Durability of multi-drug antiretroviral therapy (mega-ART) in treatment-experienced people with HIV in the ARCA database

ObjectiveTo explore the durability of multi-drug antiretroviral regimens in treatment-experienced PWH.DesignThis retrospective observational study including PWH who started mega-ART regimens between 1 January 2009 and 31 December 2019, selected from the ARCA cohort.MethodsTime-dependent events were analysed by Kaplan-Meier methods, while Cox regression models were used to define the predictors of mega-ART discontinuation.ResultsA total of 1,514 ART-experienced PWH were included. Over a median follow-up of 47 weeks (IQR 15-127), 1,299 (83%) mega-ART were interrupted, with an incidence of 85.62 per 100 person-years of follow-up. In the multivariable analysis, predictors of higher risk of mega-ART discontinuation were a higher number of antiretroviral drugs included in baseline regimens (aHR 1.206, CI 95% 1.016-1.431, <i>p</i> = .032) and a higher baseline HIV RNA log₁₀ (aHR 1.113, CI 95% 1.048-1.181, <i>p</i> < .001); otherwise, shorter duration of previous ART was associated with a lower risk of discontinuation (aHR 0.982, CI 95% 0.965-0.999, <i>p</i> = .037). When mega-ART was stopped, 299 PWH (23%) had HIV RNA levels above 50 copies/ml, 16/299 (1%) had HIV RNA levels >50 copies/ml but less than 200 copies/ml, 792 PWH (61%) had HIV RNA levels below 50 copies/ml, and 208 PWH (16%) had an undetermined HIV RNA load.ConclusionsMega-ART was characterized by limited durability and poor virological success.