{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T16:48:46Z","timestamp":1780937326276,"version":"3.54.1"},"reference-count":21,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2021,7,2]],"date-time":"2021-07-02T00:00:00Z","timestamp":1625184000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"INTEGRATE"},{"DOI":"10.13039\/501100004359","name":"Swedish Research Council","doi-asserted-by":"publisher","award":["2016\u201301675"],"award-info":[{"award-number":["2016\u201301675"]}],"id":[{"id":"10.13039\/501100004359","id-type":"DOI","asserted-by":"publisher"}]},{"name":"European Union by the CARE H2020","award":["825673"],"award-info":[{"award-number":["825673"]}]},{"name":"Stockholm County Council (ALF","award":["20190451"],"award-info":[{"award-number":["20190451"]}]},{"DOI":"10.13039\/501100018713","name":"CIMED","doi-asserted-by":"publisher","award":["20200645"],"award-info":[{"award-number":["20200645"]}],"id":[{"id":"10.13039\/501100018713","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Funda\u00e7\u00e3o para a Ci\u00eancia e Tecnologia","award":["PTDC\/SAU-INF\/31990\/20170"],"award-info":[{"award-number":["PTDC\/SAU-INF\/31990\/20170"]}]},{"name":"Funda\u00e7\u00e3o para a Ci\u00eancia e Tecnologia","award":["GHTM-UID\/Multi\/04413\/2013"],"award-info":[{"award-number":["GHTM-UID\/Multi\/04413\/2013"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,8,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>INSTIs have become a pillar of first-line ART. Real-world data are needed to assess their effectiveness in routine care.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>We analysed ART-naive patients who started INSTI-based regimens in 2012\u201319 whose data were collected by INTEGRATE, a European collaborative study including seven national cohorts.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Kaplan\u2013Meier analyses assessed time to virological failure (VF), defined as one viral load (VL) \u22651000\u2009copies\/mL, two consecutive VLs \u226550\u2009copies\/mL, or one VL \u226550\u2009copies\/mL followed by treatment change after \u226524\u2009weeks of follow-up, and time to INSTIs discontinuation (INSTI-DC) for any reason. Factors associated with VF and INSTI-DC were explored by logistic regression analysis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of 2976 regimens started, 1901 (63.9%) contained dolutegravir, 631 (21.2%) elvitegravir and 444 (14.9%) raltegravir. The 1\u2009year estimated probabilities of VF and INSTI-DC were 5.6% (95% CI 4.5\u20136.7) and 16.2% (95% CI 14.9\u201317.6), respectively, and were higher for raltegravir versus both elvitegravir and dolutegravir. A baseline VL \u2265100\u2009000\u2009copies\/mL [adjusted HR (aHR) 2.17, 95% CI 1.55\u20133.04, P\u2009&amp;lt;\u20090.001] increased the risk of VF, while a pre-treatment CD4 count \u2265200 cells\/mm3 reduced the risk (aHR 0.52, 95% CI 0.37\u20130.74, P\u2009&amp;lt;\u20090.001). Predictors of INSTI-DC included use of raltegravir versus dolutegravir (aHR 3.03, 95% CI 2.34\u20133.92, P\u2009&amp;lt;\u20090.001), use of &amp;gt;3 drugs versus 3 drugs (aHR 2.73, 95% CI 1.55\u20134.79, P\u2009&amp;lt;\u20090.001) and starting ART following availability of dolutegravir (aHR 0.64, 95% CI 0.48\u20130.83, P\u2009=\u20090.001). Major INSTI mutations indicative of transmitted drug resistance occurred in 2\/1114 (0.2%) individuals.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>This large multi-cohort study indicates high effectiveness of elvitegravir- or dolutegravir-based first-line ART in routine practice across Europe.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jac\/dkab200","type":"journal-article","created":{"date-parts":[[2021,6,1]],"date-time":"2021-06-01T20:02:25Z","timestamp":1622577745000},"page":"2394-2399","source":"Crossref","is-referenced-by-count":8,"title":["Effectiveness of integrase strand transfer inhibitor-based regimens in HIV-infected treatment-naive individuals: results from a European multi-cohort study"],"prefix":"10.1093","volume":"76","author":[{"given":"Barbara","family":"Rossetti","sequence":"first","affiliation":[{"name":"Infectious Diseases Unit, University Hospital of Siena, Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1343-812X","authenticated-orcid":false,"given":"Massimiliano","family":"Fabbiani","sequence":"additional","affiliation":[{"name":"Infectious Diseases Unit, University Hospital of Siena, Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Domenico","family":"Di Carlo","sequence":"additional","affiliation":[{"name":"University of Milan \u2018La Statale\u2019, Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Incardona","sequence":"additional","affiliation":[{"name":"EuResist Network, Roma, Italy"},{"name":"I-PRO, Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Abecasis","sequence":"additional","affiliation":[{"name":"Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical\u2014Universidade Nova de Lisboa, Lisbon, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Perpetua","family":"Gomes","sequence":"additional","affiliation":[{"name":"Laborat\u00f3rio de Biologia Molecular (LMCBM, SPC, CHLO-HEM), Lisbon, Portugal"},{"name":"Centro de Investiga\u00e7\u00e3o Interdisciplinar Egas Moniz (CiiEM), Instituto Universit\u00e1rio Egas Moniz, Caparica, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna Maria","family":"Geretti","sequence":"additional","affiliation":[{"name":"Institute of Infection, University of Liverpool, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carole","family":"Seguin-Devaux","sequence":"additional","affiliation":[{"name":"Department of Infection and Immunity, Luxembourg Institute of Health, Luxembourg"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7611-781X","authenticated-orcid":false,"given":"Federico","family":"Garcia","sequence":"additional","affiliation":[{"name":"Hospital Universitario San Cecilio, Granada, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rolf","family":"Kaiser","sequence":"additional","affiliation":[{"name":"University of Cologne, Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Modica","sequence":"additional","affiliation":[{"name":"Infectious Diseases Unit, University Hospital of Siena, Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian","family":"Shallvari","sequence":"additional","affiliation":[{"name":"I-PRO, Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anders","family":"S\u00f6nnerborg","sequence":"additional","affiliation":[{"name":"Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maurizio","family":"Zazzi","sequence":"additional","affiliation":[{"name":"University of Siena, Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"EuResist Network, INTEGRATE study group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Abecasis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Bobkova","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C","family":"Seguin-Devaux","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Fabbiani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F","family":"Garcia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. 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