Factors Associated with Virological Failure in First-Line Antiretroviral Therapy in Patients Diagnosed with HIV-1 between 2010 and 2018 in Israel

Tali Wagner, Itzchak Levy, Daniel Elbirt, Eduardo Shahar, Karen Olshtain-Pops, Hila Elinav, Michal Chowers, Valery Istomin, Klaris Riesenberg, Dikla Geva, Neta S. Zuckerman, Marina Wax, Rachel Shirazi, Yael Gozlan, Natasha Matus, Shirley Girshengorn, Rotem Marom, Ella Mendelson, Orna Mor*, Dan Turner

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Despite the progress in contemporary antiretroviral therapy (ART) and the continuous changes in treatment guidelines, virological failure (VF) is still an ongoing concern. The goal of this study was to assess factors related to VF after first-line ART. A longitudinal cohort retrospective study of individuals on first-line ART diagnosed with HIV-1 in 2010–2018 and followed-up for a median of two years was conducted. Demographics, baseline and longitudinal CD4 counts, treatment regimens, adherence and VF were recorded. The Cox proportional hazards regression and mixed models were used. A cohort of 1130 patients were included. Overall, 80% were males and 62% were Israeli-born individuals. Compared to individuals diagnosed in 2010–2014, when treatment was initiated according to CD4 levels, those diagnosed in 2015–2018 were older and had lower baseline CD4 counts. VF was recorded in 66 (5.8%) patients. Diagnosis with CD4 <200 cells/mmᶟ with AIDS-defining conditions (HR = 2.75, 95%CI:1.52–4.97, p < 0.001) and non-integrase strand transfer inhibitor regimens (non-INSTI, HR = 1.80, 95%CI:1.01–3.24, p = 0.047) increased VF risk. No impact of baseline resistance was observed. We concluded that the early detection of HIV-1 infection and usage of INSTI-based regimens are recommended to reduce VF.

Original languageEnglish
Article number2439
JournalViruses
Volume15
Issue number12
DOIs
StatePublished - Dec 2023

Keywords

  • CD4 trajectory curves
  • HIV-1
  • INSTI regimens
  • adherence
  • first-line ART
  • people living with HIV-1 (PLHIV)
  • virological failure (VF)

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