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Integrase Inhibitor Use Doubles in Big Elderly Cohort--No Jump in 2-Drug Regimens / Use of 2-Drug ART
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HIV Drug Therapy, Glasgow 2018, October 28-31, 2018, Glasgow
Mark Mascolini
Among more than 1000 HIV-positive people older than 65 in Italy, the proportion taking an integrase inhibitor more than doubled from 20.9% in 2015 to 47.6% in 2017 [1]. Over the same years, GEPPO Cohort researchers saw no jump in use of double-antiretroviral regimens including an integrase inhibitor.
Prescribing for elderly people with HIV can pose challenges because many such people have multiple morbidities requiring drug therapy. Polypharmacy (in this analysis taking 5 or more non-HIV drugs), toxicity, and drug-drug interactions can result. Integrase inhibitors have gained popularity among all people with HIV and may simplify treatment in elderly people who might combine an integrase drug with only 1 other antiretroviral.
GEPPO Cohort investigators conducted this analysis to chart trends in integrase inhibitor use from August 2015 through November 2017 in HIV-positive people older than 65. The analysis involved 1183 antiretroviral-treated people in 2015 and 1526 people treated in 2017. From 2015 to 2017, the proportion of people taking an integrase inhibitor vaulted from 20.9% (247 of 1183) to 47.6% (726 of 1526) (P < 0.001). Over that same period frequency of dolutegravir use rose from 3.6% to 60.7% (P < 0.001), while raltegravir use slipped from 78.9% to 30.6% (P < 0.001).
Among elderly people taking an integrase inhibitor, 214 in 2015 and 217 in 2017 had demographic and clinical data available for analysis. The 2015 group included a higher proportion of men (80% versus 67% in 2017). Otherwise the 2015 and 2017 groups were similar in median age (70.5 and 71.7), years with HIV infection (18.7 and 16.3), years taking antiretrovirals (15.6 and 16), CD4 nadir (177 and 198), and current CD4 count (564 and 583).
The proportion of people taking a 2-drug regimen including an integrase inhibitor stayed flat at 40.5% in 2015 and 42.5% in 2017 (P = 0.63). The most popular 2-drug combos in 2017 were dolutegravir plus 3TC or FTC (23.1%), plus a nonnucleoside (22.1%), or plus a protease inhibitor (21.1%). Among people taking dolutegravir in 2017, more than half (55.5%) took it as part of a 2-drug combination.
The GEPPO team observed that dolutegravir-based 2-drug regimens "have a high genetic barrier [to resistance] and could save options and toxicity in patients with long antiretroviral experience, multimorbidities, and polypharmacy."
Reference
1. Nozza S, Calza S, Guaraldi G, et al. Use of integrase strand transfer inhibitors (INSTIs) in a cohort of HIV-infected geriatric patients (GEPPO cohort). HIV Drug Therapy, Glasgow 2018, October 28-31, 2018, Glasgow. Abstract P155.
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