{"doi":"10.1093/cid/ciaa1037","title":"Clinical Effectiveness of Integrase Strand Transfer Inhibitor–Based Antiretroviral Regimens Among Adults With Human Immunodeficiency Virus: A Collaboration of Cohort Studies in the United States and Canada","abstract":"BACKGROUND: Integrase strand transfer inhibitor (InSTI)-based regimens are now recommended as first-line antiretroviral therapy (ART) for adults with human immunodeficiency virus, but evidence on long-term clinical effectiveness of InSTI-based regimens remains limited. We examined whether InSTI-based regimens improved longer-term clinical outcomes. METHODS: We included participants from clinical cohorts in the North American AIDS Cohort Collaboration on Research and Design who initiated their first ART regimen, containing either InSTI (ie, raltegravir, dolutegravir, and elvitegravir-cobicistat) or efavirenz (EFV) as an active comparator, between 2009 and 2016. We estimated observational analogs of 6-year intention-to-treat and per-protocol risks, risk differences (RDs), and hazard ratios (HRs) for the composite outcome of AIDS, acute myocardial infarction, stroke, end-stage renal disease, end-stage liver disease, or death. RESULTS: Of 15 993 participants, 5824 (36%) initiated an InSTI-based and 10 169 (64%) initiated an EFV-based regimen. During the 6-year follow-up, 440 in the InSTI group and 1097 in the EFV group incurred the composite outcome. The estimated 6-year intention-to-treat risks were 14.6% and 14.3% for the InSTI and EFV groups, respectively, corresponding to a RD of 0.3% (95% confidence interval, -2.7% to 3.3%) and a HR of 1.08 (.97-1.19); the estimated 6-year per-protocol risks were 12.2% for the InSTI group and 11.9% for the EFV group, corresponding to a RD of 0.3% (-3.0% to 3.7%) and a HR of 1.09 (.96-1.25). CONCLUSIONS: InSTI- and EFV-based initial ART regimens had similar 6-year composite clinical outcomes. The risk of adverse clinical outcomes remains substantial even when initiating modern ART.","journal":"Clinical Infectious Diseases","year":2020,"id":79637,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":16,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9491,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":329432,"name":"Stephen R. Cole","orcid":"0000-0003-2117-1311","position":1,"is_corresponding":false},{"id":277337,"name":"Daniel Westreich","orcid":"0000-0003-3069-1650","position":2,"is_corresponding":false},{"id":130929,"name":"Michael G. Hudgens","orcid":"0000-0002-9106-4194","position":3,"is_corresponding":false},{"id":301953,"name":"Adaora A. Adimora","orcid":"0000-0001-5035-1552","position":4,"is_corresponding":false},{"id":240243,"name":"Keri N. Althoff","orcid":"0000-0002-5068-6595","position":5,"is_corresponding":false},{"id":14779,"name":"Michael J. Silverberg","orcid":"0000-0001-9322-1395","position":6,"is_corresponding":false},{"id":340149,"name":"Kate Buchacz","orcid":"0000-0001-5335-5217","position":7,"is_corresponding":false},{"id":268275,"name":"Jun Li","orcid":"0000-0002-8664-4813","position":8,"is_corresponding":false},{"id":352751,"name":"Jessie K. Edwards","orcid":"0000-0002-1741-335X","position":9,"is_corresponding":false},{"id":240239,"name":"Peter F. Rebeiro","orcid":"0000-0003-1951-9104","position":10,"is_corresponding":false},{"id":240252,"name":"Viviane D. Lima","orcid":"0000-0003-4943-091X","position":11,"is_corresponding":false},{"id":104965,"name":"Vincent C. Marconi","orcid":"0000-0001-8409-4689","position":12,"is_corresponding":false},{"id":240257,"name":"Timothy R. Sterling","orcid":"0000-0002-4822-6979","position":13,"is_corresponding":false},{"id":240247,"name":"Michael A. Horberg","orcid":"0000-0002-6971-7646","position":14,"is_corresponding":false},{"id":240244,"name":"M. John Gill","orcid":"0000-0002-8546-8790","position":15,"is_corresponding":false},{"id":340159,"name":"Mari M. Kitahata","orcid":"0000-0002-5410-7175","position":16,"is_corresponding":false},{"id":249713,"name":"Joseph J. Eron","orcid":"0000-0002-4938-0644","position":17,"is_corresponding":false},{"id":240242,"name":"Richard D. Moore","orcid":"0000-0001-8250-5069","position":18,"is_corresponding":false},{"id":413648,"name":"Haidong Lu","orcid":"0000-0002-7908-2517","position":0,"is_corresponding":true}],"reference_count":40,"raw_metadata":null,"created_at":"2026-07-18T21:50:57.971597Z","pmid":"32780095","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}