First-line efavirenz + tenofovir disoproxil fumarate + emtricitabine/lamivudine (Atripla) remains effective overall in maintaining long-term viral suppression, a European study published in AIDS found.
While the World Health Organization now prefers first-line therapy based on dolutegravir instead of Atripla, dolutegravir-based treatment is not accessible everywhere at a low cost, study authors noted. By contrast, a generic version of Atripla is available around the world, and many patients remain on the regimen after being originally prescribed it in the 2000s and 2010s.
For this paper, data was analyzed from 19,527 participants in the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) and UK Collaborative HIV Cohort (UK CHIC) studies. Patients were followed for a median of 3.7 years after first being virally suppressed on Atripla. Rates of virologic failure and treatment interruption declined over the first three years, to less than 3.5/100 person-years for those who remained on the study regimen. Treatment interruption rates were also low.
However, results differed for some subgroups: Atripla was less successful among African-Americans, young people (< 35 years old), and those who reported acquiring HIV through injection drug use or heterosexual intercourse.
"The substantial differences in rates of [viral failure] and treatment interruption according to demographic and clinical characteristics may be useful for targeted monitoring and adherence interventions," the study authors concluded.