeling to explore relationships between demographic factors, HIV disease characteristics, and ART components and weight change following ART initiation. Results Weight gain was greater in more recent trials and with the use of newer ART regimens. Pooled analysis revealed baseline demographic factors associated with weight gain including lower CD4 cell count, higher HIV type 1 RNA, no injection drug use, female sex, and black race. Integrase strand transfer inhibitor use was associated with more weight gain than were protease inhibitors or nonnucleoside reverse transcriptase inhibitors (NNRTIs), with dolutegravir and bictegravir associated with more weight gain than elvitegravir/cobicistat. Among the NNRTIs, rilpivirine was associated with more weight gain than efavirenz. Among nucleoside/nucleotide reverse transcriptase inhibitors, tenofovir alafenamide was associated with more weight gain than tenofovir disoproxil fumarate, abacavir, or zidovudine. Conclusions Weight gain is ubiquitous in clinical trials of ART initiation and is multifactorial in nature, with demographic factors, HIV-related factors, and the composition of ART regimens as contributors. The mechanisms by which certain ART agents differentially contribute to weight gain are unknown.

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Comparison of Overall and Comorbidity-Free Life Expectancy Between Insured Adults With and Without HIV Infection, 2000-2016

Julia L. Marcus, Wendy A Leyden, Stacey E. Alexeeff … (2020)

This cohort study compares overall life expectancy and comorbidity-free life expectancy by HIV status for insured adults with and without HIV infection from 2000 to 2016 in the US. Question Is antiretroviral therapy associated with improved survival among individuals with HIV infection? Findings In this cohort study of 39 000 adults with HIV infection and 387 785 adults without HIV infection in the US, individuals with HIV infection lived 6.8 fewer years overall and 9.5 fewer years without major chronic comorbidities, even after initiation of antiretroviral therapy at high CD4 cell counts. Meaning The results suggest that life expectancy of adults with HIV infection may be near that of life expectancy of individuals without HIV infection, but greater attention is needed to prevention of comorbidities among individuals with HIV infection. Importance Antiretroviral therapy (ART) has improved life expectancy for individuals with HIV infection, but recent data comparing life span and comorbidity-free years by HIV status are lacking. Objective To quantify the gap in life span and comorbidity-free years by HIV status among adults with access to care. Design, Setting, and Participants This matched cohort study used data from insured adults with and without HIV infection (aged ≥21 years) matched 1:10 at medical centers of Kaiser Permanente in northern and southern California and the mid-Atlantic states of Washington DC, Maryland, and Virginia from January 1, 2000, through December 31, 2016. Data were analyzed from September 1, 2019, through March 31, 2020. Exposures HIV status and, for individuals with HIV infection, ART initiation at a CD4 cell count of 500/μL or greater. Main Outcomes and Measures Overall life expectancy and expected years free of major chronic comorbidities, including chronic liver disease, chronic kidney disease, chronic lung disease, diabetes, cancer, and cardiovascular disease. Results Of 39 000 individuals with HIV infection and 387 785 matched uninfected adults, 374 421 (87.7%) were male, with a mean (SD) age of 41.4 (10.8) years. Among 359 244 individuals with known race/ethnicity, 90 177 (25.1%) were non-Hispanic black and 87 191 (24.3%) were Hispanic. From 2000 to 2003, overall life expectancy at age 21 years of age was 37.6 years among individuals with HIV infection and 59.7 years among uninfected adults, (difference, 22.1 years; 95% CI, 20.2-24.0 years). From 2014 to 2016, overall life expectancy at 21 years of age among individuals with HIV infection increased to 56.0 years compared with 65.1 years among uninfected adults (difference, 9.1 years; 95% CI, 7.9-10.2 years). During 2011 to 2016, individuals with HIV infection who initiated ART with a CD4 cell count of 500/μL or greater had a life expectancy at 21 years of age of 57.4 years compared with 64.2 years among uninfected adults (difference, 6.8 years; 95% CI, 5.0-8.5 years). From 2000 to 2003, the expected number of comorbidity-free years remaining at 21 years of age was 11.3 for individuals with HIV infection and 26.6 years for uninfected adults (difference, 15.3 years; 95% CI, 13.9-16.6 years). This difference in comorbidity-free years persisted over time but decreased to 9.5 years (95% CI, 7.7-11.2 years) for individuals with HIV infection who initiated ART at a CD4 cell count of 500/μL or greater. Conclusions and Relevance The results suggest that life expectancy of adults with HIV infection may be near that of life expectancy of individuals without HIV infection, but greater attention is needed to prevention of comorbidities among individuals with HIV infection.

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Journal

Title: JAMA

Abbreviated Title: JAMA

Publisher: American Medical Association (AMA)

ISSN (Print): 0098-7484

Publication date (Electronic): October 14 2020

Affiliations

[1 ]University of Alabama at Birmingham

[2 ]Harvard Medical School and Massachusetts General Hospital, Boston

[3 ]Monash University and Alfred Hospital, Melbourne, Australia

[4 ]University of California, Los Angeles

[5 ]AIDS Research Consortium of Atlanta, Atlanta, Georgia

[6 ]Harvard Medical School and Brigham and Women’s Hospital, Boston, Massachusetts

[7 ]University of California, San Diego, La Jolla

[8 ]San Francisco Department of Public Health and University of California, San Francisco

[9 ]Emory University School of Medicine, Atlanta, Georgia

[10 ]School of Medicine, University of North Carolina, Chapel Hill

[11 ]University Hospital Cologne, Cologne, Germany

[12 ]University Hospital Zurich and Institute of Medical Virology, University of Zurich, Zurich, Switzerland

[13 ]University of Paris and Saint-Louis/Lariboisière Hospitals, APHP, Paris, France

[14 ]International Antiviral Society–USA, San Francisco, California

[15 ]University of California, San Francisco

Article

DOI: 10.1001/jama.2020.17025

PubMed ID: 33052386

SO-VID: e6b111d0-1dac-42dc-8c58-21f96351d875

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Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults : 2020 Recommendations of the International Antiviral Society–USA Panel

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Most cited references 62

Dolutegravir plus Two Different Prodrugs of Tenofovir to Treat HIV

Weight Gain Following Initiation of Antiretroviral Therapy: Risk Factors in Randomized Comparative Clinical Trials

Comparison of Overall and Comorbidity-Free Life Expectancy Between Insured Adults With and Without HIV Infection, 2000-2016

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