The efficacy of initial antiretroviral therapy regimens in real life is lower than that shown in phase 3 trials, with post-2010 regimens failing in >20% of people over three years, a systematic review published in AIDS showed.
Researchers compared data from 181 studies published between 1994 and mid-2017 comprising a total of 77,999 participants. Mean intention-to-treat efficacy increased with newer regimens; for instance, looking at 144-week results, efficacy averaged 77.1% among studies published after 2010, compared to 61.8% overall. The corresponding numbers for week-48 results were 83.8% among studies published after 2010 compared to 71.3% overall.
Integrase inhibitor- and tenofovir-based regimens predicted greater efficacy at all time points. Resistance genotyping before treatment and once-daily antiretroviral treatment also predicted viral control at week 48.
To further increase real-world regimen efficacy, study authors recommended that initial regimens not based on integrase inhibitors be listed as non-preferred in guidelines, access to pre-antiretroviral genotyping be improved, and early start of once-daily treatment be increased. They also called for collecting socioeconomic data during clinical trials, conducting longer post-approval studies, and incorporating real-world data into guideline development, among other recommendations.