Background: Women face unique complexities in HIV treatment yet are underrepresented
in antiretroviral therapy (ART) studies.
Objective: This analysis assessed the one-year durability of the first integrase strand transfer inhibitor
(INSTI)-based regimens prescribed to women in a large cohort of patients living with HIV in care.
Methods: Women with HIV who initiated their first INSTI-containing regimen between 08/12/2013
and 11/30/2015 were identified in the OPERA cohort, a collaboration of 79 US outpatient clinics.
Discontinuation within the first year of treatment with an INSTI was compared between dolutegravir
(DTG), raltegravir (RAL) and elvitegravir (EVG), using multivariable Cox regression and Kaplan-
Meier estimates. Virologic response and regimen modifications were described and compared across
Results: A total of 537 treatment-naïve (DTG: 39%, EVG: 48%, RAL: 13%) and 878 treatmentexperienced
(DTG: 57%, EVG: 29%, RAL: 13%) women were analyzed. In the first twelve months after
initiation, women taking EVG or RAL were more likely to discontinue their initial INSTI than those
taking DTG among both treatment-naïve (adjusted hazard ratio EVG vs. DTG: 1.59 (95% CI: 1.09,
2.39); RAL vs. DTG: 2.46 (1.49, 4.05)) and treatment-experienced women (EVG vs. DTG: 1.39 (1.02,
1.88); RAL vs. DTG: 2.17 (1.51, 3.12)). Following discontinuation of the initial INSTI, women commonly
switched to a regimen containing a different drug from the INSTI class (treatment-naïve DTG:
34%, RAL: 33% EVG: 41%; treatment-experienced DTG: 23%, RAL: 19% EVG: 41%).
Conclusion: In treatment-naïve and treatment-experienced women living with HIV, women taking
DTG had the lowest risk for early (≤1 year) discontinuation.