LAUSR

OBJECTIVE Historically, a high burden of resistance to antiretroviral therapy (ART) in heavily treatment experienced (HTE) persons with HIV (PWH) resulted in limited treatment options (LTO). We evaluated the prevalence, risk factors, and virologic control of HTE PWH with LTO throughout the modern ART era. DESIGN We examined all ART-experienced PWH in care between 2000-2017 in the Centers for AIDS Research Network of Integrated Clinical Systems cohort. METHODS We computed the annual prevalence of HTE PWH with LTO defined as having ≤2 available classes with ≤2 active drugs per class based on genotypic data and cumulative antiretroviral resistance. We used multivariable Cox proportional hazards models to examine risk of LTO by 3-year study entry periods adjusting for demographic and clinical characteristics. RESULTS Among 27,133 ART-experienced PWH, 916 were classified as having LTO. The prevalence of PWH with LTO was 5.2-7.5% in 2000-2006, decreased to 1.8% in 2007, and remained < 1% after 2012. Persons entering the study in 2009-2011 had an 80% lower risk of LTO compared with those entering in 2006-2008 (adjusted hazard ratio 0.20; 95% CI: 0.09-0.42). We found a significant increase in undetectable HIV viral loads among PWH ever classified as having LTO from < 30% in 2001 to >80% in 2011, comparable to persons who never had LTO. CONCLUSIONS Results of this large multicenter study show a dramatic decline in the prevalence of PWH with LTO to < 1% with the availability of more potent drugs and a marked increase in virologic suppression in the current ART era.