Tolerability Drives Most ART Switch Decisions in Patients Living With HIV/AIDS

A retrospective study of a Colombian cohort examined the causes of antiretroviral switch in people living with HIV/AIDS, as well as the time to ART switch.

illustrated rendering of hiv virus

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There are many factors that can lead to clinicians considering a switch in a patient’s antiretroviral (ART) regimen, including pill burden, weight gain, gastrointestinal intolerance, or complications of comorbid conditions. However, interruption of an ART regimen by switching medications can potentially lead to resistance, rebound of viral loads, and also carries a risk of treatment failure.

In a poster presented at IDWeek 2022, held October 19-23, 2022, in Washington, DC, investigators in Colombia examined the causes of ART switch in people living with HIV/AIDS (PLWHA), as well as the time to ART switch, in a Colombian cohort. In patients requiring 2 or more ART switches, the team further analyzed the clinical and sociodemographical factors fueling those decisions.

Collecting data from 20 different HIV clinics and HIV care centers in Colombia, investigators conducted a review of databases and clinical records for this observational, multicenter, retrospective, analytical cohort study. Patient records were included in the review as long as the individual was > 18 years old, had confirmed HIV infection, and a history of changing ART between January 1, 2017, and December 31, 2019. Patients must have had at least 6 months of follow-up at their HIV clinics to be included in the study.

The research team relied on an exploratory Cox model as they performed a time to event analysis, and they used logistic regression to compare people with only 1 ART switch with those who registered more than 2 switches.

Data from 796 patients were included in the analysis. A total of 646 PLWHA registered 1 ART switch during the study period, and a majority (497, 76.9%) were male, < 50 years (456, 70.6%), and of mixed race (571, 88.4%). Among those who switched ART once, tolerability was the main reason for 367 (56.8%) individuals.

For those who switched ART 2 or more times, a majority were also male (117, 78.0%) , < 50 years (114, 76.0%), and of mixed race (128, 85.3%).

Tolerability drove faster ART switch decisions, with a median time to switch of 12.2 months, while simplification was the reason that took the longest time to act on (median 42.4 months).

“In the Cox model, we found that people 50 years or older [HR= 0.6; 95% CI (0.5-0.7)] and CDC stage 3 [HR= 0.8; 95% CI (0.6-0.9)] had less hazard for switching ART over time,” investigators reported.

“When comparing patients with only 1 ART switch versus those who had 2 or more ART switches, we found that having dyslipidemia increased the odds of switching ART more than 1 time [aOR=1.6; 95%CI (1.1- 2.4)]. As opposed to having CD4 counts greater than 200 cell/mL which decreases the odds of having more than one ART switch [aOR= 0.5; 95%CI (0.2-0.9)].”

Time to first switch also ranked shorter among the Colombian cohort compared with other countries. Overall, the results indicate that clinicians in Colombia should focus on choosing regimens with optimal tolerability profiles following current recommendations of ART initiation so as to limit switching when possible.

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