[Association between initial antiretroviral therapy regimens and virological outcomes in HIV-infected individuals in Taizhou, Zhejiang Province, 2006-2025].

Objective

To analyze the association between the initial antiretroviral therapy (ART) regimens and virological outcomes among HIV-infected individuals in Taizhou, Zhejiang Province, 2006-2025.

Methods

The data were collected from the China Information System for Disease Control and Prevention. The subjects were HIV-infected individuals in Taizhou from 2006 to 2025, who received ART for ≥24 weeks and underwent viral load testing ≥2 times. Cox proportional hazards regression model analysis was used to examine the association between the initial ART regimens and virological outcomes.

Results

A total of 3 710 HIV-infected individuals were included. Apart from the two nucleotide reverse transcriptase inhibitors backbone drugs, the proportions of selecting efavirenz (EFV), nevirapine (NVP), lopinavir/ritonavir (LPV/r), dolutegravir (DTG), and other drugs as the third drug were 80.22% (2 976/3 710), 15.12% (561/3 710), 1.32% (49/3 710), 1.08% (40/3 710), and 2.26% (84/3 710) respectively-205 individuals (5.53%) with virological failure. The M(Q1, Q3) follow-up time at the time of virological failure was 1.76 (1.36, 2.26) years, and the virological failure rate was 3.03/100 person-years. When grouped by ART regimens, the proportions of virological failure in the EFV group, NVP group, LPV/r group, DTG group, other group were 4.20% (125/2 976), 13.55% (76/561), 6.12% (3/49), 0.00% (0/40), and 1.19% (1/84), respectively. The virological failure rate in the NVP group was higher (P<0.001). After adjusting for the educational level of the study subjects, initial CD4+T lymphocyte counts, initial viral load, time interval from diagnosis to ART initiation, and the year of ART initiation, the risk of virological failure in the NVP group was 4.93 times that of the [integrase inhibitors/protease inhibitors(INSTI/PI)] group (95%CI: 1.73-14.05), and 2.72 times that of the EFV group (95%CI: 1.92-3.85).

Conclusion

Among HIV-infected individuals in Taizhou who received NVP-based initial ART regimens between 2006 and 2025, the risk of virological failure was higher than among those who received EFV-based or INSTI/PI-based regimens, suggesting that when formulating ART regimens in clinical practice, the use of regimens based on EFV or INSTI/PI should be given priority.