Impact of baseline plasma HIV-1 RNA and time to virological suppression on virological rebound according to first-line antiretroviral regimen.

International audienceObjectives: We investigated the risk of virological rebound in HIV-1-infected patients achieving virological suppressionon first-line combined ART (cART) according to baseline HIV-1 RNA, time to virological suppression andtype of regimen.Patients and methods: Subjects were 10836 adults who initiated first-line cART (two nucleoside or nucleotidereverse transcriptase inhibitors!efavirenz, a ritonavir-boosted protease inhibitor or an integrase inhibitor) from1 January 2007 to 31 December 2014. Cox proportional hazards models with multiple adjustment and propensityscore matching were used to investigate the effect of baseline HIV-1 RNA and time to virological suppressionon the occurrence of virological rebound.Results: During 411436 patient-months of follow-up, risk of virological rebound was higher in patients withbaseline HIV-1 RNA 100000 copies/mL versus ,100000 copies/mL, in those achieving virological suppressionin.6months versus ,6months, and lower with efavirenz or integrase inhibitors than with ritonavir-boosted protease inhibitors. Baseline HIV-1 RNA .100000 copies/mL was associated with virological rebound forritonavir-boosted protease inhibitors but not for efavirenz or integrase inhibitors. Time to virological suppression.6months was strongly associated with virological rebound for all regimens.Conclusions: In HIV-1-infected patients starting cART, risk of virological rebound was lower with efavirenz orintegrase inhibitors than with ritonavir-boosted protease inhibitors. These data, from a very large observationalcohort, in addition to the more rapid initial virological suppression obtained with integrase inhibitors, reinforcethe positioning of this class as the preferred one for first-line therapy