Treatment persistence of bictegravir/emtricitabine/tenofovir alafenamide and efavirenz+lamivudine+tenofovir disoproxil among HIV-1 patients newly starting treatment in China

Abstract Background: Though bictegravir/emtricitabine/tenofovir (BIC/TAF/TAF) have been regulatory approved and included in the National Reimbursement Drug List in China, due to the affordability concern, generic version of efavirenz+lamivudine+tenofovir (EFV+3TC+TDF) is still recommended as the 1st-line therapy in the clinical guideline and widely used in clinical practice. The aim of the study is to assess the persistence with 1st-line BIC/TAF/TAF and EFV+3TC+TDF in newly treated HIV-1 patients in the real-world setting in China. Methods: A retrospective analysis of the medical records of HIV patients initiating 1st-line antiretroviral therapy in the First Hospital of Changsha in January 1st, 2021-July 31st, 2022 was conducted. Persistence was assessed as the number of days on the therapy from the index until treatment discontinuation or end of data availability. Kaplan-Meier Curves and Cox Proportional Hazard models were used to evaluate the discontinuation rates. Subgroup analysis was performed excluding BIC/FTC/TAF patients with treatment discontinuation due to economic reason, and EFV+3TC+TDF patients with a viral load >500,000 copies/mL. Results: A total of 310 eligible patients were included in the study, with 244 and 66 patients in the BIC/FTC/TAF group and EFV+3TC+TDF group, respectively. Compared with EFV+3TC+TDF patients, BIC/FTC/TAF patients were significantly younger and had significantly higher total cholesterol and low-density level (all p<0.05). No significant difference was shown in the time to discontinuation between BIC/FTC/TAF patients and EFV+3TC+TDF patients. After excluding BIC/FTC/TAF patients with treatment discontinuation due to economic reason, EFV+3TC+TDF group were shown to have a significantly higher risk of discontinuation than BIC/FTC/TAF group (hazard ratio [HR] = 9.6, 95% confidence interval [CI]=1.2-74.2). After further removing the EFV+3TC+TDF patients with a viral load>500,000 copies/mL, the analysis showed similar results (HR=9.7, 95% CI = 1.2 - 76.9). 79.4% of the EFV+3TC+TDF patients discontinued treatment due to clinical reasons, while 83.3% of the BIC/FTC/TAF patients discontinued treatment due to economic reasons. Conclusions: Compared with BIC/FTC/TAF, EFV+TDF+3TC patients were significantly more likely to discontinue the 1st-line treatment.