Background

Real-world comparisons of initial antiretroviral third-drug classes are limited in middle-income settings. We evaluated whether the initial third-drug class predicts time to loss of virologic suppression in Colombia.

Methods

Historical cohort of 609 ART-naïve adults (2016-2020). Outcome: first HIV RNA ≥200 copies/mL. We compared NNRTI, PI, and INSTI regimens using adjusted and IPTW-weighted Cox models.

Results

Regimens were NNRTI (72%), PI (20%), and INSTI (8%); 19.9% lost suppression. Compared with NNRTI, PIs showed higher but nonsignificant hazards (aHR 1.50, 95% CI 0.98-2.27). For INSTIs, we did not detect significant differences (aHR 1.22, 95% CI 0.64-2.31). Diagnosis-to-ART delays and treatment interruptions were associated with loss of suppression.

Conclusions

Treatment continuity and timely initiation predicted sustained suppression better than drug class. Low INSTI usage limits statistical power to detect differences. Structural barriers to continuity may limit the real-world benefit of newer regimens.

Plain Language Summary Title

Impact of treatment continuity and drug choice on HIV viral suppression in a Colombian cohort (2016-2020)

Plain Language Summary

Why was the study done? When people start HIV treatment, most first regimens include 2 “backbone” medicines plus a third medicine from one of several common drug groups. Newer “integrase inhibitor” drugs are often recommended, but there is limited evidence from everyday clinical care in middle-income countries. What did the researchers do? We reviewed medical records from 609 adults who started their first HIV treatment between 2016 and 2020 in 9 HIV care centers in Colombia. We checked whether the type of third medicine in the first regimen was linked to losing viral suppression over the next 2 years. Viral suppression means the amount of HIV in the blood stays very low; losing suppression means the virus becomes detectable again. What did the researchers find? About 1 in 5 people lost viral suppression within 2 years. Overall, we did not detect statistically significant differences in loss of suppression between the main third-medicine groups. However, the number of patients taking newer drugs was small, which limits the ability to detect differences. In contrast, treatment interruption (stopping treatment for a time) and starting treatment later after diagnosis were strongly linked to losing suppression. What do the findings mean? These results suggest that, in routine Colombian care, protecting continuous access to HIV medicines, supporting people to stay on treatment, and reducing administrative barriers are critical to maximize the real-world effectiveness of any drug regimen chosen at the start.

Search results

Initial Antiretroviral Third-Drug Class and Time to Loss of Virologic Suppression: A Real-World Colombian Cohort Study