Uptake of drug-reduced antiretroviral strategies and impact on costs over 2015–22: experience from an HIV clinic in Paris, France

Background While current HIV care includes drug-reduced antiretroviral strategies, intermittent therapy, recently recommended in France, could benefit from further evaluation in real-life clinical practice. Objectives To evaluate the uptake, efficacy and cost impact of drug-reduced antiretroviral strategies (DRS) in a large HIV clinic in Paris. Methods This retrospective study included all virally suppressed adult individuals living with HIV treated at our clinic from 2015 to 2022, on three-drug (3-DR) or two-drug (2-DR) daily regimens, with ≥1 clinical and viral load assessment recorded per year. We defined DRS as either 2-DR or intermittent oral regimen (4 or 5 days weekly). Main outcomes included DRS uptake, factors associated with DRS prescription, virological failure (VF) by ART strategy and costs. Findings We analysed 2170 individuals (median age: 50.6, viral suppression: 6.0 years) on daily 3-DR (77.5%) and 2-DR (22.5%). Over 8 years, 1048 participants (48.3%) switched to a DRS that consisted of intermittent ART (ART-I) in 580 participants and a 2-DR in 442 participants. The VF rate was 11.2% for 3-DR, 5.3% for 2-DR and 1.8% for intermittent ART. Overall, in 2022, 1184 participants (54.6%) were receiving a DRS. Average yearly cost of HIV care per participant dropped from €15 687 in 2015 to €7437 in 2022, with per-participant costs of €7643 for 3-DR, €8869 for 2-DR and €3388 for ART-I. Conclusions Drug-reduced ART regimens were prescribed to over half of the study population. Intermittent regimens, widely used in our setting, are highly effective and cost-saving, and deserve to be evaluated for implementation, particularly in resource-constrained contexts.