Which antiretrovirals should be prescribed as first-line treatments? Changes over the past 10 years in France

Objective. - To describe the changes in first-line antiretroviral (ART) regimens in France between 2005 and 2015 and patients' characteristics related to the use of protease inhibitors in 2015. Methods. - We extracted all patients starting ART between 2005 and 2015 from a large prospective cohort. Regimens were classified as three nucleoside reverse transcriptase inhibitors (NRTI), or two NRTIs with a boosted protease inhibitor (bPI), with a non-nucleoside reverse transcriptase inhibitor (NNRTI), or with an INSTI. Patients' characteristics at the time of initiation were collected. A multinomial logit model was fitted to analyze characteristics related to the choice of regimen in 2015. Results. - We analyzed data from 15,897 patients. The proportion of patients starting with (i) a bPI decreased from 60% before 2014 to 38.1% in 2015; (ii) an NNRTI decreased from 30% to 17.8% in 2015; (iii) an INSTI gradually increased to 39.4% in 2015. In 2015, patients with an initial viral load >5 log copies/mL were less likely to receive NNRTI (OR = 0.08) or INSTI regimens (OR = 0.69) than bPIs. Patients with initial CD4(+) T cell count <200/mm(3) were less likely to receive an NNRTI (OR = 0.28) or an INSTI regimen (OR = 0.52) than a bPI. Women were less likely to receive an NNRTI (OR = 0.79) or an INSTI regimen (OR = 0.71) than a bPI; although this depended on age. Conclusion. - The use of bPI as first-line ART declined sharply in France from 2005 to 2015. bPI remained of preferential use in patients with high viral load, low CD4(+) T cell count, and in women. (C) 2018 Elsevier Masson SAS. All rights reserved.