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Older and Transgender People Less Likely to Get Integrase Drugs in Big DC Cohort
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IDWeek, October 2-6, 2019, Washington, DC
Mark Mascolini
Older age and transgender status predicted a lower chance of getting an integrase strand transfer inhibitor (INSTI) prescription in a large Washington, DC cohort [1]. Hispanics had a better chance of getting INSTIs than blacks. And having a major nucleoside (NRTI) or nonnucleoside (NNRTI) mutation independently predicted current or previous INSTI use.
US antiretroviral guidelines now recommend INSTIs as the only first-line therapy for most people with HIV infection. George Washington University researchers who conducted this study speculated that many clinicians switched patients from NNRTIs or protease inhibitors to INSTIs because of these recommendations, and because of the potency and tolerability of INSTIs. They conducted this cross-sectional analysis to identify factors predicting which people with HIV take an INSTI regimen.
The DC Cohort is an observational, longitudinal study of people with HIV infection at 14 sites in Washington, DC. This analysis focused on antiretroviral-experienced cohort members at least 18 years old on June 30, 2018 who had one or more study visits between April 2017 and March 2018. The investigators used multivariate multinomial logistic regression adjusted for demographics, clinical factors, and HIV-related variables to identify predictors of INSTI use.
Among the 4584 study participants, 58.2% were 50 or older, 69.4% male, 2.5% transgender, 80.3% black, and 36% men who have sex with men (MSM). While 2978 people (65%) currently took an INSTI, 1299 (28%) never took an INSTI, and 307 (7%) formerly used an INSTI.
Multivariate analysis identified seven independent predictors of current versus never INSTI use at the following adjusted odds ratios (aOR) and 95% confidence intervals (CI):
Higher chance of current INSTI use:
-- Age 18-24 vs 50+: aOR 1.90, 95% CI 1.18 to 3.06
-- Major NRTI mutation: aOR 2.00, 95% CI 1.58 to 2.53
-- Major NNRTI mutation: aOR 1.56, 95% CI 1.24 to 1.95
-- Hispanic vs black: aOR 1.39, 95% CI 1.05 to 1.84
-- Current alcohol use: aOR 1.16, 95% CI 1.00 to 1.35
-- Latest viral load above 50 copies: aOR 1.26, 95% CI 1.06 to 1.49
Lower chance of current INSTI use:
-- Transgender vs male: aOR 0.48, 95% CI 0.32 to 0.72
A somewhat different set of factors predicted former versus never INSTI use:
Higher chance of former INSTI use:
-- Women vs men: aOR 1.36, 95% CI 1.03 to 1.80
-- Major NRTI mutation: aOR 2.37, 95% CI 1.63 to 3.44
-- Latest viral load above 50 copies: aOR 2.09, 95% CI 1.57 to 2.77
The researchers underlined their findings that older people and transgender people proved less likely to have an INSTI prescription than younger people or men. Blacks in this cohort proved less likely to get an INSTI prescription than Hispanics. They called for further research to explore whether lower prescription of INSTIs to these groups "is detrimental for long-term HIV outcomes." The investigators believe their results suggest resistance history is an important determinant of INSTI prescription.
Reference
1. Monroe AK, Levy ME, Greenberg AE, et al. Differences between individuals currently taking integrase inhibitor (INSTI)-based therapy and those not taking INSTIs in the era of INSTIs as recommended first-line therapy. IDWeek, October 2-6, 2019, Washington, DC. Abstract 2492.
Differences between individuals currently taking integrase inhibitor (INSTI)-based therapy and those not taking INSTIs in the era of INSTIs as recommended first-line therapy
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