700 – Effectiveness of Antiretroviral Therapy in People With and Without TB in the IeDEA Cohort

Background

The efficacy of antiretroviral therapy (ART) regimens used to treat people with HIV (PWH) on concomitant tuberculosis (TB) treatment has been evaluated in few clinical trials or programmatic data. We sought to assess virologic response 1 year after ART initiation in ART-naïve PWH with and without TB within the International epidemiology Databases to Evaluate AIDS (IeDEA).  

Methods

We conducted a retrospective analysis of individual data collected between January 2013 and November 2022. Concomitant TB was defined as TB reported at ART initiation or after ≥1 visit during the first 6 months on ART.  Data from 15 sites from the Caribbean, Central and South America, Central and West African IeDEA regions were analyzed to evaluate the proportion of participants with virologic response defined as HIV-1 RNA <1,000 copies/mL 1 year after ART initiation. 

Results

54,276ART-naïve PWH started ART, 3,944 with and 50,332 without concomitant TB. Overall, median age was 35.4 (IQR 28.5-43.7) years; 54% were females. At ART initiation, median CD4 count and HIV-1 RNA were 211 (IQR 35–392) cells/mm³ and 4.9 (IQR 4.3 – 5.5) log₁₀ copies/mL, respectively. People with TB had lower CD4 and higher HIV-1 RNA at ART initiation (table 1). Overall, 10,036 (18%) started dolutegravir, 40,481 (75%) efavirenz, and 3,759 (7%) other ART regimens. One year after ART initiation, 21,084 (39%) achieved HIV-1 RNA <1,000 copies/mL and 3,703 (7%) had HIV-1 RNA ≥1,000 copies/mL, 29,489 (54%) had no virologic data, including 1,346 (3%) who died, 8,900 (16%) who had no HIV-1 RNA available and 19,243 (35%) who were lost-to follow-up. Characteristics of participants with and without virologic data were similar. Of the 24,245 participants with HIV-1 RNA available, the proportion of participants achieving HIV-1 RNA <1,000 copies/mL were 1,238/1448 (85%; 95% CI: 84%-87%) and 19,846/22,797 (87%; 95% CI: 88%-87%) people with and without concomitant TB, respectively. Virologic response rates were 90% (95% CI 90%-91%) on dolutegravir and 86% on efavirenz (CI 85%-86%).

Conclusions

Virologic response and non-response rates 1 year after ART initiation were similar among PWH with or without TB. Dolutegravir and efavirenz-based ART provided high virologic response rates. However, more than 50% of people starting ART had no virologic data available, including large numbers lost to follow-up, which is a concern to properly identify virological failure and prevent HIV related morbidity and mortality. 

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