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Title
Probability of single tablet regimens BIC/FTC/TAF, E/C/F/TAF, RPV/FTC/TAF, DTG/RPV or DTG/ABC/3TC discontinuation at 18 months in real life settings in the ANRS-CO3 - AquiVIH-NA cohort
Presenter
Olivier Leleux
Authors
O. Leleux1, A. Peyrouny- Mazeau1, A. Perrier1, M. Hessamfar2, G. Le Moal3, D. Neau4, H. Wille5, C. Cazanave4, E. Lazaro6, P. Duffau2, B. Castan7, V. Gaborieau8, L. Wittkop1,9, F. Bonnet1,2
Institutions
1Bordeaux Population Health Research Center, INSERM U 1219, CIC-EC 1401, Univ. Bordeaux - ISPED, Bordeaux, France, 2Centre Hospitalier Universitaire (CHU) de Bordeaux, Service de Médecine Interne et Maladies Infectieuses, Hôpital Saint-André, Bordeaux, France, 3Centre Hospitalier Universitaire (CHU) de Poitiers, Service de Maladies Infectieuses et Tropicales, Poitiers, France, 4Centre Hospitalier Universitaire (CHU) de Bordeaux, Service de Maladies Infectieuses et Tropicales, Hôpital Pellegrin, Bordeaux, France, 5Centre Hospitalier de la Côte Basque, Service de Maladies Infectieuses, Bayonne, France, 6Centre Hospitalier Universitaire (CHU) de Bordeaux, Service de Médecine Interne et Maladies Infectieuses, Hôpital Haut-Lévèque, Pessac, France, 7Centre Hospitalier de Périgueux, Service de Maladies Infectieuses et Tropicales, Périgueux, France, 8Centre Hospitalier de Pau, Service de Maladies Infectieuses, Pau, France, 9Centre Hospitalier Universitaire (CHU) de Bordeaux, Service d’Information Médicale, Bordeaux, France

BACKGROUND: Single tablet regimens (STRs) have been associated with improved adherence to treatment for people living with HIV (PLWH) and now account for the vast majority of treatments in France. However, the probability of STRs discontinuation and virological failure (VF) in suppressed HIV RNA persons who start STRs in real life settings is unknown.
METHODS: PLWH included in the French regional prospective cohort ANRS-CO3-AquiHIV-NA were included if they had a suppressed HIV RNA and CD4 count available when switching to one of the following regimens BIC/FTC/TAF, E/C/F/TAF, DTG/RPV, RPV/FTC/TAF or DTG/ABC/3TC at least once during their follow-up between 2018/01/01 and 2021/12/31.
RESULTS: During the period, 2934 PLWH have received at least once STRs, which represent 3243 STRs different lines (299 PLWH add two or more STRs), 1182 BIC/FTC/TAF, 307 E/C/F/TAF, 413 DTG/RPV, 1147 RPV/FTC/TAF, 194 DTG/ABC/3TC regimens. Women represented 29% of PLWHA, ranging from 26% on BIC/FTC/TAF to 33.0% on DTG/ABC/3TC. Median age was 52.5 years ranging from 50.5 years on E/C/F/TAF and DTG/RPV to 55.9 years DTG/RPV; 17.9% were AIDS stage, ranging from 14.7% on RPV/FTC/TAF to 22,2% on DTG/ABC/3TC; 13.5% were sub-saharian African origin ranging from 8% on DTG/RPV to 16.2% on RPV/FTC/TAF. The median CD4 count was 702 cells/mm3 [IQR: 510-922].
At 18 months of follow-up, the cumulative probability (Aalen Johansen method) of STRs discontinuation was 19.5% overall [IQR: 18,1-21.0%], 16.9% [IQR: 13.0-21.1%] for DTG/RPV, 17.0% [IQR: 14.8-19.3%] for RPV/FTC/TAF, 17.8% [IQR: 15.4-20.2%] for BIC/FTC/TAF, 26.3% [IQR: 21.3-31.6%] for E/C/F/TAF, and 37.9% [IQR: 30.7-45.0%] for DTG/ABC/3TC.
The main reported causes of discontinuation were side-effects (33%), physician choice (21%) non-optimal treatment (18%) and person’s choice (12%).
At 18 months, 3.3% [IQR: 2.6-4.0%] of PLWH had a cumulative probability of VF on STRs (two consecutive HIV RNA >50 cp/ml or one >1000 cp/ml), ranging from 2.3% [IQR: 1.5-3.4%] on RPV/FTC/TAF and 7.7% [IQR: 3.9-13.2%] on DTG/ABC/3TC.
CONCLUSIONS: The highest risk of discontinuation at M18 was observed on the E/C/F/TAF and DTG/ABC/3TC strategies. Virus-suppressed PLWH who switched to one of the STRs maintained virologic suppression with a low risk of VF observed in 3,3% of PLWH.

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