Probability of Starting Two-Drug Regimen (2DR) vs. Three-Drug Regimen (3DR) in ART-Naïve and ART-Experienced Person with HIV (PWH) Across the First Wave of COVID-19 Pandemic
Alessandra Vergori,
Nicola Gianotti,
Alessandro Tavelli,
Camilla Tincati,
Andrea Giacomelli,
Elena Matteini,
Giuseppe Lapadula,
Lucia Taramasso,
Loredana Sarmati,
Antonella D’Arminio Monforte,
Andrea Antinori,
Alessandro Cozzi-Lepri,
on behalf of the ICONA Foundation Study
Affiliations
Alessandra Vergori
Viral Immunodeficiency Unit, National Institute for Infectious Diseases L. Spallanzani, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00143 Roma, Italy
Nicola Gianotti
Infectious Diseases, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), San Raffaele Scientific Institute, 20133 Milano, Italy
Alessandro Tavelli
Icona Foundation, 20133 Milan, Italy
Camilla Tincati
Clinica di Malattie Infettive, Dipartimento di Scienze della Salute, ASST Santi Paolo e Carlo-Presidio Ospedaliero San Paolo, Università degli Studi di Milano, 20133 Milano, Italy
Andrea Giacomelli
Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20133 Milano, Italy
Elena Matteini
Dipartimento di Sicurezza e Bioetica, Università Cattolica del Sacro Cuore, 00143 Roma, Italy
Giuseppe Lapadula
IRCCS Fondazione San Gerardo, Monza, Università di Milano Bicocca, 20133 Milano, Italy
Lucia Taramasso
Infectious Disease Clinic, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Policlinico San Martino Hospital, 16132 Genova, Italy
Loredana Sarmati
Clinical Infectious Diseases, Department of System Medicine, Tor Vergata University, 00143 Roma, Italy
Antonella D’Arminio Monforte
Icona Foundation, 20133 Milan, Italy
Andrea Antinori
Viral Immunodeficiency Unit, National Institute for Infectious Diseases L. Spallanzani, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00143 Roma, Italy
Alessandro Cozzi-Lepri
Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, Univesity College London, London WC1E 6BT, UK
Background: This study examined the impact of the COVID-19 lockdown on antiretroviral therapy (ART) prescriptions among persons living with HIV (PWH) in Italy. Methods: Data from the ICONA cohort included ART-naïve individuals who started ART between January 2019 and December 2022, and ART-experienced individuals who started new ART with HIV RNA ≤50 cps/mL from January 2016 to December 2022. The analysis focused on the proportion of PWH starting or switching to dual (2DR) versus triple (3DR) ART regimens. Comparisons were made using Chi-square and Kruskal-Wallis tests, with logistic regression (LR) to assess associations, adjusting for sex and age. Results: Among 2481 ART-naïve PWH, 17% were female, with a median age of 40. Using 2020 as the comparator (the lockdown year), the odds ratio (OR) from fitting a LR showed a reduced probability of prescribing 2DR both before and after 2020. The proportion of PWH starting 2DR was 9% in 2019, 18% in 2020, 13% in 2021, and 10% in 2022. Among 12,335 ART-experienced PWH, 20% were female, with a median age of 47. The proportion switching to 2DR rose from 24% in 2016 to 38% in 2020, 62% in 2021, and 65% in 2022, showing a >3-fold higher probability to be switched to 2DR instead of 3DR in recent years (2021-2022). Conclusions: For ART-naive PWH, 2DR initiation did not decrease during the 2020 lockdown but changed in the following years, possibly indicating shifts in clinical practice or resuming HIV services. For ART-experienced PWH, 2DR prescriptions increased significantly over time, especially for INSTI-based regimens.
