The efficacy of first-line HIV treatment continues to improve, according to an analysis of outcomes in 78,000 people in 181 separate studies. Outcomes in people starting treatment in recent years are better than those in people who started treatment in the 1990s or 2000s.
The researchers wanted to find out how many people were still on the same drug combination and with an undetectable viral load, two years after starting their treatment.
In people starting treatment between 1994 and 2000, it was 52%. Between 2001 and 2005, it was 61%. In 2006 to 2010, the figure rose to 65%. And in the most recent period included, 2011 to 2015, 80% still had an undetectable viral load after two years on the same treatment.
Almost everyone who did not do well on their first treatment switched to an alternative drug combination which suited them better.
The study contained some pointers to which drug combinations are likely to have the greatest success. People starting treatment with integrase inhibitors (such as dolutegravir or raltegravir) were more likely to still be on their first-line treatment three years later. People using a nucleoside backbone of tenofovir and emtricitabine also did well.
Once a day dosing (rather than twice a day) had a greater impact on effectiveness than the number of pills taken.
But good as these results are, the researchers believe that it’s still possible to do better. They note that even with the most modern treatment regimens, a fifth of people stop or change their treatment regimen within two years of starting.