Which antiretrovirals should be prescribed as first-line treatments? Changes over the past 10 years in France

•We aimed to describe the changes in first-line antiretroviral (ART) regimens in France between 2005 and 2015 as well as patients’ characteristics related to the use of protease inhibitors in 2015. We extracted data from 15,897 patients who started a first antiretroviral therapy between 2005 and 2015. Before 2014, 60% of initial treatment regimens were based on boosted protease inhibitors. The use of integrase strand transfer inhibitors as first-line treatments was recommended in 2014, and they have since been gradually replacing boosted protease inhibitors in the first-line treatment setting. In 2015, boosted protease inhibitors were still more frequently prescribed to young women, patients with high viral loads, and patients low CD4 cell counts. To describe the changes in first-line antiretroviral (ART) regimens in France between 2005 and 2015 and patients’ characteristics related to the use of protease inhibitors in 2015. We extracted all patients starting ART between 2005 and 2015 from a large prospective cohort. Regimens were classified as three nucleoside reverse transcriptase inhibitors (NRTI), or two NRTIs with a boosted protease inhibitor (bPI), with a non-nucleoside reverse transcriptase inhibitor (NNRTI), or with an INSTI. Patients’ characteristics at the time of initiation were collected. A multinomial logit model was fitted to analyze characteristics related to the choice of regimen in 2015. We analyzed data from 15,897 patients. The proportion of patients starting with (i) a bPI decreased from 60% before 2014 to 38.1% in 2015; (ii) an NNRTI decreased from 30% to 17.8% in 2015; (iii) an INSTI gradually increased to 39.4% in 2015. In 2015, patients with an initial viral load ˃5 log copies/mL were less likely to receive NNRTI (OR=0.08) or INSTI regimens (OR=0.69) than bPIs. Patients with initial CD4+ T cell count ˂200/mm3 were less likely to receive an NNRTI (OR=0.28) or an INSTI regimen (OR=0.52) than a bPI. Women were less likely to receive an NNRTI (OR=0.79) or an INSTI regimen (OR=0.71) than a bPI; although this depended on age. The use of bPI as first-line ART declined sharply in France from 2005 to 2015. bPI remained of preferential use in patients with high viral load, low CD4+ T cell count, and in women. Décrire les choix de premier traitement antirétroviral en France entre 2005 et 2015 et analyser les caractéristiques liées à l’utilisation d’inhibiteurs de protéase (IP) en 2015. Tous les patients ayant débuté leur traitement entre le 01