{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T19:18:55Z","timestamp":1762543135323,"version":"3.41.2"},"reference-count":20,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2019,11,19]],"date-time":"2019-11-19T00:00:00Z","timestamp":1574121600000},"content-version":"vor","delay-in-days":18,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Intern AIDS Soc"],"published-print":{"date-parts":[[2019,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>The relative efficacy of different antiretroviral (<jats:styled-content style=\"fixed-case\">ART<\/jats:styled-content>) regimens has been extensively evaluated in the context of clinical trials, using <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content> viral load (<jats:styled-content style=\"fixed-case\">VL<\/jats:styled-content>) measurements at pre\u2010specified timepoints after <jats:styled-content style=\"fixed-case\">ART<\/jats:styled-content> onset. However, data from real\u2010life studies using combined longitudinal measurements of cumulative viraemia are scarce. This study aimed to address the independent effect of different <jats:styled-content style=\"fixed-case\">ART<\/jats:styled-content> regimens on <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content> cumulative viraemia over the first 12\u00a0months after treatment initiation, using programmatic data from the Ministry of Health of Brazil.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Retrospective cohort study analysing cumulative viraemia under the most frequently used <jats:styled-content style=\"fixed-case\">ART<\/jats:styled-content> regimens in Brazil (tenofovir, lamivudine and dolutegravir (regimen 1); tenofovir, lamivudine and efavirenz (regimen 2); tenofovir, lamivudine and ritonavir\u2010boosted atazanavir (regimen 3)).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results and Discussion<\/jats:title><jats:p>We included 112,243 patients &gt;12\u00a0years old who received their first <jats:styled-content style=\"fixed-case\">ART<\/jats:styled-content> prescription between January 2014 and August 2017. Univariate analysis indicated that cumulative viraemia was significantly lower in patients receiving regimen 1 as compared with those receiving regimens 2 or 3 (<jats:italic>p<\/jats:italic>&lt;0.0001 for both pairwise comparisons). In a multivariable analysis adjusted for age, sex, baseline T <jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content>4+ counts and baseline <jats:styled-content style=\"fixed-case\">HIV VL<\/jats:styled-content>,<jats:styled-content style=\"fixed-case\"> ART<\/jats:styled-content> regimen persisted with statistically significant effect on 12\u2010month cumulative viraemia. The model predicted a 45\u2010unit increase in log<jats:sub>10<\/jats:sub> copy\u2010days\/<jats:styled-content style=\"fixed-case\">mL<\/jats:styled-content> cumulative viraemia for regimen 2 as compared with regimen 1, and a 70\u2010unit increase in log<jats:sub>10<\/jats:sub> copy\u2010days\/<jats:styled-content style=\"fixed-case\">mL<\/jats:styled-content> cumulative viraemia for regimen 3 as compared with regimen 1 (95%<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 41 to 49 and 61 to 79 respectively; <jats:italic>p<\/jats:italic>&lt;0.001 for both comparisons). In models restricted to youths (13 to 24\u00a0years old) and female patients, <jats:styled-content style=\"fixed-case\">ART<\/jats:styled-content> regimen had similar effects. <jats:styled-content style=\"fixed-case\">ART<\/jats:styled-content> regimen with dolutegravir in association with a tenofovir\u2010lamivudine backbone was superior to regimens containing efavirenz or boosted atazanavir in reducing <jats:styled-content style=\"fixed-case\">HIV VL<\/jats:styled-content>, as shown by cumulative viraemia over the first 12\u00a0months after treatment initiation. The superiority persisted even after adjusting the analysis for potential confounders.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our findings could bring direct benefits to patients as suggested by lower viral replication during treatment, lower risk of <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content> transmission, and a potential reduction in resistance mutations in the initial 12\u00a0months under <jats:styled-content style=\"fixed-case\">ART<\/jats:styled-content>.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.25397","type":"journal-article","created":{"date-parts":[[2019,11,19]],"date-time":"2019-11-19T18:59:13Z","timestamp":1574189953000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Comparison of cumulative viraemia following treatment initiation with different antiretroviral regimens: a real\u2010life study in Brazil"],"prefix":"10.1002","volume":"22","author":[{"given":"Ana R","family":"Pascom","sequence":"first","affiliation":[{"name":"Department of Surveillance, Prevention and Control of STIs Ministry of Health of Brazil HIV\/AIDS and Viral Hepatitis Brasilia Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rosana EGG","family":"Pinho","sequence":"additional","affiliation":[{"name":"Department of Surveillance, Prevention and Control of STIs Ministry of Health of Brazil HIV\/AIDS and Viral Hepatitis Brasilia Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fernanda","family":"Rick","sequence":"additional","affiliation":[{"name":"Department of Surveillance, Prevention and Control of STIs Ministry of Health of Brazil HIV\/AIDS and Viral Hepatitis Brasilia Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nazle MC","family":"Veras","sequence":"additional","affiliation":[{"name":"Department of Surveillance, Prevention and Control of STIs Ministry of Health of Brazil HIV\/AIDS and Viral Hepatitis Brasilia Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Filipe de Barros","family":"Perini","sequence":"additional","affiliation":[{"name":"Department of Surveillance, Prevention and Control of STIs Ministry of Health of Brazil HIV\/AIDS and Viral Hepatitis Brasilia Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mariana V","family":"Meireles","sequence":"additional","affiliation":[{"name":"Department of Surveillance, Prevention and Control of STIs Ministry of Health of Brazil HIV\/AIDS and Viral Hepatitis Brasilia Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gerson F","family":"Pereira","sequence":"additional","affiliation":[{"name":"Department of Surveillance, Prevention and Control of STIs Ministry of Health of Brazil HIV\/AIDS and Viral Hepatitis Brasilia Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adele S","family":"Benzaken","sequence":"additional","affiliation":[{"name":"Tropical Medicine Foundation Heitor Vieira Dourado Manaus Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6660-3088","authenticated-orcid":false,"given":"Vivian I","family":"Avelino\u2010Silva","sequence":"additional","affiliation":[{"name":"Department of Infectious and Parasitic Diseases Faculdade de Medicina da Universidade de Sao Paulo Sao Paulo 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PascomAR PeriniF RickF BenzakenA.Comparative effectiveness of first\u2010line antiretroviral therapy regimens: Results from a large real\u2010world cohort in Brazil after the implementation of dolutegravir. 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