A Prescription Pattern of HIV First-Line Tenofovir Alafenamide-Based Single-Tablet Regimens: A Multi-Institutional Study in Taiwan

OBJECTIVES: In Taiwan, single-tablet regimens (STRs) have been implemented for first-line or more for HIV treatment. Previous evidence suggests that tenofovir alafenamide (TAF) is associated with less renal and bone toxicity. Additionally, rilpivirine (RPV) was associated with psychiatric disorders. However, the impact of bictegravir (BIC) on weight gain remains unclear. This study was aimed to analyze prescribing pattern of two TAF-based STRs using real-world data, including TAF/emtricitabine(FTC)/RPV and TAF/FTC/BIC.

METHODS: This was a retrospective cohort study using a multi-institutional electronic medical records database. From October 2019 to April 2023, HIV patients newly receiving TAF/FTC/RPV or TAF/FTC/BIC were included. Baseline characteristics and biochemical data, including age, line of highly active antiretroviral therapy (HAART) treatment, and comorbidity (e.g., psychotic disease), HIV-RNA viral load and CD4, were assessed.

RESULTS: We included 1403 TAF/FTC/BIC and 408 TAF/FTC/RPV new users, of whom ages were 39.5 and 41.4 years old, respectively. The average CD4 counts were 452 and 572 cells/uL among TAF/FTC/BIC and TAF/FTC/RPV users. For HIV-RNA viral load, the undetectable rate was higher in TAF/FTC/RPV users than TAF/FTC/BIC users (67.9% vs. 34.1%, P value <0.01). Moreover, naïve antiretroviral users were higher in TAF/FTC/BIC group compared to TAF/FTC/RPV group (45.7% vs. 18.3%, P value <0.01). The rate of psychotic disease history was similar between TAF/FTC/RPV users (5.6%) and TAF/FTC/BIC users (5.5%). TAF/FTC/RPV users (11.5%) had a higher rate of hyperlipidemia history compared to TAF/FTC/BIC users (8.2%).

CONCLUSIONS: Patients with higher CD4 counts and unmeasurable HIV-RNA viral load tend to prefer TAF/FTC/RPV. Moreover, TAF/FTC/RPV is more prone to developing drug resistance, resulting in fewer antiretroviral-naïve users. These findings align with previous evidence. Surprisingly, we expected patients with comorbidity of psychiatric disorders to choose TAF/FTC/BIC; however, the analysis yielded no significant difference. As for a history of hyperlipidemia, our results indicate a higher likelihood of using TAF/FTC/RPV.