EACS2023: 283 Comparative observational study of darunavir/cobicistat/emtricitabine/tenofovir alafenamide versus bictegravir/emtricitabine/tenofovir alafenamide in high-risk non-adherent people living with HIV H. Knobel , C. Canepa , M.J. Fernández-Quiroga , I. Arrieta , E. Cañas-Ruano , J. Villar , A. Guelar , A. Marcos , R. Güerri , A. González Hospital del Mar, Infectious Diseases, Barcedlona, Spain General data Abstract category: Antiretroviral therapy – observational studies Abstract body Purpose: Antiretroviral therapy (ART) selection for people living with HIV (PLWH) at high risk of non-adherence is challenging. Limited studies exist on this population. Our objective was to evaluate the effectiveness of darunavir/cobicistat/emtricitabine/tenofovir alafenamide (D/C/F/T) and bictegravir/emtricitaibine/tenofovir alafenamide (B/F/T) in this population. Method: We conducted a retrospective single-center observational study in Barcelona, Spain, from January 2018 to April 2023. Inclusion criteria were age ≥18 years-old, HIV-1 RNA ≥1000 copies/mL, and presence of one or more risk factors for nonadherence (alcoholism, drug use, psychiatric disorder, methadone use, language barrier, social issues, treatment refusal, previous missed appointments). Exclusion criteria included resistance mutations to D/C/F/T or B/F/T components. The primary endpoint was the proportion of participants achieving HIV-RNA < 200 copies/mL at the end of follow-up using intention-to-treat (ITT) analysis. Secondary endpoints included adherence, safety, and observed HIV-RNA < 50 copies/mL at 48 weeks (excluding participants with missing data). Descriptive statistics, Wilcoxon rank sum test, and chi-square test were used for data analysis. Results: Ninety-seven PLWH were included, 36 received D/C/F/T and 61 received B/F/T. Baseline characteristics and risk factors for non-adherence are summarized in Table 1. Table 2 illustrates the evolution of adherence, effectiveness, and safety for both treatments.). PLWH who received D/C/F/T and B/F/T achieved the primary endpoint at rates of 50% and 68.9%, respectively (P: 0.07). When adjusting for adherence, there was no significant difference in the outcome between both groups. All individuals with treatment interruption and intermittent high viremia during follow-up achieved viral re-suppression (15 from D/C/F/T and 16 from B/F/T). Only 1 participant in the D/C/F/T developed the M184V mutation. Conclusions: Both treatments are good therapeutic options for PLWH at high risk of non-adherence to ART. Even in cases with treatment interruptions, the re-suppression of viral load was possible and the development of resistance was exceptional. General conditions 1. I confirm that I previewed this abstract and that all information is correct. I accept that the content of this abstract cannot be modified or corrected after the submission deadline and I am aware that it will be published exactly as submitted.: Yes 2. I confirm that the submission of the abstract constitutes my consent to publication (e.g. conference website, programmes, other promotions, etc.). : Yes 3. I herewith confirm that the contact details saved in this system are those of the corresponding author, who will be notified about the status of the abstract. The corresponding author is responsible for informing the other authors about the status of the abstract.: Yes 4. I agree that all data provided may be used (saved, stored, processed, transmitted and deleted) in compliance with the privacy policy to provide the services described.: Yes 1 1 1 1 1 1 1 1 1 1 1 95
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