ArticleThe lancet. HIV2022
Associations of modern initial antiretroviral drug regimens with all-cause mortality in adults with HIV in Europe and North America: a cohort study.
Article in The lancet. HIV, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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11 citing papers in PubMed, 19 citations in OpenAlex.
- Virologic Outcomes of Common First-Line Antiretroviral Regimens Among Adults with HIV - China, 2021-2023.China CDC weekly · 2026Article
- Virologic, immunologic, and metabolic outcomes and mortality in people with HIV on bictegravir/emtricitabine/tenofovir alafenamide fumarate versus dolutegravir-based antiretroviral therapies: a retrospective multicenter cohort study in China.The Lancet regional health. Western Pacific · 2026Article
- Maternal Antiretroviral Use and the Risk of Prematurity and Low Birth Weight in Perinatally HIV-Exposed Children-7 Years' Experience in Two Romanian Centers.Medicina (Kaunas, Lithuania) · 2026Observational
- Persistent cell-associated HIV-1 RNA in virally suppressed individuals on INSTI-based ART.Journal of virus eradication · 2025Article
- Mortality using raltegravir versus other integrase strand-transfer inhibitors in people with HIV in Europe and Australia: a prospective multicentre study.EClinicalMedicine · 2025Article
- [HIV mortality trends in Mexico, 2000-2022].Revista medica del Instituto Mexicano del Seguro Social · 2024Article
- Prognostic prediction models for treatment experienced people living with HIV: a protocol for systematic review and meta-analysis.BMJ open · 2024Article
- Longitudinal trajectories of weight changes among people living with HIV on antiretroviral therapy: A group-based study.iScience · 2023Article
- Prevention, treatment and cure of HIV infection.Nature reviews. Microbiology · 2023Review
- Associations of modern initial antiretroviral therapy regimens with all-cause mortality in people living with HIV in resource-limited settings: a retrospective multicenter cohort study in China.Nature communications · 2023Article
- Long-Term Benefits from Early Antiretroviral Therapy Initiation in HIV Infection.NEJM evidence · 2023Article
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26 authors at 20 institutions in 11 countries.
Funding
Abstract
backgroundOver the past decade, antiretroviral therapy (ART) regimens that include integrase strand inhibitors (INSTIs) have become the most commonly used for people with HIV starting ART. Although trials and observational studies have compared virological failure on INSTI-based with other regimens, few data are available on mortality in people with HIV treated with INSTIs in routine care. Therefore, we compared all-cause mortality between different INSTI-based and non-INSTI-based regimens in adults with HIV starting ART from 2013 to 2018.
methodsThis cohort study used data on people with HIV in Europe and North America from the Antiretroviral Therapy Cohort Collaboration (ART-CC) and UK Collaborative HIV Cohort (UK CHIC). We studied the most common third antiretroviral drugs (additional to nucleoside reverse transcriptase inhibitor) used from 2013 to 2018: rilpivirine, darunavir, raltegravir, elvitegravir, dolutegravir, efavirenz, and others. Adjusted hazard ratios (aHRs; adjusted for clinical and demographic characteristics, comorbid conditions, and other drugs in the regimen) for mortality were estimated using Cox models stratified by ART start year and cohort, with multiple imputation of missing data.
findings62 500 ART-naive people with HIV starting ART (12 422 [19·9%] women; median age 38 [IQR 30-48]) were included in the study. 1243 (2·0%) died during 188 952 person-years of follow-up (median 3·0 years [IQR 1·6-4·4]). There was little evidence that mortality rates differed between regimens with dolutegravir, elvitegravir, rilpivirine, darunavir, or efavirenz as the third drug. However, mortality was higher for raltegravir compared with dolutegravir (aHR 1·49, 95% CI 1·15-1·94), elvitegravir (1·86, 1·43-2·42), rilpivirine (1·99, 1·49-2·66), darunavir (1·62, 1·33-1·98), and efavirenz (2·12, 1·60-2·81) regimens. Results were similar for analyses making different assumptions about missing data and consistent across the time periods 2013-15 and 2016-18. Rates of virological suppression were higher for dolutegravir than other third drugs.
interpretationThis large study of patients starting ART since the introduction of INSTIs found little evidence that mortality rates differed between most first-line ART regimens; however, raltegravir-based regimens were associated with higher mortality. Although unmeasured confounding cannot be excluded as an explanation for our findings, virological benefits of first-line INSTIs-based ART might not translate to differences in mortality.
fundingUS National Institute on Alcohol Abuse and Alcoholism and UK Medical Research Council.
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