We evaluated treatment duration and viral suppression (VS) outcomes with integrase strand transfer inhibitor (INSTI)-based regimens versus other contemporary regimens among adults in routine HIV care. Eligible participants were seen during January 1, 2007 to June 30, 2018 at nine U.S. HIV clinics, initiated antiretroviral therapy (ART) (baseline date), and had ≥2 clinic visits thereafter. We assessed the probability of remaining on a regimen and achieving HIV RNA <200 copies/mL on initial INSTI versus non-INSTI ART by Kaplan–Meier analyses and their correlates by Cox regression. Among 1,005 patients, 335 (33.3%) were prescribed an INSTI-containing regimen and 670 (66.7%) a non-INSTI regimen, which may have included non-nucleoside reverse transcriptase inhibitors, protease inhibitors, and other agents. In both groups, most patients were male, nonwhite, and aged <50 years. Comparing the INSTI with non-INSTI group, the median baseline log₁₀ HIV viral load (VL; copies/mL) was 4.6 versus 4.5, and the median CD4⁺ cell count (cells/mm³) was 352 versus 314. In Kaplan–Meier analysis, the estimated probabilities of remaining on initial regimens at 2 and 4 years were 58% and 40% for INSTI and 51% and 33% for non-INSTI group, respectively (log-rank test p = .003). In multivariable models, treatment with an INSTI (vs. non-INSTI) ART was negatively associated with a regimen switch [hazard ratio (HR) 0.67, 95% confidence interval (CI) 0.56–0.81, p < .001] and was positively associated with achieving VS (HR 1.52; CI 1.29–1.79, p < .001), both irrespective of baseline VL levels. Initial INSTI-based regimens were associated with longer treatment durations and better VS than non-INSTI regimens. Results support INSTI regimens as the initial therapy in U.S. treatment guidelines.

中文翻译：

---

基于 INSTI 的成人 HIV 患者初始抗逆转录病毒治疗，HIV 门诊研究，2007-2018

我们在常规 HIV 护理中评估了基于整合酶链转移抑制剂 (INSTI) 的方案与其他当代方案的治疗持续时间和病毒抑制 (VS) 结果。符合条件的参与者于 2007 年 1 月 1 日至 2018 年 6 月 30 日在美国 9 家 HIV 诊所就诊，开始抗逆转录病毒治疗 (ART)（基线日期），此后进行了≥2 次诊所就诊。我们通过 Kaplan-Meier 分析评估了在初始 INSTI 与非 INSTI ART 中保持方案并实现 HIV RNA <200 拷贝/mL 的可能性，并通过 Cox 回归评估了它们的相关性。在 1,005 名患者中，335 名 (33.3%) 接受了包含 INSTI 的方案，670 名 (66.7%) 接受了非 INSTI 方案，其中可能包括非核苷逆转录酶抑制剂、蛋白酶抑制剂和其他药物。在两组中，大多数患者都是男性，非白人，年龄 <50 岁。比较 INSTI 与非 INSTI 组，中位基线日志₁₀ HIV 病毒载量（VL；拷贝/mL）为 4.6 对 4.5，CD4 ⁺细胞计数（细胞/mm ³）中位数为 352 对 314。在 Kaplan-Meier 分析中，估计在 2 INSTI 组和 4 年分别为 58% 和 40%，非 INSTI 组分别为 51% 和 33%（对数秩检验p  = .003）。在多变量模型中，使用 INSTI（与非 INSTI）ART 治疗与方案转换呈负相关 [风险比 (HR) 0.67，95% 置信区间 (CI) 0.56–0.81，p  < .001] 且呈正相关与实现 VS 相关（HR 1.52；CI 1.29–1.79，p < .001)，无论基线 VL 水平如何。与非 INSTI 方案相比，基于 INSTI 的初始方案与更长的治疗持续时间和更好的 VS 相关。结果支持 INSTI 方案作为美国治疗指南中的初始治疗。