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Lagi F, Giacomelli A, Borghi V, Ciccullo A, Taramasso L, Madeddu G, D'Ettorre G, Giacometti A, Ducci F, De Vito A, Pincino R, Di Giambenedetto S, Mussini C, Antinori S, Sterrantino G. Efficacy and tolerability of dolutegravir/lamivudine versus dolutegravir/rilpivirine in switching from a three-drug regimen based on nonnucleoside reverse transcriptase inhibitors: A retrospective cohort study. J Med Virol 2023; 95:e29149. [PMID: 37805832 DOI: 10.1002/jmv.29149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 09/17/2023] [Accepted: 09/26/2023] [Indexed: 10/09/2023]
Abstract
Real-life comparisons of dolutegravir/rilpivirine (DTG/RPV) and DTG/lamivudine (3TC) regimens in people living with human immunodeficiency virus (PLWHIV) who switched from a standard three-drug regimen based on nonnucleoside reverse transcriptase inhibitors (NNRTIs) are missing. This study aimed to compare DTG/3TC and DTG/RPV in virologically suppressed patients (HIV-RNA < 50 copies/mL) coming from any NNRTI-based regimen in terms of discontinuation due to virologic failure (VF) discontinuation rates due to all causes, and adverse events. As a secondary outcome, we evaluated the difference in creatinine, total cholesterol, CD4, and triglycerides from baseline to weeks 48 after the switch. Of the 415 PLWHs included in the study, 278 (66.9%) switched to DTG/3TC, and 137 (33.1%) switched to DTG/RPV. Overall, 48 PLWHs (11.6%) discontinued the treatment:38 with DTG/3TC and 10 with DTG/RPV with similar discontinuation rates: 5.01 × 100 py (95% confidence interval [CI] 3.64-6.94) and 4.66 × 100 py (95% CI 2.51-8.67), respectively. The most common reason for discontinuation was toxicity (26 patients, 22/278 [7.9%] in the DTG/3TC group and 4/137 [2.9%] in the DTG/RPV group), mainly neurologic toxicity (never above grade 2). We found no differences in discontinuation rates due to treatment adverse events. Two study participants experienced virological failure in the DTG/3TC arm. We observed no significant difference in CD4 cell counts, lipid parameters, or renal function between the two groups at 48 weeks. This study demonstrated that, in clinical practice, a two-drug regimen with DTG/3TC or DTG/RPV is characterized by a low discontinuation rate and VF in virologically suppressed PLWHs switched from an NNRTI-based three antiretroviral drugs regimen.
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Affiliation(s)
- Filippo Lagi
- Infectious and Tropical Diseases Unit, Emergency Department, Careggi University Hospital, Florence, Italy
| | - Andrea Giacomelli
- Department of Infectious Diseases, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Vanni Borghi
- Department of Infectious Diseases, Azienda Ospedaliero, Universitaria Policlinico of Modena, Modena, Italy
| | - Arturo Ciccullo
- Section of Infectious Diseases, Department of Safety and Bioethics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Lucia Taramasso
- Infectious Diseases Unit, Department of Internal Medicine, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
| | - Giordano Madeddu
- Department of Medicine, Surgery and Pharmacy, Unit of Infectious Disease, University of Sassari, Sassari, Italy
| | - Gabriella D'Ettorre
- Department of Public Health and Infectious Diseases, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Andrea Giacometti
- Institute of Infectious Diseases and Public Health, Department of Biological Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Filippo Ducci
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Andrea De Vito
- Department of Medicine, Surgery and Pharmacy, Unit of Infectious Disease, University of Sassari, Sassari, Italy
| | - Rachele Pincino
- Department of Health Sciences (DISSAL), Infectious Diseases Unit, University of Genoa, Genoa, Italy
| | - Simona Di Giambenedetto
- Section of Infectious Diseases, Department of Safety and Bioethics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Cristina Mussini
- Department of Infectious Diseases, Azienda Ospedaliero, Universitaria Policlinico of Modena, Modena, Italy
| | - Spinello Antinori
- Department of Infectious Diseases, ASST Fatebenefratelli-Sacco, Milan, Italy
- Luigi Sacco Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Gaetana Sterrantino
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Thornhill JP, Cromarty B, Gaddie J, Mushunje S, Ferrand RA. Two-drug antiretroviral regimens for HIV. BMJ 2023; 382:e071079. [PMID: 37657789 DOI: 10.1136/bmj-2022-071079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Affiliation(s)
- John P Thornhill
- Blizard Institute, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, UK
- Barts Health NHS Trust, London, UK
| | - Ben Cromarty
- UK Community Advisory Board (UK-CAB) HIV treatment advocates network
| | | | - Shiellah Mushunje
- UK Community Advisory Board (UK-CAB) HIV treatment advocates network
| | - Rashida A Ferrand
- Clinical Research Department, London School of Hygiene and Tropical Medicine, UK
- Biomedical Research and Training Institute, Harare, Zimbabwe
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Compagnucci A, Chan MK, Saïdi Y, Cressey TR, Bamford A, Riault Y, Coelho A, Nolan A, Chalermpantmetagul S, Morkunaite G, Amuge P, Musiime V, Violari A, Cotton M, Kekitiinwa AR, Kaudha E, Groenewald M, Liberty AA, Kanjanavanit S, Volokha A, Bologna R, Pavia Ruz N, Prieto Tato L, Paioni P, Marques L, Reliquet V, Niehues T, Welch SB, Ford D, Giaquinto C, Gibb DM, Babiker A, Ramos Amador JT. Nucleoside/nucleotide reverse transcriptase inhibitor sparing regimen with once daily integrase inhibitor plus boosted darunavir is non-inferior to standard of care in virologically-suppressed children and adolescents living with HIV - Week 48 results of the randomised SMILE Penta-17-ANRS 152 clinical trial. EClinicalMedicine 2023; 60:102025. [PMID: 37304494 PMCID: PMC10251070 DOI: 10.1016/j.eclinm.2023.102025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/11/2023] [Accepted: 05/11/2023] [Indexed: 06/13/2023] Open
Abstract
Background Integrase inhibitor (INSTI) with boosted darunavir (DRV/r), a regimen with a high-resistance barrier, avoiding NRTI toxicities, might be a switching option in children living with HIV (CLWHIV). Methods SMILE is a randomised non-inferiority trial evaluating safety and antiviral efficacy of once-daily INSTI + DRV/r vs. continuing on current standard-of-care (SOC) triple ART (2NRTI + boosted PI/NNRTI) in virologically-suppressed CLWHIV aged 6-18 years. The primary outcome is the proportion with confirmed HIV-RNA ≥50 copies/mL by week 48, estimated by Kaplan-Meier method. Non-inferiority margin was 10%. Registration number for SMILE are: ISRCTN11193709, NCT #: NCT02383108. Findings Between 10th June 2016 and 30th August 2019, 318 participants were enrolled from Africa 53%, Europe 24%, Thailand 15% and Latin America 8%, 158 INSTI + DRV/r [153 Dolutegravir (DTG); 5 Elvitegravir (EVG)], 160 SOC. Median (range) age was 14.7 years (7.6-18.0); CD4 count 782 cells/mm3 (227-1647); 61% female. Median follow-up was 64.3 weeks with no loss to follow-up. By 48 weeks, 8 INSTI + DRV/r vs. 12 SOC had confirmed HIV-RNA ≥50 copies/mL; difference (INSTI + DRV/r-SOC) -2.5% (95% CI: -7.6, 2.5%), showing non-inferiority. No major PI or INSTI resistance mutations were observed. There were no differences in safety between arms. By week 48, difference (INSTI + DRV/r-SOC) in mean CD4 count change from baseline was -48.3 cells/mm3 (95% CI: -93.4, -3.2; p = 0.036). Difference (INSTI + DRV/r-SOC) in mean HDL change from baseline was -4.1 mg/dL (95% CI: -6.7, -1.4; p = 0.003). Weight and Body Mass Index (BMI) increased more in INSTI + DRV/r than SOC [difference: 1.97 kg (95% CI: 1.1, 2.9; p < 0.001), 0.66 kg/m2 (95% CI: 0.3, 1.0; p < 0.001)]. Interpretation In virologically-suppressed children, switching to INSTI + DRV/r was non-inferior virologically, with similar safety profile, to continuing SOC. Small but significant differences in CD4, HDL-cholesterol, weight and BMI were observed between INSTI + DRV/r vs. SOC although clinical relevance needs further investigation. SMILE data corroborate adult findings and provide evidence for this NRTI-sparing regimen for children and adolescents. Funding Fondazione Penta Onlus, Gilead, Janssen, INSERM/ANRS and UK MRC. ViiV-Healthcare provided Dolutegravir.
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Affiliation(s)
| | | | - Yacine Saïdi
- INSERM SC10-US19, Essais Thérapeutiques et Maladies Infectieuses, Villejuif, France
| | - Tim R. Cressey
- AMS-CMU & IRD Research Collaboration, Faculty of Associated Medical Sciences (AMS), Chiang Mai University, Thailand
| | - Alasdair Bamford
- MRC Clinical Trials Unit at UCL, London, UK
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Yoann Riault
- INSERM SC10-US19, Essais Thérapeutiques et Maladies Infectieuses, Villejuif, France
| | - Alexandra Coelho
- INSERM SC10-US19, Essais Thérapeutiques et Maladies Infectieuses, Villejuif, France
| | | | - Suwalai Chalermpantmetagul
- AMS-CMU & IRD Research Collaboration, Faculty of Associated Medical Sciences (AMS), Chiang Mai University, Thailand
| | | | - Pauline Amuge
- Baylor College of Medicine Children's Foundation, Kampala, Uganda
| | - Victor Musiime
- Joint Clinical Research Centre, Lubowa, Kampala, Uganda
- Makerere University, Department of Paediatrics and Child Health, Kampala, Uganda
| | - Avy Violari
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Mark Cotton
- FAMCRU, Department of Paediatrics & Child Health, Family Center for Research with Ubuntu, Stellenbosch University, South Africa
| | | | | | - Marisa Groenewald
- FAMCRU, Department of Paediatrics & Child Health, Family Center for Research with Ubuntu, Stellenbosch University, South Africa
| | - Afaaf A. Liberty
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Alla Volokha
- Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine
| | | | - Noris Pavia Ruz
- Clínica para niños con VIH, UNAM/HGM; Unidad de Investigación en Medicina Experimental, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | | | - Paolo Paioni
- Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Laura Marques
- Centro Materno-Infantil do Norte, CHU Porto, Porto, Portugal
| | - Véronique Reliquet
- Infectious Diseases Department, CHU Hôtel Dieu and INSERM UIC 1413, Nantes University, Nantes, France
| | - Tim Niehues
- Centre for Child Health and Adolescence, Helios Klinikum Krefeld, Academic Hospital, RWTH Aachen, Krefeld, Germany
| | - Steven B. Welch
- Department of Paediatrics, Heartlands Hospital, University Hospitals Birmingham, Birmingham, UK
| | | | - Carlo Giaquinto
- Department of Women's and Children's Health, University of Padova, Padova, Italy
| | | | | | - Jose Tomas Ramos Amador
- Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC); Fundación para la Investigación Biomédica HCSC; Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain
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Dolutegravir Plus 3TC in Virologically Suppressed PLWHIV: Immunological Outcomes in a Multicenter Retrospective Cohort in Spain during the COVID-19 Pandemic. Viruses 2023; 15:v15020322. [PMID: 36851536 PMCID: PMC9963008 DOI: 10.3390/v15020322] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/18/2023] [Accepted: 01/19/2023] [Indexed: 01/26/2023] Open
Abstract
Dolutegravir (DTG) based dual therapies for treating PLWHIV are a standard of care nowadays. Switching to DTG and lamivudine (3TC) safety and efficacy were proven in TANGO randomized clinical trial. This multicenter retrospective study included 1032 HIV virologically suppressed patients switching to DTG+3TC from 13 Spanish hospitals. DTG+3TC provided high rates of undetectable viral load over 96%, corresponding to 96.6% (889/921) at 24 weeks, 97.5% (743/763) at 48 weeks, and 98.3% (417/425) at 96 weeks. No significant differences are evident when comparing the total population according to sex, presence of comorbidity, or presence of AIDS. The analysis for paired data showed an increase in CD4+ cell count. A statistically significant increase in CD4+ lymphocyte count was found in those without comorbidities in the three-time series analyzed [average increase at 24 weeks: 48.7 (SD: 215.3) vs. 25.8 (SD: 215.5), p-value = 0.050; a mean increase at 48 weeks: 75.1 (SD: 232.9) vs. 42.3 (SD: 255.6), p-value = 0.003; a mean increase at 96 weeks: 120.1 (SD: 205.0) vs. 63.8 (SD:275.3), p-value = 0.003]. In conclusion, our cohort demonstrates that DTG+3TC is an effective treatment strategy for virologically-suppressed PLWHIV independent of age, sex, and HIV stage, as well as a safe and durable strategy.
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Nyamankolly E, Bellecave P, Wittkop L, Le Marec F, Duffau P, Lazaro E, Vareil MO, Tumiotto C, Hessamfar M, Cazanave C, Perrier A, Leleux O, Bonnet F, Neau D. Long-term follow-up of HIV-1 multi-drug-resistant treatment-experienced participants treated with etravirine, raltegravir and boosted darunavir: towards drug-reduced regimen? ANRS CO3 Aquitaine Cohort 2007-2018. Int J Antimicrob Agents 2023; 61:106696. [PMID: 36470511 DOI: 10.1016/j.ijantimicag.2022.106696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 11/19/2022] [Accepted: 11/26/2022] [Indexed: 12/04/2022]
Abstract
OBJECTIVE To assess the efficacy of raltegravir, etravirine and darunavir/ritonavir (TRIO regimen) in treatment-experienced patients with human immunodeficiency virus-1 (HIV-1) infection by describing the proportion of patients who experienced virological failure (VF) at Week 24. The secondary objectives were to assess the HIV-1 plasma viral load (pVL) after Week 24, the proportion of patients who were receiving dual therapy or monotherapy at the last visit, and the number of deaths. METHODS Patients from the ANRS CO3 Aquitaine Cohort who were prescribed the TRIO regimen between February 2007 and September 2018 were classified into two groups based on their pVL at study inclusion: the virological failure group (VFG; pVL >50 copies/mL) and the virologically suppressed group (VSG; pVL <50 copies/mL). The impact of baseline pVL and genotypic susceptibility score (GSS) on VF was analysed. RESULTS In total, 184 patients were enrolled in this study, with 123 (66.8%) in the VFG and 61 (33.2%) in the VSG. The median length of follow-up was 7.5 (interquartile range 4.1-9.6) years, and 29 (15.8%) patients died. Thirty-seven (25.5%) patients experienced VF at Week 24, including 32/145 (32.7%) in the VFG and 5/47 (10.6%) in the VSG (P<0.01). Resistance-associated mutations were detected in integrase, reverse transcriptase and protease for 7/37 (18.9%), 3/37 (8.1%) and 1/37 (2.7%) patients, respectively. High pVL and GSS at baseline were independently associated with VF. At the last visit, 76/184 (41.3%) patients were still receiving the TRIO regimen, while 55/184 (29.9%) were receiving dual therapy and 1/184 (0.5%) was receiving protease inhibitor monotherapy. Among the 56 patients receiving dual therapy or monotherapy, 51 (96.2%) had pVL <50 copies/mL. CONCLUSION Despite a high level of mutation resistance at baseline, long-term virological follow-up was favourable and one-third of patients were eligible for drug-reducing strategies.
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Affiliation(s)
- Elsa Nyamankolly
- CHU de Bordeaux, Service des Maladies Infectieuses et Tropicales, Hôpital Pellegrin, Bordeaux, France.
| | | | - Linda Wittkop
- Bordeaux Population Health Research Center, INSERM U1219, CIC-EC 1401, Univ. Bordeaux - ISPED, 33076, Bordeaux, France; CHU de Bordeaux, Service d'information médicale, Bordeaux, France
| | - Fabien Le Marec
- Bordeaux Population Health Research Center, INSERM U1219, CIC-EC 1401, Univ. Bordeaux - ISPED, 33076, Bordeaux, France
| | - Pierre Duffau
- CHU de Bordeaux, COREVIH Nouvelle Aquitaine, Bordeaux, France; CHU de Bordeaux, Service de Médecine Interne, Hôpital Saint-André, Bordeaux, France
| | - Estibaliz Lazaro
- CHU de Bordeaux, COREVIH Nouvelle Aquitaine, Bordeaux, France; CHU de Bordeaux, Service de Médecine Interne et Maladies Infectieuses, Hôpital Haut-Lévêque, Pessac, France
| | - Marc-Olivier Vareil
- CHU de Bordeaux, COREVIH Nouvelle Aquitaine, Bordeaux, France; CH Bayonne Service des Maladies Infectieuses, Bayonne, France
| | - Camille Tumiotto
- CHU de Bordeaux, Virology Laboratory, Bordeaux, France; Université de Bordeaux, Fundamental Microbiology and Pathogenicity Laboratory, Bordeaux, France
| | - Mojgan Hessamfar
- Bordeaux Population Health Research Center, INSERM U1219, CIC-EC 1401, Univ. Bordeaux - ISPED, 33076, Bordeaux, France; CHU de Bordeaux, COREVIH Nouvelle Aquitaine, Bordeaux, France; CHU de Bordeaux, Service de Médecine Interne et Maladies Infectieuses, Hôpital Saint-André, Bordeaux, France
| | - Charles Cazanave
- CHU de Bordeaux, Service des Maladies Infectieuses et Tropicales, Hôpital Pellegrin, Bordeaux, France
| | - Adélaïde Perrier
- Bordeaux Population Health Research Center, INSERM U1219, CIC-EC 1401, Univ. Bordeaux - ISPED, 33076, Bordeaux, France
| | - Olivier Leleux
- Bordeaux Population Health Research Center, INSERM U1219, CIC-EC 1401, Univ. Bordeaux - ISPED, 33076, Bordeaux, France
| | - Fabrice Bonnet
- Bordeaux Population Health Research Center, INSERM U1219, CIC-EC 1401, Univ. Bordeaux - ISPED, 33076, Bordeaux, France; CHU de Bordeaux, COREVIH Nouvelle Aquitaine, Bordeaux, France; CHU de Bordeaux, Service de Médecine Interne et Maladies Infectieuses, Hôpital Saint-André, Bordeaux, France
| | - Didier Neau
- CHU de Bordeaux, Service des Maladies Infectieuses et Tropicales, Hôpital Pellegrin, Bordeaux, France; CHU de Bordeaux, COREVIH Nouvelle Aquitaine, Bordeaux, France
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Gibas KM, Kelly SG, Arribas JR, Cahn P, Orkin C, Daar ES, Sax PE, Taiwo BO. Two-drug regimens for HIV treatment. Lancet HIV 2022; 9:e868-e883. [PMID: 36309038 PMCID: PMC10015554 DOI: 10.1016/s2352-3018(22)00249-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 08/16/2022] [Accepted: 08/22/2022] [Indexed: 12/05/2022]
Abstract
Combination therapy with three antiretroviral agents has been integral to successful HIV-1 treatment since 1996. Although the efficacy, adverse effects, and toxicities of contemporary three-drug regimens have improved, even the newest therapies have potential adverse effects. The use of two-drug regimens is one way to reduce lifetime exposure to antiretroviral drugs while maintaining the benefits of viral suppression. Multiple large, randomised trials have shown the virological non-inferiority of certain two-drug regimens versus three-drug comparators, including adverse effect differences that reflect known profiles of the antiretroviral drugs in the respective regimens. Two-drug combinations are now recommended in treatment guidelines and include the first long-acting antiretroviral regimen for the treatment of HIV-1. Recommended two-drug regimens differ in their risks for, and factors associated with, virological failure and emergent resistance. The tolerability, safety, metabolic profiles, and drug interactions of two-drug regimens also vary by the constituent drugs. No current two-drug regimen is recommended for people with chronic hepatitis B virus as none include tenofovir. Two-drug regimens have increased options for individualised care.
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Affiliation(s)
- Kevin M Gibas
- Division of Infectious Diseases, Vanderbilt University Medical Center, Vanderbilt University, Nashville, TN, USA
| | - Sean G Kelly
- Division of Infectious Diseases, Vanderbilt University Medical Center, Vanderbilt University, Nashville, TN, USA
| | - Jose R Arribas
- Infectious Diseases Unit, La Paz University Hospital, Hospital La Paz Institute for Health Research, Madrid, Spain; School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
| | - Pedro Cahn
- Fundación Huésped, Buenos Aires, Argentina
| | - Chloe Orkin
- Department of Immunobiology, Queen Mary University of London, London, UK
| | - Eric S Daar
- The Lundquist Institute, Harbor University of California, Los Angeles, Torrence, CA, USA
| | - Paul E Sax
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA
| | - Babafemi O Taiwo
- Division of Infectious Diseases, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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Prevalence and Structure of HIV-1 Drug Resistance to Antiretrovirals in the Volga Federal District in 2008-2019. Viruses 2022; 14:v14091898. [PMID: 36146704 PMCID: PMC9503045 DOI: 10.3390/v14091898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/16/2022] [Accepted: 08/22/2022] [Indexed: 11/16/2022] Open
Abstract
The increasing number of HIV-infected people who are receiving ART, including those with low adherence, is causing the spread of HIV drug resistance (DR). A total of 1396 plasma samples obtained from treatment-experienced patients from the Volga federal district (VFD), Russia, were examined to investigate HIV DR occurrence. The time periods 2008−2015 and 2016−2019 were compared. Fragmentary Sanger sequencing was employed to identify HIV resistance to reverse transcriptase inhibitors (RTIs) and protease inhibitors (PIs) using an ABI 3500XL genetic analyzer, a ViroSeq™ HIV-1 genotyping system (Alameda, CA, USA) and AmpliSense HIV-Resist-Seq reagent kits (Moscow, Russia). In 2016−2019, HIV DR was detected significantly more often than in 2008−2015 (p < 0.01). Mutations to RTIs retained leading positions in the structure of DR. Frequencies of resistance mutations to nucleoside and non-nucleoside RTIs (NRTIs and NNRTIs) in the spectra of detected mutations show no significant differences. Resistance to NRTIs after 2016 began to be registered more often as a part of multidrug resistance (MDR), as opposed to resistance to a single class of antiretrovirals. The frequency of DR mutations to PIs was low, both before and after 2016 (7.9% and 6.1% in the spectrum, respectively, p > 0.05). MDR registration rate became significantly higher from 2008 to 2019 (17.1% to 72.7% of patients, respectively, p < 0.01). M184V was the dominant replacement in all the years of study. A significant increase in the frequency of K65R replacement was revealed. The prevalence of integrase strand transfer inhibitor (INSTI) resistance mutations remains to be investigated.
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Pérez-Cordón L, Sánchez A, Marin S, Force L, Serra-Prat M, Palomera E, Campins L. Real-world effectiveness and durability of dual antiretroviral therapy in HIV-infected patients. Eur J Hosp Pharm 2022; 31:ejhpharm-2022-003277. [PMID: 35882532 PMCID: PMC10895179 DOI: 10.1136/ejhpharm-2022-003277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 07/11/2022] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND AND OBJECTIVES While randomised controlled trials in HIV-infected patients have shown that certain dual antiretroviral therapy (DAT) regimens are non-inferior in terms of efficacy compared with classical triple-drug regimens, few real clinical experiences have been described. The aim of the study was to investigate, in real clinical practice, DAT effectiveness, durability, and risk factors for treatment discontinuation. METHODS This was a prospective cohort study that included HIV-infected patients treated with DAT (2015-2020). DAT was considered effective when patients achieved or maintained virological suppression and was assessed at 24 and 48 weeks. DAT durability was evaluated using the Kaplan-Meier method. Adherence and treatment cost were compared with patients' previous antiretroviral regimens. RESULTS 51 patients were included, 27.5% with HIV-1 RNA ≥50 copies/mL at baseline, treated with a wide range of dual combinations. At 48 weeks follow-up, 83.8% and 50.0% of patients who started DAT with HIV-1 RNA <50 copies/mL and ≥50 copies/mL, respectively, were suppressed. 39 out of 51 patients (76.5%) maintained DAT for a mean treatment duration of 40.5±14.8 weeks. Full adherence was observed in 78.4% of patients compared with 70.2% in the previous regimen. Mean daily cost was €18.6±4.3 compared with €16.1±7.9 in the previous regimen (p=0.008). CONCLUSION DAT effectiveness and durability were higher in patients who were virologically suppressed at baseline. DAT is a possible alternative for virologically non-suppressed patients who cannot be treated with a triple-drug regimen.
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Affiliation(s)
| | | | - Sergio Marin
- Pharmacy Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Lluis Force
- Department of Internal Medicine, Hospital de Mataró, Mataró, Spain
| | | | | | - Lluis Campins
- Pharmacy Department, Hospital de Mataró, Mataró, Spain
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Trujillo-Rodríguez M, Muñoz-Muela E, Serna-Gallego A, Milanés-Guisado Y, Praena-Fernández JM, Álvarez-Ríos AI, Herrera-Hidalgo L, Domínguez M, Lozano C, Romero-Vazquez G, Roca C, Espinosa N, Gutiérrez-Valencia A, López-Cortés LF. Immunological and inflammatory changes after simplifying to dual therapy in virologically suppressed HIV-infected patients through week 96 in a randomized trial. Clin Microbiol Infect 2022; 28:1151.e9-1151.e16. [PMID: 35289296 DOI: 10.1016/j.cmi.2022.02.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 02/24/2022] [Accepted: 02/27/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To evaluate whether simplification of antiretroviral treatment to dual therapy (DT) negatively impacts immune recovery (IR), immune activation and inflammation (IA/I), and HIV reservoir. METHODS An open-label, single-centre, randomized controlled trial conducted in adult virologically suppressed HIV-infected patients on triple therapy (TT) with elvitegravir-cobicistat, emtricitabine and tenofovir alafenamide or dolutegravir (DTG), abacavir, and lamivudine (3TC). Participants were randomized to continue TT or switch to DTG, or darunavir/cobicistat (DRVc) plus 3TC. IR was assessed by CD4+/CD8+ ratio at 48 and 96 weeks. Changes in immune activation, proliferation, exhaustion, senescence, and apoptosis in CD4+ and CD8+ T cells, plasma sCD14, hsCRP, D-dimers, β2-microglobulin, IL-6, TNF-α and IP-10 levels, cell-associated HIV-DNA (CA-DNA), and unspliced HIV-RNA (usRNA) were also analysed. RESULTS One hundred and fifty-one participants were enrolled. Fourteen patients did not complete the follow up. In the ITT and PP analysis, the IR was similar between the treatment arms. In the ITT analysis, the median increase in CD4+/CD8+ ratio was 0.10, 0.04, and 0.07 at week 48, and 0.09, 0.05, and 0.08 at week 96 for TT, DTG/3TC, and DRVc/3TC, respectively. After adjusting for confounding factors, the slopes of changes in CD4+/CD8+ ratio over time were independent of treatment (F = 1.699; p = 0.436) and related only to baseline values (F = 756.871; p = 0.000). There were no differences in IA/I, CA-DNA, or usRNA between treatment arms. DISCUSSION Both IR and IA/I, CA-DNA, and usRNA were similar in the three treatment groups, regardless of maintaining TT or simplifying to DTG/3TC or DRVc/3TC in virologically suppressed HIV-infected patients.
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Affiliation(s)
- María Trujillo-Rodríguez
- Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Instituto de Biomedicina de Sevilla/Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Spain
| | - Esperanza Muñoz-Muela
- Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Instituto de Biomedicina de Sevilla/Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Spain
| | - Ana Serna-Gallego
- Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Instituto de Biomedicina de Sevilla/Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Spain
| | - Yusnelkis Milanés-Guisado
- Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Instituto de Biomedicina de Sevilla/Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Spain
| | | | - Ana Isabel Álvarez-Ríos
- Departamento de Bioquímica Clínica, Hospital Universitario Virgen del Rocío/CSIC/SAS/Universidad de Sevilla, Spain
| | - Laura Herrera-Hidalgo
- Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Instituto de Biomedicina de Sevilla/Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Spain; Farmacia Hospitalaria, Instituto de Biomedicina de Sevilla/Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Spain
| | - Montserrat Domínguez
- Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Instituto de Biomedicina de Sevilla/Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Spain
| | - Carmen Lozano
- Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Instituto de Biomedicina de Sevilla/Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Spain
| | - Gloria Romero-Vazquez
- Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Instituto de Biomedicina de Sevilla/Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Spain
| | - Cristina Roca
- Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Instituto de Biomedicina de Sevilla/Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Spain
| | - Nuria Espinosa
- Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Instituto de Biomedicina de Sevilla/Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Spain
| | - Alicia Gutiérrez-Valencia
- Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Instituto de Biomedicina de Sevilla/Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Spain.
| | - Luis F López-Cortés
- Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Instituto de Biomedicina de Sevilla/Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Spain
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Fournier AL, Hocqueloux L, Braun DL, Metzner KJ, Kouyos RD, Raffi F, Briant AR, Martinez E, De Lazzari E, Negredo E, Rijnders B, Rokx C, Günthard HF, Parienti JJ. Dolutegravir monotherapy as maintenance strategy: a meta-analysis of individual participant data from randomized controlled trials. Open Forum Infect Dis 2022; 9:ofac107. [PMID: 35615294 PMCID: PMC9125303 DOI: 10.1093/ofid/ofac107] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 03/03/2022] [Indexed: 11/14/2022] Open
Abstract
Background Dolutegravir monotherapy (DTG-m) results in virological failure (VF) in some people with human immunodeficiency virus (PWH). We sought to identify the independent factors associated with the risk of VF and to explore the effect size heterogeneity between subgroups of PWH enrolled in DTG-m trials. Methods We searched for randomized clinical trials (RCTs) evaluating DTG-m versus combined antiretroviral therapy (cART) among PWH virologically controlled for at least 6 months on cART. We performed an individual participant data meta-analysis of VF risk factors and quantified their explained heterogeneity in random-effect models. Definition of VF was a confirmed plasma human immunodeficiency virus (HIV)-1 ribonucleic acid (RNA) >50 copies/mL by week 48. Results Among 416 PWH from 4 RCTs, DTG-m significantly increased the risk of VF (16 of 227 [7%] versus 0 of 189 for cART; risk difference 7%; 95% confidence interval [CI], 1%–2%; P = .02; I2 = 51%). Among 272 participants exposed to DTG-m, VF were more likely in participants with the following: first cART initiated ≥90 days from HIV acute infection (adjusted hazard ratio [aHR], 5.16; 95% 95% CI, 1.60–16.65), CD4 T cells nadir <350/mm3 (aHR, 12.10; 95% CI, 3.92–37.40), HIV RNA signal at baseline (aHR, 4.84; 95% CI, 3.68–6.38), and HIV-deoxyribonucleic acid (DNA) copy number at baseline ≥2.7 log/106 peripheral blood mononuclear cells (aHR, 3.81; 95% CI, 1.99–7.30). Among these independent risk factors, the largest effect size heterogeneity was found between HIV DNA subgroups (I2 = 80.2%; P for interaction = .02). Conclusions Our study supports the importance of a large viral reservoir size for explaining DTG-m simplification strategy failure. Further studies are needed to link size and genetic diversity of the HIV-1 reservoir.
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Affiliation(s)
- Anna L Fournier
- INSERM U1311 DYNAMICURE, Université Caen Normandie, Caen, France Infectious Diseases, Department, UNICAEN, Normandie University Hospital, Caen, France
| | | | - Dominique L Braun
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Karin J Metzner
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Roger D Kouyos
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - François Raffi
- Infectious Diseases Department, Hotel-Dieu Hospital, INSERM CIC 1413, Nantes University Hospital, Nantes, France
| | - Anaïs R Briant
- Department of Biostatistic and Clinical Research, Caen University hospital, Caen, France
| | | | | | | | - Bart Rijnders
- Erasmus University Medical Center, Rotterdam, Netherlands. Departments of Internal Medicine and Department of Medical Microbiology and Infectious diseases
| | - Casper Rokx
- Erasmus University Medical Center, Rotterdam, Netherlands. Departments of Internal Medicine and Department of Medical Microbiology and Infectious diseases
| | - Huldrych F Günthard
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Jean-Jacques Parienti
- INSERM U1311 DYNAMICURE, Université Caen Normandie, Caen, France Infectious Diseases, Department, UNICAEN, Normandie University Hospital, Caen, France
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Pérez-González A, Suárez-García I, Ocampo A, Poveda E. Two-Drug Regimens for HIV-Current Evidence, Research Gaps and Future Challenges. Microorganisms 2022; 10:433. [PMID: 35208887 PMCID: PMC8880461 DOI: 10.3390/microorganisms10020433] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/08/2022] [Accepted: 02/09/2022] [Indexed: 02/04/2023] Open
Abstract
During the last 30 years, antiretroviral treatment (ART) for human immunodeficiency virus (HIV) infection has been continuously evolving. Since 1996, three-drug regimens (3DR) have been standard-of-care for HIV treatment and are based on a protease inhibitor (PI) or a non-nucleoside reverse transcriptase inhibitor (NNRTI) plus two nucleoside reverse transcriptase inhibitors (NRTIs). The effectiveness of first-generation 3DRs allowed a dramatic increase in the life expectancy of HIV-infected patients, although it was associated with several side effects and ART-related toxicities. The development of novel two-drug regimens (2DRs) started in the mid-2000s in order to minimize side effects, reduce drug-drug interactions and improve treatment compliance. Several clinical trials compared 2DRs and 3DRs in treatment-naïve and treatment-experienced patients and showed the non-inferiority of 2DRs in terms of efficacy, which led to 2DRs being used as first-line treatment in several clinical scenarios, according to HIV clinical guidelines. In this review, we summarize the current evidence, research gaps and future prospects of 2DRs.
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Affiliation(s)
- Alexandre Pérez-González
- Group of Virology and Pathogenesis, Galicia Sur Health Research Institute (IIS Galicia Sur), Complexo Hospitalario Universitario de Vigo, SERGAS-UVigo, 36213 Vigo, Spain;
- Infectious Diseases Unit, Department of Internal Medicine, Galicia Sur Health Research Institute (IIS Galicia Sur), Complexo Hospitalario Universitario de Vigo, SERGAS-UVigo, 36213 Vigo, Spain;
| | - Inés Suárez-García
- Infectious Diseases Group, Internal Medicine Department, Hospital Universitario Infanta Sofía, FIIB HUIS HHEN, 28703 San Sebastián de los Reyes, Spain;
- Facultad de Ciencias Biomédicas y de la Salud, Universidad Europea, 28670 Madrid, Spain
- CIBER de Enfermedades Infecciosas, 28029 Madrid, Spain
| | - Antonio Ocampo
- Infectious Diseases Unit, Department of Internal Medicine, Galicia Sur Health Research Institute (IIS Galicia Sur), Complexo Hospitalario Universitario de Vigo, SERGAS-UVigo, 36213 Vigo, Spain;
| | - Eva Poveda
- Group of Virology and Pathogenesis, Galicia Sur Health Research Institute (IIS Galicia Sur), Complexo Hospitalario Universitario de Vigo, SERGAS-UVigo, 36213 Vigo, Spain;
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12
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Landman R, de Truchis P, Assoumou L, Lambert S, Bellet J, Amat K, Lefebvre B, Allavena C, Katlama C, Yazdanpanah Y, Molina JM, Petrov-Sanchez V, Gibowski S, Alvarez JC, Leibowitch J, Capeau J, Fellahi S, Duracinsky M, Morand-Joubert L, Costagliola D, Alvarez JC, Girard PM, LAMAURY I, BANI-SADR F, FORCE G, CHABROL A, CABY F, PATEY O, FRESARD A, GAGNEUX-BRUNON A, CHIROUZE C, DUVIVIER C, LOURENCO J, TOLSMA V, JANSSEN C, LEROLLE N, CATALAN P, RAMI A, DE PONTHAUD L, PICHANCOURT G, NASRI S, LANDOWSKI S, BOTTERO J, MFUTILA KAYKAY F, PIALOUX G, BOUCHAUD O, ABGRALL S, GATEY C, WEISS L, PAVIE J, SALMON-CERON D, ZUCMAN D, LELIEVRE JD, PALICH R, SIMON A, MEYOHAS MC, GRAS J, CABIE A, PIRCHER M, MORLAT P, HESSAMFAR M, NEAU D, CAZENAVE C, GENET C, FAUCHER JF, MAKHLOUFI D, BOIBIEUX A, BREGIGEON-RONOT S, LAROCHE H, SAUTEREAU A, REYNES J, MAKINSON A, RAFFI F, BOLLENGIER-STRAGIER O, NAQVI A, CUA E, ROSENTHAL E, ARVIEUX C, BUZELE R, REY D, BATARD ML, BERNARD L, DELOBEL P, PIFFAUT M, VERDON R, PIROTH L, BLOT M, LECLERCQ P, SIGNORI-SCHMUCK A, HULEUX T, MEYBECK A, MAY T, MIAILHES P, PERPOINT T, GREDER-BELAN A, ELHARRAR B, KHUONG MA, POUPARD M, BLUM L, MICHAU C, PRAZUCK T, PHILIBERT P, SLAMA L, HIKOMBO H, DARASTEANU I, GIRARD PM, ALVAREZ JC, MATHEZ D, DE TRUCHIS P, LANDMAN R, MEYNARD JL, MORAND-JOUBERT L, LAMBERT S, LE DU D, PERRONNE C, ASSOUMOU L, COSTAGLIOLA D, MELCHIOR JC, DURACINSKI M, PETROV-SANCHEZ V, AMAT K, BENALYCHERIF A, SYLLA B, GELLEY A, GIBOWSKI S, LE MEUT G, THIEBAUT R, CLUMECK N, LECLERCQ V, CECCHERINI-SILBERSTEIN F, DECOSTER L, LAMAURY I, BANI-SADR F, FORCE G, CHABROL A, CABY F, PATEY O, FRESARD A, GAGNEUX-BRUNON A, CHIROUZE C, DUVIVIER C, LOURENCO J, TOLSMA V, JANSSEN C, LEROLLE N, CATALAN P, RAMI A, DE PONTHAUD L, PICHANCOURT G, NASRI S, LANDOWSKI S, BOTTERO J, MFUTILA KAYKAY F, PIALOUX G, BOUCHAUD O, ABGRALL S, GATEY C, WEISS L, PAVIE J, SALMON-CERON D, ZUCMAN D, LELIEVRE JD, PALICH R, SIMON A, MEYOHAS MC, GRAS J, CABIE A, PIRCHER M, MORLAT P, HESSAMFAR M, NEAU D, CAZENAVE C, GENET C, FAUCHER JF, MAKHLOUFI D, BOIBIEUX A, BREGIGEON-RONOT S, LAROCHE H, SAUTEREAU A, REYNES J, MAKINSON A, RAFFI F, BOLLENGIER-STRAGIER O, NAQVI A, CUA E, ROSENTHAL E, ARVIEUX C, BUZELE R, REY D, BATARD ML, BERNARD L, DELOBEL P, PIFFAUT M, VERDON R, PIROTH L, BLOT M, LECLERCQ P, SIGNORI-SCHMUCK A, HULEUX T, MEYBECK A, MAY T, MIAILHES P, PERPOINT T, GREDER-BELAN A, ELHARRAR B, KHUONG MA, POUPARD M, BLUM L, MICHAU C, PRAZUCK T, PHILIBERT P, SLAMA L, HIKOMBO H, DARASTEANU I, GIRARD PM, ALVAREZ JC, MATHEZ D, DE TRUCHIS P, LANDMAN R, MEYNARD JL, MORAND-JOUBERT L, LAMBERT S, LE DU D, PERRONNE C, ASSOUMOU L, COSTAGLIOLA D, MELCHIOR JC, DURACINSKI M, PETROV-SANCHEZ V, AMAT K, BENALYCHERIF A, SYLLA B, GELLEY A, GIBOWSKI S, LE MEUT G, THIEBAUT R, CLUMECK N, LECLERCQ V, CECCHERINI-SILBERSTEIN F, DECOSTER L. A 4-days-on and 3-days-off maintenance treatment strategy for adults with HIV-1 (ANRS 170 QUATUOR): a randomised, open-label, multicentre, parallel, non-inferiority trial. THE LANCET HIV 2022; 9:e79-e90. [DOI: 10.1016/s2352-3018(21)00300-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 10/22/2021] [Accepted: 11/11/2021] [Indexed: 12/31/2022]
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Krentz HB, Campbell S, Lahl M, Gill MJ. Uptake Success and Cost Savings from Switching to a Two-Drug Antiretroviral Regimen. AIDS Patient Care STDS 2022; 36:1-7. [PMID: 34910887 DOI: 10.1089/apc.2021.0118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The emergence of dual therapy for antiretroviral (ARV)-experienced persons living with HIV (PWH) offers the opportunity to reduce lifetime exposure to unnecessary ARV drugs while maintaining viral suppression and reducing the cost of care. Our objective, using retrospective analysis of a quality care initiative, was to examine in routine clinical practice the clinical impact of switching PWH stable on a three-drug to a two-drug single-tablet formulation (STF) ARV regimen. We also examined the cost implications of this STF adjustment. Between January 1, 2020 and January 1, 2021 eligible patients (i.e., virally suppressed, no active hepatitis B infection, no documented nucleoside reverse transcriptase inhibitors/integrase strand transfer inhibitor resistance) were offered, on a convenience basis and as part of routine care, the opportunity to adjust their current three-drug STF to a two-drug STF (dolutegarvair/lamivudine). The acceptance, clinical efficacy, safety, tolerability, and cost of treatment were measured for patients who switched in 2020. Of 989 eligible PWH, 408 were approached and 391 (39.5%) switched to two-drug regimen; 99% remained on the two-drug STF at year's end (median 240 days follow-up). Only 2/391 patients who switched lost viral control. The total ARV drug cost for all 989 patients decreased by 10.3% generating an actual savings of $1,596,666 among patients approached and switched in 2020. Patient interest and uptake in switching to two-drug STF was substantial and resulted in few discontinuations for any reason. It provided significant and immediate cost savings within the first year. Our results bring clarity to discussions on whether using two-drug regimens would be practical and acceptable in nonclinical trial settings.
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Affiliation(s)
- Hartmut B. Krentz
- Southern Alberta Clinic, Calgary, Canada
- Department of Medicine, University of Calgary, Calgary, Canada
| | | | | | - M. John Gill
- Southern Alberta Clinic, Calgary, Canada
- Department of Medicine, University of Calgary, Calgary, Canada
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14
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Mule S, Singh A, Greish K, Sahebkar A, Kesharwani P, Shukla R. Drug repurposing strategies and key challenges for COVID-19 management. J Drug Target 2021; 30:413-429. [PMID: 34854327 DOI: 10.1080/1061186x.2021.2013852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
COVID-19 is a clinical outcome of viral infection emerged due to strain of beta coronavirus which attacks the type-2 pneumocytes in alveoli via angiotensin-converting enzyme 2 (ACE2) receptors. There is no satisfactory drug developed against 'SARS-CoV2', highlighting an immediate necessity chemotherapeutic repurposing plan COVID-19. Drug repurposing is a method of selection of approved therapeutics for new use and is considered to be the most effective drug finding strategy since it includes less time and cost to obtain treatment compared to the de novo drug acquisition process. Several drugs such as hydroxychloroquine, remdesivir, teicoplanin, darunavir, ritonavir, nitazoxanide, chloroquine, tocilizumab and favipiravir (FPV) showed their activity against 'SARS-CoV2' in vitro. This review has emphasized on repurposing of drugs, and biologics used in clinical set up for targeting COVID-19 and to evaluate their pharmacokinetics, pharmacodynamics and safety with their future aspect. The key benefit of drug repurposing is the wealth of information related to its safety, and easy accessibility. Altogether repurposing approach allows access to regulatory approval as well as reducing sophisticated safety studies.
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Affiliation(s)
- Shubham Mule
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research-Raebareli, Lucknow, India
| | - Ajit Singh
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research-Raebareli, Lucknow, India
| | - Khaled Greish
- Nanomedicine Unit, College of Medicine and Medical Sciences, Al-Jawhara Center for Molecular Medicine and Inherited Disorders, Arabian Gulf University, Manama, Bahrain
| | - Amirhossein Sahebkar
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Prashant Kesharwani
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, India
| | - Rahul Shukla
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research-Raebareli, Lucknow, India
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Patel R, Evitt L, Mariolis I, Di Giambenedetto S, d'Arminio Monforte A, Casado J, Cabello Úbeda A, Hocqueloux L, Allavena C, Barber T, Jha D, Kumar R, Kamath RD, Vincent T, van Wyk J, Koteff J. HIV Treatment with the Two-Drug Regimen Dolutegravir Plus Lamivudine in Real-world Clinical Practice: A Systematic Literature Review. Infect Dis Ther 2021; 10:2051-2070. [PMID: 34426899 PMCID: PMC8572911 DOI: 10.1007/s40121-021-00522-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/04/2021] [Indexed: 12/15/2022] Open
Abstract
The two-drug regimen dolutegravir plus lamivudine demonstrated durable efficacy for up to 3 years in phase III studies and a high barrier to resistance in treatment-naive and virologically suppressed people with HIV (PWH). This systematic literature review summarizes real-world evidence evaluating effectiveness and safety of dolutegravir plus lamivudine. We searched Ovid MEDLINE®, Embase®, PubMed, Cochrane library, and relevant international conference proceedings from 2013 to 2020. Qualitative synthesis of virologic suppression at Week 48, treatment-emergent resistance, discontinuation rates, and comorbidities was undertaken, with no statistical analyses conducted. Linked publications and potential for duplication in reporting of outcomes for cohorts and populations were identified, and the publication reporting the highest number of PWH receiving dolutegravir plus lamivudine was included in the analysis. Thirty-four studies reporting on cohorts of PWH not suspected to be linked or to include duplicate data receiving dolutegravir plus lamivudine were identified (N = 5017). Of 3744 virologically suppressed PWH who switched to dolutegravir plus lamivudine, 603 (16%) reported history of virologic failure. Nineteen studies included effectiveness data (n = 3558), four of which included data from treatment-naive PWH (n = 69). In studies with > 100 PWH, high rates of virologic suppression (Week 48, 97-100%) were maintained with dolutegravir plus lamivudine, with low rates of virologic failure (0-3.3 per 100 person-years of follow-up); one instance of emergent integrase strand transfer inhibitor resistance was reported in a complex treatment-experienced individual. Rates of discontinuation due to adverse events were low and consistent with previously observed trial data. Dolutegravir plus lamivudine minimally impacted renal function and had minimal impact on or improved lipid profiles and bone mineral density. This systematic review demonstrates that effectiveness and safety of dolutegravir plus lamivudine in clinical practice support data from randomized controlled trials with regard to high rates of virologic response, low rates of discontinuation, and a high barrier to resistance.
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Affiliation(s)
- Rickesh Patel
- ViiV Healthcare, 980 Great West Road, Brentford, TW8 9GS, Middlesex, UK.
| | - Lee Evitt
- ViiV Healthcare, 980 Great West Road, Brentford, TW8 9GS, Middlesex, UK
| | | | - Simona Di Giambenedetto
- UOC Malattie Infettive, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dipartimento di Sicurezza e Bioetica, Sezione di Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonella d'Arminio Monforte
- Department of Health Sciences, Clinic of Infectious Diseases, 'San Paolo' Hospital, University of Milan, Milan, Italy
| | - José Casado
- Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Alfonso Cabello Úbeda
- Infectious Diseases Division, Fundación Jimenez Diaz University Hospital, Madrid, Spain
| | - Laurent Hocqueloux
- Infectious Diseases Department, Centre Hospitalier Régional d'Orléans, Orléans, France
| | | | | | - Diwakar Jha
- GlaxoSmithKline Knowledge Centre, Gurgaon, Haryana, India
| | - Rahul Kumar
- GlaxoSmithKline Knowledge Centre, Gurgaon, Haryana, India
| | | | - Tia Vincent
- ViiV Healthcare, 980 Great West Road, Brentford, TW8 9GS, Middlesex, UK
| | - Jean van Wyk
- ViiV Healthcare, 980 Great West Road, Brentford, TW8 9GS, Middlesex, UK
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Ciccullo A, Borghi V, Giacomelli A, Cossu MV, Sterrantino G, Latini A, Giacometti A, De Vito A, Gennari W, Madeddu G, Capetti A, d'Ettorre G, Mussini C, Rusconi S, Di Giambenedetto S, Baldin G. Five Years With Dolutegravir Plus Lamivudine as a Switch Strategy: Much More Than a Positive Finding. J Acquir Immune Defic Syndr 2021; 88:234-237. [PMID: 34446677 DOI: 10.1097/qai.0000000000002787] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 08/12/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Results from clinical trials and observational studies suggest that dolutegravir plus lamivudine could be an effective and well-tolerated option for simplification in HIV-1-positive patients. We aimed to assess long-time efficacy and safety in our multicenter cohort. METHODS This was a retrospective study enrolling HIV-1-infected, virologically suppressed patients switching to dolutegravir + lamivudine. We performed survival analysis to evaluate time to virological failure (VF, defined by a single HIV-RNA ≥1000 copies/mL or by 2 consecutive HIV-RNA ≥ 50 copies/mL) and treatment discontinuation (defined as the interruption of either 3TC or dolutegravir), assessing predictors via Cox regression analyses. RESULTS Seven-hundred eighty-five patients were considered for the analysis: 554 were men (70.6%), with a median age of 52 years (interquartile range 45-58 years). Estimated probabilities of maintaining virological suppression at weeks 96, 144, and 240 were 97.7% (SD ±0.6), 96.9% (SD ±0.8), and 96.4% (SD ±0.9), respectively. A non-B HIV subtype (P = 0.014) and a previous VF (P = 0.037) resulted predictors of VF. We did not observe differences in probability of VF in people living with HIV with an M184V resistance mutation (P = 0.689); however, in a deeper analysis, M184V mutation was a predictor of VF (P = 0.038) in patients with time of virological suppression <88 months. Estimated probabilities of remaining on study regimen at 96, 144, and 240 weeks were 82.9% (SD ±1.4), 79.7% (SD ±1.6) and 74.3% (SD ±2.2), respectively. CONCLUSIONS Our findings show the long-term efficacy and tolerability of dolutegravir plus lamivudine in virologically suppressed patients.
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Affiliation(s)
- Arturo Ciccullo
- UOC Malattie Infettive, P.O. San Salvatore, L'Aquila, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Vanni Borghi
- Azienda Ospedaliero Universitaria di Modena, Clinica Malattie Infettive e Tropicali, Modena, Italy
| | - Andrea Giacomelli
- Infectious Diseases Unit, DIBIC Luigi Sacco, University of Milan, Milan, Italy
| | - Maria Vittoria Cossu
- Division of Infectious Diseases, Department of Infectious Diseases, Luigi Sacco University Hospital, Milan, Italy
| | - Gaetana Sterrantino
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Alessandra Latini
- Infectious Dermatology and Allergology Unit, IFO S. Gallicano Institute (IRCCS), Rome, Italy
| | - Andrea Giacometti
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Public Health, Polytechnic University of Marche, Ancona. Italy
| | - Andrea De Vito
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - William Gennari
- Azienda Ospedaliero Universitaria di Modena Laboratorio di Microbiologia e Virologia, Modena, Italy
| | - Giordano Madeddu
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Amedeo Capetti
- Division of Infectious Diseases, Department of Infectious Diseases, Luigi Sacco University Hospital, Milan, Italy
| | - Gabriella d'Ettorre
- Department of Public Health and Infectious Diseases, Azienda Policlinico Umberto I, Rome, Italy
| | - Cristina Mussini
- Azienda Ospedaliero Universitaria di Modena, Clinica Malattie Infettive e Tropicali, Modena, Italy
| | - Stefano Rusconi
- Infectious Diseases Unit, DIBIC Luigi Sacco, University of Milan, Milan, Italy
| | - Simona Di Giambenedetto
- Catholic University of the Sacred Heart, Rome, Italy
- UOC Malattie Infettive, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy ; and
| | - Gianmaria Baldin
- UOC Malattie Infettive, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy ; and
- Mater Olbia Hospital, Olbia, Italy
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17
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Maggiolo F, Gianotti N, Comi L, Di Filippo E, Fumagalli L, Nozza S, Galli L, Valenti D, Rizzi M, Castagna A. Rilpivirine plus cobicistat-boosted darunavir as alternative to standard three-drug therapy in HIV-infected, virologically suppressed subjects: Final results of the PROBE 2 trial. Antivir Ther 2021; 26:51-57. [DOI: 10.1177/13596535211042226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Primary analysis at 24 weeks showed that switching to rilpivirine plus darunavir/cobicistat was non-inferior to continuing a standard three-drug antiretroviral regimen in virologically suppressed people with HIV. We present efficacy and safety data from the 48-week analysis. Methods PROBE 2 is a randomized, open-label trial. Adults who were on a three-drug therapy and had had <50 HIV-1 RNA copies/mL for at least 6 months were randomly assigned (1:1) to 25 mg rilpivirine plus 800/150 darunavir/cobicistat once daily (early switch group) or to continue their regimen for 24 weeks before switching (late switch group). In the 48-week analysis, the efficacy endpoint was the proportion of participants with <50 copies/mL of HIV-RNA (US Food and Drug Administration snapshot algorithm). The trial is registered with ClinicalTrials.gov , number NCT04064632. Findings 160 participants were recruited and randomized. At week 48, 70 (87.5%) in the early switch group and 76 (94.8%) in the late switch group maintained HIV-RNA <50 copies/mL. Virological failure (≥50 HIV-RNA copies/mL) was not seen in any patient of the early switch group and in 2 subjects in the late switch group none of which had treatment emergent resistance-associated mutation. Adverse events leading to treatment discontinuation occurred in 7 (8.7%) participants in the early switch group and in none in the late switch group. Interpretation The combination of rilpivirine plus darunavir/cobicistat sustained virological suppression, was associated with a low frequency of virological failure, and had a favorable safety profile, which support its use as a nucleoside reverse transcriptase inhibitor-sparing and integrase inhibitor-sparing alternative to three-drug regimens.
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Affiliation(s)
| | | | - Laura Comi
- ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | | | | | | | | | | | - Antonella Castagna
- San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
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18
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Arancón Pardo A, Moreno Palomino M, Jiménez-Nácher I, Moreno F, González Fernández MÁ, González-García J, Herrero Ambrosio A. Real-World Experience with Two-Drug Regimens in HIV-1-Infected Patients Beyond the Indication of Clinical Trials: 48 Weeks' Results. AIDS Res Hum Retroviruses 2021; 37:761-767. [PMID: 34465135 DOI: 10.1089/aid.2021.0041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Data on two-drug regimens (2DRs) have shown high efficacy and tolerability in treatment-naive and treatment-experienced HIV-1 patients. Current guidelines recommend 2DRs as alternative to three-drug regimens (3DRs) to reduce long-term drug exposure and costs. Nevertheless, real-world experience with 2DR is limited. This study assessed the use of 2DR in routine clinical practice in a tertiary hospital. A retrospective, observational, descriptive study was performed on the use of dual therapy in adult HIV-1 patients. Individuals on antiretroviral treatment (ART) with dolutegravir plus lamivudine or dolutegravir plus rilpivirine who started 2DR between November 1, 2018, and April 30, 2019, were eligible for our study. Follow-up period was 48 weeks. Overall, 112 patients started 2DR; median age was 51 years and 88.4% were men. Most patients (97.3%) were treatment experienced before dual therapy, with 9.6 ± 8.0 years of prior ART on average. Around 96.4% of patients were virologically suppressed before 2DR. Most common reasons to start dual therapy were treatment simplification (49.5%), avoidance of long-term toxicities (21.1%), and intolerance to previous ART (18.3%). The main regimen used in dual therapy was dolutegravir plus lamivudine (98.2%). Only eight patients discontinued dual therapy; the main reason for discontinuation was toxicity. All patients who did not discontinue 2DR were virologically suppressed at week 48. ART simplification saved €130,117.58 during the study period. In our cohort, dual therapy was mainly used for virologically suppressed patients, before availability of the single-tablet 2DR. Switching to a 2DR may be a key option for treatment simplification and avoidance of long-term toxicities. Furthermore, 2DR could provide a more cost-effective alternative to 3DR.
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Affiliation(s)
- Ana Arancón Pardo
- Pharmacy Department, La Paz University Hospital-IdiPAZ, Madrid, Spain
| | | | | | - Francisco Moreno
- Pharmacy Department, La Paz University Hospital-IdiPAZ, Madrid, Spain
| | | | - Juan González-García
- Infectious Diseases Unit, Internal Medicine Department, La Paz University Hospital-IdiPAZ, Madrid, Spain
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19
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Wolf E, Boesecke C, Balogh A, Bidner H, Cordes C, Heiken H, Krznaric I, Kümmerle T, Stellbrink HJ, Schneider J, Spinner CD. Virologic outcomes of switching to boosted darunavir plus dolutegravir with respect to history of drug resistance. AIDS Res Ther 2021; 18:58. [PMID: 34496848 PMCID: PMC8425038 DOI: 10.1186/s12981-021-00384-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 08/23/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The DUALIS study showed that switching to boosted darunavir (bDRV) plus dolutegravir (DTG; 2DR) was non-inferior to continuous bDRV plus 2 nucleoside/nucleotide reverse-transcriptase inhibitors (NRTIs; 3DR) in treatment-experienced virologically suppressed people living with HIV (PLWH). We analyzed virologic outcomes with respect to treatment history and HIV drug resistance. DESIGN Post hoc analysis of a randomized trial. METHODS Main inclusion criteria were an HIV RNA level < 50 copies/mL for ≥ 24 weeks and no resistance to integrase strand transfer inhibitors or bDRV. Resistance-associated mutations (RAMs) were interpreted using the Stanford HIVdb mutation list. Outcomes measures were 48-week virologic response (HIV RNA < 50 copies/mL, FDA snapshot) and HIV RNA ≥ 50 copies/mL (including discontinuation due to a lack of efficacy or reasons other than adverse events and HIV RNA ≥ 50 copies/mL, referred to as snapshot non-response). RESULTS The analysis population included 263 patients (2DR: 131, 3DR: 132): 90.1% males; median age, 48 years; CD4 + T-cell nadir < 200/µl, 47.0%; ≥ 2 treatment changes, 27.4%; NRTI, non-NRTI (NNRTI), and major protease inhibitor (PI) RAMs in 9.5%, 14.4%, and 3.4%, respectively. In patients with RAMs in the 2DR and 3DR groups, virologic response rates were 87.8% and 96.0%, respectively; the corresponding rates in those without RAMs were 85.7% and 81.8%. RAMs were unrelated to virologic non-response in either group. No treatment-emergent RAMs were observed. CONCLUSIONS DTG + bDRV is an effective treatment option without the risk of treatment-emergent resistance for PLWH on suppressive first- or further-line treatment with or without evidence of pre-existing NRTI, NNRTI, or PI RAMs. TRIAL REGISTRATION EUDRA-CT Number 2015-000360-34; registered 07 April 2015; https://www.clinicaltrialsregister.eu/ctr-search/trial/2015-000360-34/DE .
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20
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Prazuck T, Verdon R, Le Moal G, Ajana F, Bernard L, Sunder S, Roncato-Saberan M, Ponscarme D, Etienne M, Viard JP, Pasdeloup T, Darasteanu I, Pialoux G, de la Blanchardière A, Avettand-Fènoël V, Parienti JJ, Hocqueloux L. Tenofovir disoproxil fumarate and emtricitabine maintenance strategy in virologically controlled adults with low HIV-1 DNA: 48 week results from a randomized, open-label, non-inferiority trial. J Antimicrob Chemother 2021; 76:1564-1572. [PMID: 33724373 DOI: 10.1093/jac/dkab038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/21/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Low HIV reservoirs may be associated with viral suppression under a lower number of antiretroviral drugs. We investigated tenofovir disoproxil fumarate/emtricitabine as a maintenance strategy in people living with HIV (PLHIV) with low HIV-DNA. METHODS TRULIGHT (NCT02302547) was a multicentre, open-label, randomized trial comparing a simplification to tenofovir disoproxil fumarate/emtricitabine versus a triple regimen continuation (tenofovir disoproxil fumarate/emtricitabine with a third agent, control arm) in virologically suppressed adults with HIV-DNA <2.7 log10 copies/106 PBMCs and no prior virological failure (VF). The primary endpoint (non-inferiority margin 12%) was the percentage of participants with a plasma viral load (pVL) <50 copies/mL in ITT (Snapshot approach) and PP analyses at Week 48 (W48). RESULTS Of the 326 participants screened, 223 (68%) were randomized to the tenofovir disoproxil fumarate/emtricitabine arm (n = 113) or control arm (n = 110). At W48, the tenofovir disoproxil fumarate/emtricitabine and control arms maintained a pVL < 50 copies/mL in 100/113 (88.5%) and 100/110 (90.9%) participants, respectively (ITT difference 2.4%, 95% CI -5.9 to 10.7; PP difference 3.4%, 95% CI -4.2 to 11.0). Six VFs occurred in the tenofovir disoproxil fumarate/emtricitabine arm (two with emerging mutations M184V and K65R) versus two in the control arm (ITT difference 3.5%, 95% CI -1.9 to 9.4). All VFs were resuppressed after treatment modification. CONCLUSIONS Although non-inferiority was shown, simplification to tenofovir disoproxil fumarate/emtricitabine should not be used for most PLHIV because of a low risk of VF with resistance.
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Affiliation(s)
- Thierry Prazuck
- Service des Maladies Infectieuses et Tropicales, CHR d'Orléans-La Source, Orléans, France
| | - Renaud Verdon
- Service des Maladies Infectieuses, CHU Côte de Nacre, Caen, France
| | - Gwenaël Le Moal
- Service des Maladies Infectieuses, CHU La Milétrie, Poitiers, France
| | - Faïza Ajana
- Service des Maladies Infectieuses, CHU Lille Tourcoing, France
| | - Louis Bernard
- Service des Maladies Infectieuses, CHU Bretonneau, Tours, France
| | - Simon Sunder
- Service des Maladies Infectieuses et Tropicales, CHG de Niort, Niort, France
| | - Mariam Roncato-Saberan
- Service des Maladies Infectieuses, Groupe Hospitalier de La Rochelle-Ré - Aunis, La Rochelle, France
| | - Diane Ponscarme
- Service des Maladies Infectieuses, CHU Saint-Louis, Paris, France
| | - Manuel Etienne
- Service des Maladies Infectieuses, CHU de Rouen, Rouen, France
| | - Jean-Paul Viard
- Centre de Diagnostic et Thérapeutique, Hôtel-Dieu, Paris, France
| | | | | | - Gilles Pialoux
- Service des Maladies Infectieuses, CHU Tenon, Paris, France
| | | | - Véronique Avettand-Fènoël
- Université de Paris, Faculté de Médecine, INSERM, U1016, CNRS, UMR8104, Laboratoire de Microbiologie clinique, unité de virologie, CHU Necker, Paris, France
| | - Jean-Jacques Parienti
- Service des Maladies Infectieuses, CHU Côte de Nacre, Caen, France.,EA 2656 GRAM 2.0, Caen Université, Caen, France
| | - Laurent Hocqueloux
- Service des Maladies Infectieuses et Tropicales, CHR d'Orléans-La Source, Orléans, France
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21
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Delaugerre C, Nere ML, Eymard-Duvernay S, Armero A, Ciaffi L, Koulla-Shiro S, Sawadogo A, Ngom Gueye NF, Ndour CT, Mpoudi Ngolle M, Amara A, Chaix ML, Reynes J. Deep sequencing analysis of M184V/I mutation at the switch and at the time of virological failure of boosted protease inhibitor plus lamivudine or boosted protease inhibitor maintenance strategy (substudy of the ANRS-MOBIDIP trial). J Antimicrob Chemother 2021; 76:1286-1293. [PMID: 33624081 DOI: 10.1093/jac/dkab002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 12/23/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The ANRS12286/MOBIDIP trial showed that boosted protease inhibitor (bPI) plus lamivudine dual therapy was superior to bPI monotherapy as maintenance treatment in subjects with a history of M184V mutation. OBJECTIVES We aimed to deep analyse the detection of M184V/I variants at time of switch and at the time of virological failure (VF). METHODS Ultra-deep sequencing (UDS) was performed on proviral HIV-DNA at inclusion among 265 patients enrolled in the ANRS 12026/MOBIDIP trial, and on plasma from 31 patients experiencing VF. The proportion of M184V/I variants was described and the association between the M184V/I mutation at 1% of threshold and VF was explored with logistic regression models. RESULTS M184V and I mutations were detected in HIV-DNA for 173/252 (69%) and 31/252 (12%) of participants, respectively. Longer duration of first-line treatment, higher plasma viral load at first-line treatment failure and higher baseline HIV-DNA load were associated with the archived M184V. M184I mutation was always associated with a STOP codon, suggesting defective virus. The 48 week estimated probability of remaining free from VF was comparable with or without the M184V/I mutation for dual therapy. At failure, M184V and major PI mutations were detected in 1/17 and 5/15 patients in the bPI arm and in 2/2 and 0/3 in the bPI+lamivudine arm, respectively. CONCLUSIONS Using UDS evidenced that archiving of M184V in HIV-DNA is heterogeneous despite past historical M184V in 96% of cases. The antiviral efficacy of lamivudine-based dual therapy regimens is mainly due to the residual lamivudine activity.
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Affiliation(s)
- Constance Delaugerre
- Department of Virology, Hôpital Saint Louis, Assistance Publique-Hôpitaux de Paris, Paris, France.,INSERM U944, University of Paris, Paris, France
| | - Marie-Laure Nere
- Department of Virology, Hôpital Saint Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Sabrina Eymard-Duvernay
- TransVIHMI, Institut de Recherche pour le Développement (IRD) - INSERM U1175 University of Montpellier, Montpellier, France
| | - Alix Armero
- Department of Virology, Hôpital Saint Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Laura Ciaffi
- TransVIHMI, Institut de Recherche pour le Développement (IRD) - INSERM U1175 University of Montpellier, Montpellier, France
| | - Sinata Koulla-Shiro
- Department of Infectious Diseases, Central Hospital Yaoundé, Yaoundé, Cameroon
| | - Adrien Sawadogo
- Day Care Center, University Hospital Souro Sanou, Bobo Dioulasso, Burkina Faso
| | | | | | | | - Ali Amara
- INSERM U944, University of Paris, Paris, France
| | - Marie-Laure Chaix
- Department of Virology, Hôpital Saint Louis, Assistance Publique-Hôpitaux de Paris, Paris, France.,INSERM U944, University of Paris, Paris, France
| | - Jacques Reynes
- TransVIHMI, Institut de Recherche pour le Développement (IRD) - INSERM U1175 University of Montpellier, Montpellier, France.,Department of Infectious Diseases, Montpellier University Hospital, Montpellier, France
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22
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Navarro J, González-Cordón A, Casado JL, Bernardino JI, Domingo P, Portilla J, Llibre JM, Colomer J, Rial-Crestelo D, Vizcarra P, Curran A, Martínez E, Ribera E. Effectiveness of boosted darunavir plus rilpivirine in patients with long-lasting HIV-1 infection: DARIL study. J Antimicrob Chemother 2021; 75:1955-1960. [PMID: 32134108 DOI: 10.1093/jac/dkaa072] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 01/23/2020] [Accepted: 02/05/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The combination of boosted darunavir plus rilpivirine, once daily, could be a convenient, effective and well-tolerated two-drug regimen to achieve HIV suppression in HIV-infected patients. METHODS Multicentre, retrospective cohort study in nine hospitals in Spain. All HIV-infected subjects starting boosted darunavir plus rilpivirine were included, irrespective of their viral load (VL). The primary objective was the percentage of patients with VL <50 copies/mL at 48 weeks. Secondary objectives included changes in CD4+ cell count, lipid profile and renal function. RESULTS Eighty-one of 84 patients reached Week 48. Fifty-nine (70.2%) patients had VL <50 copies/mL at baseline and the rest had a median VL of 202 (IQR 98-340) copies/mL. Subjects had a median of 21 years of infection with six prior regimens. The main reasons for starting boosted darunavir plus rilpivirine were simplification (44%), kidney or bone toxicity (28.6%) and virological failure (17.9%). Historical genotypes from 47 patients showed 41 (87.2%) patients with NRTI RAMs, 21 (44.7%) with NNRTI RAMs, 12 (25.5%) with primary PI RAMs and 7 (14.9%) with integrase strand transfer inhibitor (INSTI) RAMs. One patient had low-level resistance to boosted darunavir and five patients had some resistance to rilpivirine. At 48 weeks, 71 (87.7%) patients had VL <50 copies/mL. According to undetectable or detectable baseline VL, effectiveness was 91.1% or 80%, respectively. There were four virological failures with no emergence of new RAMs. Three of these patients resuppressed viraemia while maintaining the same regimen. CONCLUSIONS The combination of boosted darunavir plus rilpivirine has shown good effectiveness and tolerability in this cohort of pretreated patients with a long-lasting HIV infection, exposure to multiple antiretroviral regimens and prior HIV resistance.
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Affiliation(s)
- Jordi Navarro
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Vall d'Hebron Research Institute, Barcelona, Spain
| | | | - José Luís Casado
- Infectious Diseases Department, Hospital Ramon y Cajal, Madrid, Spain
| | | | - Pere Domingo
- Infectious Diseases Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Joaquin Portilla
- Infectious Diseases Department, Hospital General Universitario de Alicante, Alicante, Spain
| | - Josep Maria Llibre
- Infectious Diseases Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Joan Colomer
- Internal Medicine Department, Hospital de Santa Caterina, Salt, Spain
| | | | - Pilar Vizcarra
- Infectious Diseases Department, Hospital Ramon y Cajal, Madrid, Spain
| | - Adrià Curran
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Vall d'Hebron Research Institute, Barcelona, Spain
| | - Esteban Martínez
- Infectious Diseases Department, Hospital Clínic - IDIBAPS, Barcelona, Spain
| | - Esteban Ribera
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Vall d'Hebron Research Institute, Barcelona, Spain
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23
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Maggiolo F, Gianotti N, Comi L, Di Filippo E, Fumagalli L, Nozza S, Galli L, Valenti D, Rizzi M, Castagna A. Rilpivirine plus cobicistat-boosted darunavir as a two-drug switch regimen in HIV-infected, virologically suppressed subjects on steady standard three-drug therapy: a randomized, controlled, non-inferiority trial (PROBE 2). J Antimicrob Chemother 2021; 75:1332-1337. [PMID: 32129855 DOI: 10.1093/jac/dkaa018] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/08/2020] [Accepted: 01/12/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND We explored the combination of rilpivirine plus cobicistat-boosted darunavir [a two-drug regimen (2DR)] when switching from standard triple combined ART. METHODS In this randomized, open-label, non-inferiority trial, participants had an HIV-RNA <50 copies/mL on a stable (>6 months) three-drug regimen. The primary endpoint was proportion with HIV-RNA <50 copies/mL at Week 24 (snapshot algorithm), with a -12% non-inferiority margin. ClinicalTrials.gov: NCT04064632. RESULTS One hundred and sixty patients were allocated (1:1) to 2DR or to continue current ART (CAR). At Week 24, 72 (90.0%) of participants with 2DR and 75 (93.8%) with CAR maintained HIV-RNA <50 copies/mL [difference -3.75% (95% CI = -11.63 to 5.63)], confirming non-inferiority. Non-inferiority was confirmed considering an HIV-RNA >50 copies/mL (0% for 2DR; 3.7% for CAR; 95% CI = -0.4 to 7.9). Four patients reported adverse events not leading to treatment discontinuation (one patient in the 2DR group and three patients in the CAR group); eight subjects discontinued therapy in the 2DR group and three in the CAR group. With 2DR, lipid serum concentrations increased, but differences were statistically significant only for tenofovir disoproxil fumarate-containing CAR and in 2DR patients receiving a pre-switch regimen including tenofovir disoproxil fumarate. Median bone stiffness decreased in the CAR group from 86.1 g/cm2 (IQR = 74-98) to 83.2 g/cm2 (IQR = 74-97) and increased in the 2DR group from 84.9 g/cm2 (IQR = 74-103) to 85.5 g/cm2 (IQR = 74-101). The reduction within the CAR group was significant (P = 0.043). CONCLUSIONS Once-daily rilpivirine plus cobicistat-boosted darunavir is an effective 2DR that combines a high virological efficacy with a potential to avoid major NRTI toxicities.
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Affiliation(s)
- F Maggiolo
- ASST Papa Giovanni XXIII, Bergamo, Italy
| | - N Gianotti
- San Raffaele Scientific Institute, Milan, Italy
| | - L Comi
- ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - L Fumagalli
- San Raffaele Scientific Institute, Milan, Italy
| | - S Nozza
- San Raffaele Scientific Institute, Milan, Italy
| | - L Galli
- San Raffaele Scientific Institute, Milan, Italy
| | | | - M Rizzi
- ASST Papa Giovanni XXIII, Bergamo, Italy
| | - A Castagna
- San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
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24
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Calza L, Colangeli V, Borderi M, Testi D, Granozzi B, Bon I, Re MC, Viale P. Simplification to dual therapy containing lamivudine and raltegravir or dolutegravir in HIV-infected patients on virologically suppressive antiretroviral therapy. J Antimicrob Chemother 2021; 75:3327-3333. [PMID: 32728708 DOI: 10.1093/jac/dkaa319] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 06/25/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Antiretroviral dual regimens including lamivudine and one boosted PI or dolutegravir are warranted in order to optimize combination ART (cART), prevent long-term toxicity and reduce the cost of treatments. OBJECTIVES We hypothesized that a maintenance dual regimen of lamivudine plus raltegravir would be effective and as well tolerated as the dual maintenance combination of lamivudine plus dolutegravir. METHODS We performed an observational, retrospective study of HIV-infected patients on suppressive ART who switched to a dual regimen containing lamivudine 300 mg once daily plus raltegravir 1200 mg once daily or dolutegravir 50 mg once daily. RESULTS In total, 109 patients (79 men; mean age 46.4 years; mean CD4+ T lymphocyte count 605 cells/mm3) were enrolled. Overall, 50 subjects switched to lamivudine plus raltegravir (Group A) and 59 to lamivudine plus dolutegravir (Group B). After 12 months, 45 patients (90%) in Group A and 52 (88.1%) in Group B had HIV RNA <20 copies/mL. No patients had severe adverse effects in either group, and the percentages of patients with mild adverse effects were comparable, except for a higher incidence of headache and sleeping disturbances in Group B than in Group A (30.5% versus 14%, P < 0.001). A comparable and non-significant weight increase was reported in both groups (+1.91 kg in Group A and +2.28 kg in Group B). CONCLUSIONS In our study, dual therapies containing lamivudine plus raltegravir or dolutegravir in virologically suppressed patients showed high and comparable efficacy, as well as good tolerability.
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Affiliation(s)
- Leonardo Calza
- Clinic of Infectious Diseases, 'Alma Mater Studiorum' University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Vincenzo Colangeli
- Clinic of Infectious Diseases, 'Alma Mater Studiorum' University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Marco Borderi
- Clinic of Infectious Diseases, 'Alma Mater Studiorum' University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Diletta Testi
- Clinic of Infectious Diseases, 'Alma Mater Studiorum' University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Bianca Granozzi
- Clinic of Infectious Diseases, 'Alma Mater Studiorum' University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Isabella Bon
- Unit of Microbiology, 'Alma Mater Studiorum' University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Maria Carla Re
- Unit of Microbiology, 'Alma Mater Studiorum' University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Pierluigi Viale
- Clinic of Infectious Diseases, 'Alma Mater Studiorum' University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
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Martinez E, Negredo E, Knobel H, Ocampo A, Sanz J, Garcia-Fraile L, Martin-Carbonero L, Lozano F, Gonzalez-Domenech CM, Gutierrez M, Montero M, Boix V, Payeras A, Torralba M, Gonzalez-Cordon A, Moreno A, Alejos B, Perez-Elias MJ. Factors associated with the number of drugs in darunavir/cobicistat regimens. J Antimicrob Chemother 2021; 75:208-214. [PMID: 31586414 DOI: 10.1093/jac/dkz399] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 08/19/2019] [Accepted: 08/23/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Darunavir/cobicistat can be used as mono, dual, triple or more than triple therapy. OBJECTIVES To assess factors associated with the number of drugs in darunavir/cobicistat regimens. METHODS A nationwide retrospective cohort study of consecutive HIV-infected patients initiating darunavir/cobicistat in Spain from July 2015 to May 2017. Baseline characteristics, efficacy and safety at 48 weeks were compared according to the number of drugs used. RESULTS There were 761 patients (75% men, 98% were antiretroviral-experienced, 32% had prior AIDS, 84% had HIV RNA <50 copies/mL and 88% had ≥200 CD4 cells/mm3) who initiated darunavir/cobicistat as mono (n=308, 40%), dual (n=173, 23%), triple (n=253, 33%) or four-drug (n=27, 4%) therapy. Relative to monotherapy, triple therapy was more common in men aged <50 years, with prior AIDS and darunavir plus ritonavir use, and with CD4 cells <200/mm3 and with detectable viral load at initiation of darunavir/cobicistat; dual therapy was more common with previous intravenous drug use, detectable viral load at initiation of darunavir/cobicistat and no prior darunavir plus ritonavir; and four-drug therapy was more common with prior AIDS and detectable viral load at initiation of darunavir/cobicistat. Monotherapy and dual therapy showed a trend to better virological responses than triple therapy. CD4 responses and adverse effects did not differ among regimens. DISCUSSION Darunavir/cobicistat use in Spain has been tailored according to clinical characteristics of HIV-infected patients. Monotherapy and dual therapy have been common and preferentially addressed to older patients with a better HIV status, suggesting that health issues other than HIV infection may have been strong determinants of its prescription.
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Affiliation(s)
- Esteban Martinez
- Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Eugenia Negredo
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | | | - Jose Sanz
- Hospital Universitario Principe de Asturias, Alcala de Henares, Spain
| | | | | | | | | | - Mar Gutierrez
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Marta Montero
- Hospital Universitario y Politecnico La Fe, Valencia, Spain
| | - Vicente Boix
- Hospital General Universitario de Alicante, Alicante, Spain
| | | | | | | | - Ana Moreno
- Hospital Universitario Ramón y Cajal, Madrid, Spain
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Guo PL, He HL, Chen XJ, Chen JF, Chen XT, Lan Y, Wang J, Du PS, Zhong HL, Li H, Liu C, Li LY, Hu FY, Tang XP, Cai WP, Li LH. Antiretroviral Long-Term Efficacy and Resistance of Lopinavir/Ritonavir Plus Lamivudine in HIV-1-Infected Treatment-Naïve Patients (ALTERLL): 144-Week Results of a Randomized, Open-Label, Non-Inferiority Study From Guangdong, China. Front Pharmacol 2021; 11:569766. [PMID: 33841131 PMCID: PMC8027496 DOI: 10.3389/fphar.2020.569766] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 09/22/2020] [Indexed: 12/13/2022] Open
Abstract
Dual therapy with lopinavir/ritonavir (LPV/r) plus lamivudine (3TC) has been demonstrated to be non-inferior to the triple drug regimen including LPV/r plus two nucleoside reverse transcriptase inhibitors (NRTIs) in 48-week studies. However, little is known about the long-term efficacy and drug resistance of this simplified strategy. A randomized, controlled, open-label, non-inferiority trial (ALTERLL) was conducted to assess the efficacy, drug resistance, and safety of dual therapy with LPV/r plus 3TC (DT group), compared with the first-line triple-therapy regimen containing tenofovir (TDF), 3TC plus efavirenz (EFV) (TT group) in antiretroviral therapy (ART)-naïve HIV-1-infected adults in Guangdong, China. The primary endpoint was the proportion of patients with plasma HIV-1 RNA < 50 copies/ml at week 144. Between March 1 and December 31, 2015, a total of 196 patients (from 274 patients screened) were included and randomly assigned to either the DT group (n = 99) or the TT group (n = 97). In the primary intention-to-treat (ITT) analysis at week 144, 95 patients (96%) in the DT group and 93 patients (95.9%) in the TT group achieved virological inhibition with plasma HIV-1 RNA <50 copies/ml (difference: 0.1%; 95% CI, -4.6-4.7%), meeting the criteria for non-inferiority. The DT group did not show significant differences in the mean increase in CD4+ cell count (247.0 vs. 204.5 cells/mm3; p = 0.074) or the CD4/CD8 ratio (0.47 vs. 0.49; p = 0.947) from baseline, or the inflammatory biomarker levels through week 144 compared with the TT group. For the subgroup analysis, baseline high viremia (HIV-1 RNA > 100,000 copies/ml) and genotype BC did not affect the primary endpoint or the mean increase in CD4+ cell count or CD4/CD8 ratio from baseline at week 144. However, in patients with genotype AE, the DT group showed a higher mean increase in CD4+ cell count from baseline through 144 weeks than the TT group (308.7 vs. 209.4 cells/mm3; p = 0.038). No secondary HIV resistance was observed in either group. Moreover, no severe adverse event (SAE) or death was observed in any group. Nonetheless, more patients in the TT group (6.1%) discontinued the assigned regimen than those in the DT group (1%) due to adverse events. Dual therapy with LPV/r plus 3TC manifests long-term non-inferior therapeutic efficacy, low drug resistance, good safety, and tolerability compared with the first-line triple-therapy regimen in Guangdong, China, indicating dual therapy is a viable alternative in resource-limited areas. Clinical Trial Registration: [http://www.chictr.org.cn], identifier [ChiCTR1900024611].
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Wei-Ping Cai
- Guangzhou Eighth People’s Hospital, Guangzhou Medical University, Guangzhou, China
| | - Ling-Hua Li
- Guangzhou Eighth People’s Hospital, Guangzhou Medical University, Guangzhou, China
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Cadiñanos J, Montejano R, de Miguel Buckley R, Marcelo C, Arribas JR. Risks and benefits of reducing the number of drugs to treat HIV-1 infection. Expert Opin Drug Saf 2021; 20:397-409. [PMID: 33557651 DOI: 10.1080/14740338.2021.1887135] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Introduction: Despite the efficacy and safety of antiretroviral therapy, new treatment options are needed to address the concerns of patients and physicians regarding long-term toxicities, costs, and convenience of lifelong antiretroviral therapy. To achieve this goal, one strategy is to reduce the number of drugs in the antiretroviral regimen.Areas covered: We review the recent evidence on the efficacy and safety of reduced drug regimens and their potential risks and benefits. There is currently strong evidence showing that some two-drug regimens have a comparable efficacy and short-term safety compared to standard three-drug regimens. The fixed-dose combination of dolutegravir/lamivudine is already an alternative for many treatment-naïve and virologically suppressed HIV-1 infected adults supported by large randomized clinical trials. The co-formulation dolutegravir plus rilpivirine is also a switch strategy for maintenance therapy. Long-acting injectable cabotegravir plus rilpivirine has already regulatory approval, and islatravir plus doravirine is an expected option in the near future. Some two-drug regimens have not been as successful.Expert opinion: Long-term safety issues of these two-drug regimens remain to be determined, but with the overwhelming evidence available in virological control and short-term safety, the potential benefits of some of these two-drug regimens appear to outweigh the risks.
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Affiliation(s)
- Julen Cadiñanos
- HIV Unit, Internal Medicine Service, Hospital Universitario La Paz-IdiPAZ, Madrid, Spain
| | - Rocio Montejano
- HIV Unit, Internal Medicine Service, Hospital Universitario La Paz-IdiPAZ, Madrid, Spain
| | - Rosa de Miguel Buckley
- HIV Unit, Internal Medicine Service, Hospital Universitario La Paz-IdiPAZ, Madrid, Spain
| | - Cristina Marcelo
- Internal Medicine Service, Hospital Universitario La Paz-IdiPAZ, Madrid, Spain
| | - Jose R Arribas
- Infectious Diseases Unit, Despacho 3.3. Hospital La Paz. IdiPAZ, Madrid, Spain
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28
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Greenberg L, Ryom L, Neesgaard B, Wandeler G, Staub T, Gisinger M, Skoll M, Günthard HF, Scherrer A, Mussini C, Smith C, Johnson M, De Wit S, Necsoi C, Pradier C, Wit F, Lehmann C, d'Arminio Monforte A, Miró JM, Castagna A, Spagnuolo V, Sönnerborg A, Law M, Hutchinson J, Chkhartishvili N, Bolokadze N, Wasmuth JC, Stephan C, Vannappagari V, Rogatto F, Llibre JM, Duvivier C, Hoy J, Bloch M, Bucher HC, Calmy A, Volny Anne A, Pelchen-Matthews A, Lundgren JD, Peters L, Bansi-Matharu L, Mocroft A. Clinical outcomes of two-drug regimens vs. three-drug regimens in antiretroviral treatment-experienced people living with HIV. Clin Infect Dis 2020; 73:e2323-e2333. [PMID: 33354721 DOI: 10.1093/cid/ciaa1878] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 12/17/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Limited data exist comparing clinical outcomes of two-drug regimens (2DRs) and three-drug regimens (3DRs) in people living with HIV. METHODS Antiretroviral treatment-experienced individuals in RESPOND switching to a new 2DR or 3DR from 1/1/12-1/10/18 were included. The incidence of clinical events (AIDS, non-AIDS cancer, cardiovascular disease, end-stage liver and renal disease, death) was compared between regimens using Poisson regression. RESULTS Of 9791 individuals included, 1088 (11.1%) started 2DRs and 8703 (88.9%) 3DRs. The most common 2DRs were dolutegravir plus lamivudine (22.8%) and raltegravir plus boosted darunavir (19.8%); the most common 3DR was dolutegravir plus 2 nucleoside reverse transcriptase inhibitors (46.9%). Individuals on 2DRs were older (median 52.6 years [interquartile range 46.7-59.0] vs 47.7 [39.7-54.3]), and a higher proportion had ≥1 comorbidity (81.6% vs 73.9%).There were 619 events during 27,159 person-years of follow-up (PYFU): 540 (incidence rate [IR] 22.5/1000 PYFU [95% CI 20.7-24.5]) on 3DRs, 79 (30.9/1000 PYFU [24.8-38.5]) on 2DRs. The most common events were death (7.5/1000 PYFU [95% CI 6.5-8.6]) and non-AIDS cancer (5.8/1000 PYFU [4.9-6.8]). After adjustment for baseline demographic and clinical characteristics, there was a similar incidence of events on both regimen types (2DRs vs 3DRs IR ratio: 0.92 [0.72-1.19]; p=0.53). CONCLUSIONS This is the first large, international cohort assessing clinical outcomes on 2DRs. After accounting for baseline characteristics, there was a similar incidence of events on 2DRs and 3DRs. 2DRs appear to be a viable treatment option with regard to clinical outcomes; further research on resistance barriers and long-term durability of 2DRs is needed.
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Affiliation(s)
- Lauren Greenberg
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, UK
| | - Lene Ryom
- CHIP, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Bastian Neesgaard
- CHIP, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Gilles Wandeler
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland
| | - Therese Staub
- Infectious Diseases, CHL (Centre Hospitalier Luxembourg), Luxembourg
| | | | | | - Huldrych F Günthard
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Alexandra Scherrer
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Cristina Mussini
- Modena HIV Cohort, Università degli Studi di Modena, Modena, Italy
| | - Colette Smith
- The Royal Free HIV Cohort Study, Royal Free Hospital, University College London, London, United Kingdom
| | - Margaret Johnson
- The Royal Free HIV Cohort Study, Royal Free Hospital, University College London, London, United Kingdom
| | - Stéphane De Wit
- Saint Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Coca Necsoi
- Saint Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Christian Pradier
- Nice HIV Cohort, Université Côte d'Azur et Centre Hospitalier Universitaire, Nice, France
| | - Ferdinand Wit
- AIDS Therapy Evaluation in the Netherlands Cohort (ATHENA), Stichting HIV Monitoring (SHM), Amsterdam, Netherlands
| | | | | | - Jose M Miró
- Hospital Clinic-IDIBAPS. University of Barcelona, Barcelona, Spain
| | | | | | - Anders Sönnerborg
- Division of Infectious Diseases, Karolinska Institutet and Department of Infectious Diseases, Karolinska University Hospital, Sweden
| | - Matthew Law
- The Australian HIV Observational Database (AHOD), UNSW, Sydney Australia
| | - Jolie Hutchinson
- The Australian HIV Observational Database (AHOD), UNSW, Sydney Australia
| | - Nikoloz Chkhartishvili
- Georgian National AIDS Health Information System (AIDS HIS), Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia
| | - Natalia Bolokadze
- Georgian National AIDS Health Information System (AIDS HIS), Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia
| | | | - Christoph Stephan
- Medical Department no. 2, Infectious Diseases Unit, Goethe-University Hospital Frankfurt, Frankfurt a.M., Germany
| | | | | | - Josep M Llibre
- Hospital Universitari Germans Trias i Pujol · Department of Internal Medicine, HIV Unit, Barcelona, Spain
| | - Claudine Duvivier
- APHP-Hôpital Necker-Enfants Malades, Service de Maladies Infectieuses et Tropicales, Centre d'Infectiologie Necker-Pasteur, IHU Imagine, Paris, France
| | - Jennifer Hoy
- Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, Victoria, Australia
| | - Mark Bloch
- The Australian HIV Observational Database (AHOD), UNSW, Sydney Australia
| | - Heiner C Bucher
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - Alexandra Calmy
- HIV/AIDS Unit in Geneva University Hospital, Geneva, Switzerland
| | | | - Annegret Pelchen-Matthews
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, UK
| | - Jens D Lundgren
- CHIP, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lars Peters
- CHIP, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Loveleen Bansi-Matharu
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, UK
| | - Amanda Mocroft
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, UK
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Sculier D, Wandeler G, Yerly S, Marinosci A, Stoeckle M, Bernasconi E, Braun DL, Vernazza P, Cavassini M, Buzzi M, Metzner KJ, Decosterd LA, Günthard HF, Schmid P, Limacher A, Egger M, Calmy A. Efficacy and safety of dolutegravir plus emtricitabine versus standard ART for the maintenance of HIV-1 suppression: 48-week results of the factorial, randomized, non-inferiority SIMPL'HIV trial. PLoS Med 2020; 17:e1003421. [PMID: 33170863 PMCID: PMC7654764 DOI: 10.1371/journal.pmed.1003421] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 10/14/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Dolutegravir (DTG)-based dual therapy is becoming a new paradigm for both the initiation and maintenance of HIV treatment. The SIMPL'HIV study investigated the outcomes of virologically suppressed patients on standard combination antiretroviral therapy (cART) switching to DTG + emtricitabine (FTC). We present the 48-week efficacy and safety data on DTG + FTC versus cART. METHODS AND FINDINGS SIMPL'HIV was a multicenter, open-label, non-inferiority randomized trial with a factorial design among treatment-experienced people with HIV in Switzerland. Participants were enrolled between 12 May 2017 and 30 May 2018. Patients virologically suppressed for at least 24 weeks on standard cART were randomized 1:1 to switching to DTG + FTC or to continuing cART, and 1:1 to simplified patient-centered monitoring versus standard monitoring. The primary endpoint was the proportion of patients virologically suppressed with <100 copies/ml through 48 weeks. The secondary endpoints included virological suppression at 48 weeks according to the US Food and Drug Administration (FDA) snapshot analysis. Non-inferiority of DTG + FTC versus cART for viral suppression was assessed using a stratified Mantel-Haenszel risk difference, with non-inferiority declared if the lower bound of the 95% confidence interval was greater than -12%. Adverse events were monitored to assess safety. Quality of life was evaluated using the PROQOL-HIV questionnaire. Ninety-three participants were randomized to DTG + FTC, and 94 individuals to cART. Median nadir CD4 count was 246 cells/mm3; median age was 48 years; 17% of participants were female. DTG + FTC was non-inferior to cART. The proportion of patients with viral suppression (<100 copies/ml) through 48 weeks was 93.5% in the DTG + FTC arm and 94.7% in the cART arm in the intention-to-treat population (risk difference -1.2%; 95% CI -7.8% to 5.6%). Per-protocol analysis showed similar results, with viral suppression in 96.5% of patients in both arms (risk difference 0.0%; 95% CI -5.6% to 5.5%). There was no relevant interaction between the type of treatment and monitoring (interaction ratio 0.98; 95% CI 0.85 to 1.13; p = 0.81). Using the FDA snapshot algorithm, 84/93 (90.3%) participants in the DTG + FTC arm had an HIV-1 RNA viral load of <50 copies/ml compared to 86/94 (91.5%) participants on standard cART (risk difference -1.1%; 95% CI -9.3% to 7.1%; p = 0.791). The overall proportion of patients with adverse events and discontinuations did not differ by randomization arm. The proportion of patients with serious adverse events was higher in the cART arm (16%) compared to the DTG + FTC arm (6.5%) (p = 0.041), but none was considered to be related to the study medication. Quality of life improved more between baseline and week 48 in the DTG + FTC compared to the cART arm (adjusted difference +2.6; 95% CI +0.4 to +4.7). The study's main limitations included a rather small proportion of women included, the open label design, and its short duration. CONCLUSIONS In this study, DTG + FTC as maintenance therapy was non-inferior to cART in terms of efficacy, with a similar safety profile and a greater improvement in quality of life, thus expanding the offer of 2-drug simplification options among virologically suppressed individuals. TRIAL REGISTRATION ClinicalTrials.gov NCT03160105.
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Affiliation(s)
- Delphine Sculier
- HIV/AIDS Unit, Department of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
- Private Practice Office, Geneva, Switzerland
| | - Gilles Wandeler
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Sabine Yerly
- Laboratory of Virology, Geneva University Hospitals, Geneva, Switzerland
| | - Annalisa Marinosci
- HIV/AIDS Unit, Department of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Marcel Stoeckle
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Basel, University of Basel, Switzerland
| | - Enos Bernasconi
- Service of Infectious Diseases, Lugano Regional Hospital, Lugano, Switzerland
| | - Dominique L. Braun
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Pietro Vernazza
- Division of Infectious Diseases and Hospital Epidemiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Matthias Cavassini
- Department of Infectious Diseases, University Hospital of Lausanne, Lausanne, Switzerland
| | - Marta Buzzi
- HIV/AIDS Unit, Department of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Karin J. Metzner
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Laurent A. Decosterd
- Pharmacology Laboratory, Clinical Pharmacology Department, University of Lausanne, Lausanne, Switzerland
| | - Huldrych F. Günthard
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Patrick Schmid
- Division of Infectious Diseases and Hospital Epidemiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | | | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Alexandra Calmy
- HIV/AIDS Unit, Department of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Durable Efficacy of Dolutegravir Plus Lamivudine in Antiretroviral Treatment-Naive Adults With HIV-1 Infection: 96-Week Results From the GEMINI-1 and GEMINI-2 Randomized Clinical Trials. J Acquir Immune Defic Syndr 2020; 83:310-318. [PMID: 31834000 PMCID: PMC7043729 DOI: 10.1097/qai.0000000000002275] [Citation(s) in RCA: 115] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Supplemental Digital Content is Available in the Text. The 2-drug regimen dolutegravir + lamivudine was noninferior to dolutegravir + tenofovir disoproxil fumarate/emtricitabine in achieving HIV-1 RNA <50 copies/mL in treatment-naive adults in the 48-week primary analysis of the GEMINI trials. We present results from the prespecified 96-week secondary analyses.
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Hocqueloux L, Raffi F, Prazuck T, Bernard L, Sunder S, Esnault JL, Rey D, Le Moal G, Roncato-Saberan M, André M, Billaud E, Valéry A, Avettand-Fènoël V, Parienti JJ, Allavena C. Dolutegravir Monotherapy Versus Dolutegravir/Abacavir/Lamivudine for Virologically Suppressed People Living With Chronic Human Immunodeficiency Virus Infection: The Randomized Noninferiority MONotherapy of TiviCAY Trial. Clin Infect Dis 2020; 69:1498-1505. [PMID: 30601976 DOI: 10.1093/cid/ciy1132] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 12/29/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We investigated whether dolutegravir (DTG) monotherapy could be used to maintain virological suppression in people living with human immunodeficiency virus (HIV) on a successful dolutegravir-based triple therapy. METHODS MONCAY (MONotherapy of TiviCAY) was a 48-week, multicentric, randomized, open-label, 12% noninferiority margin trial. Patients with CD4 nadir >100/μL, plasma HIV-1 RNA <50 copies/mL for ≥12 months, and stable regimen with DTG/abacavir (ABC)/lamivudine (3TC) were 1:1 randomized to continue their regimen or to DTG monotherapy. The primary endpoint was the proportion of patients with HIV RNA <50 copies/mL at week 24 in intention-to-treat snapshot analysis. Virologic failure (VF) was defined as 2 consecutive HIV RNA >50 copies/mL within 2 weeks apart. RESULTS Seventy-eight patients were assigned to DTG monotherapy and 80 to continue DTG/ABC/3TC. By week 24, 2 patients in the DTG group experienced VF without resistance to the integrase strand transfer inhibitor (INSTI) class; 1 patient discontinued DTG/ABC/3TC due to an adverse event. The success rate at week 24 was 73/78 (93.6%) in the DTG arm and 77/80 (96.3%) in the DTG/ABC/3TC arm (difference, 2.7%; 95% confidence interval [CI], -5.0 to 10.8). During subsequent follow-up, 5 additional VFs occurred in the DTG arm (2 of which harbored emerging resistance mutation to INSTI). The cumulative incidence of VF at week 48 was 9.7% (95% CI, 2.8 to 16.6) in the DTG arm compared with 0% in the DTG/ABC/3TC arm (P = .005 by the log-rank test). The Data Safety Monitoring Board recommended to reintensify the DTG arm with standardized triple therapy. CONCLUSIONS Because the risk of VF with resistance increases over time, we recommend avoiding DTG monotherapy as a maintenance strategy among people living with chronic HIV infection. CLINICAL TRIALS REGISTRATION NCT02596334 and EudraCT 2015-002853-36.
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Affiliation(s)
- Laurent Hocqueloux
- Service des Maladies Infectieuses et Tropicales, CHR d'Orléans-La Source, Tours
| | - François Raffi
- Service des Maladies Infectieuses, CHU Hôtel Dieu and INSERM UIC 1413 Nantes University, Tours
| | - Thierry Prazuck
- Service des Maladies Infectieuses et Tropicales, CHR d'Orléans-La Source, Tours
| | - Louis Bernard
- Service des Maladies Infectieuses, CHU Bretonneau, Tours
| | - Simon Sunder
- Service des Maladies Infectieuses et Tropicales, CHG de Niort
| | - Jean-Luc Esnault
- Service des Maladies Infectieuses, CHD de Vendée, La Roche-sur-Yon
| | - David Rey
- Le Trait d'Union, Hôpitaux Universitaires de Strasbourg
| | - Gwenaël Le Moal
- Service des Maladies Infectieuses, CHU La Milétrie, Poitiers
| | | | - Marie André
- Service des Maladies Infectieuses, CHRU-Brabois, Nancy
| | - Eric Billaud
- Service des Maladies Infectieuses, CHU Hôtel Dieu and INSERM UIC 1413 Nantes University, Tours
| | - Antoine Valéry
- Département d'Informatique Médicale, CHR d'Orléans-La Source, France
| | - Véronique Avettand-Fènoël
- Laboratoire de Microbiologie clinique, CHU Necker and Université Paris Descartes, Sorbonne Paris Cité
| | - Jean-Jacques Parienti
- Unité de Biostatistique et de Recherche Clinique, CHU de Caen; EA2656 Groupe de Recherche sur l'Adaptation Microbienne (GRAM 2.0), Université Caen Normandie, Caen, France
| | - Clotilde Allavena
- Service des Maladies Infectieuses, CHU Hôtel Dieu and INSERM UIC 1413 Nantes University, Tours
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Real-World Experience with Dolutegravir-Based Two-Drug Regimens. AIDS Res Treat 2020; 2020:5923256. [PMID: 32724674 PMCID: PMC7364229 DOI: 10.1155/2020/5923256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/08/2020] [Accepted: 05/26/2020] [Indexed: 11/18/2022] Open
Abstract
Background Dolutegravir-based 2-drug regimens (DTG 2DRs) are now accepted as alternatives to 3-drug regimens for HIV antiretroviral treatment (ART); however, literature on physician drivers for prescribing DTG 2DR is sparse. This study evaluated treatment patterns of DTG 2DR components in clinical practice in the US. Methods This was a retrospective chart review in adult patients in care in the US with HIV-1 who received DTG 2DR prior to July 31, 2017, with follow-up until January 30, 2018. Primary objectives of the study were to determine reasons for patients initiating DTG 2DR and to describe the demographics and clinical characteristics. All analyses were descriptive. Results Overall, 278 patients received DTG 2DR (male: 70%; mean age: 56 years). Most patients were treatment experienced (98%), with a mean 13.5 years of prior ART. DTG was most commonly paired with darunavir (55%) or rilpivirine (27%). The most common physician-reported reasons for initiating DTG 2DR were treatment simplification/streamlining (30%) and avoidance of potential long-term toxicities (20%). Before starting DTG 2DR, 42% of patients were virologically suppressed; of those, 95% maintained suppression while on DTG 2DR. Of the 50% of patients with detectable viral load before DTG 2DR, 79% achieved and maintained virologic suppression on DTG 2DR during follow-up. There were no virologic data for 8% of patients prior to starting DTG 2DR. Only 15 patients discontinued DTG 2DR, of whom 4 (27%) discontinued due to virologic failure. Conclusions Prior to commercial availability of the single-tablet 2DRs, DTG 2DR components were primarily used in treatment-experienced patients for treatment simplification and avoidance of long-term toxicities. Many of these patients achieved and maintained virologic suppression, with low discontinuation rates.
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Badowski M, Pérez SE, Silva D, Lee A. Two's a Company, Three's a Crowd: A Review of Initiating or Switching to a Two-Drug Antiretroviral Regimen in Treatment-Naïve and Treatment-Experienced Patients Living with HIV-1. Infect Dis Ther 2020; 9:185-208. [PMID: 32193799 PMCID: PMC7237600 DOI: 10.1007/s40121-020-00290-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION As HIV has become a manageable chronic condition, a renewed and increased interest in challenging traditional three-drug HIV therapies and moving toward two-drug regimens (2DR) for initial or maintenance treatment in people living with HIV (PLWH) has developed. As PLWH are living longer, continual advancements in antiretroviral regimens have been a focus to provide optimal life-long therapy options. Although early studies may have shown poor outcomes in virologic suppression with 2DR, newer studies and treatment options have emerged to show promise in the management of HIV. The purpose of this review is to evaluate current literature and assess the efficacy of two-drug (2DR) antiretroviral therapy in treatment-naïve and -experienced people living with HIV. METHODS A systematic search was performed between January 2009 to January 2020, using EMBASE, MEDLINE, Google Scholar, and bibliographies. Combinations of the following search terms were used: HIV-1 infection, antiretroviral therapy, dual therapy, two-drug regimen, two-drug therapy, two-drug regimen, and 2DR. Included studies were those in the adult population with at least one active comparator, outcomes assessing HIV-1 RNA viral load while on treatment, and written in English. RESULTS Thirty-three studies were included, 13 where 2DRs were evaluated as initial therapy (3 studies with extension data) and 15 where 2DRs were evaluated as maintenance or switch therapy (2 studies with extension data). CONCLUSION Although 2DRs may not be appropriate in all patient populations, they are being utilized more frequently and have the potential to reduce costs, adverse effects, and drug interactions.
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Affiliation(s)
| | - Sarah E Pérez
- College of Pharmacy, University of New Mexico, Albuquerque, NM, USA
| | - David Silva
- College of Pharmacy, University of Illinois, Chicago, IL, USA
| | - Andrea Lee
- College of Pharmacy, University of Illinois, Chicago, IL, USA
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Moreno S, Perno CF, Mallon PW, Behrens G, Corbeau P, Routy JP, Darcis G. Two-drug vs. three-drug combinations for HIV-1: Do we have enough data to make the switch? HIV Med 2020; 20 Suppl 4:2-12. [PMID: 30821898 DOI: 10.1111/hiv.12716] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2019] [Indexed: 01/01/2023]
Abstract
Three-drug combination antiretroviral therapy (ART) became available in 1996, dramatically improving the prognosis of people living with HIV. The clinical benefits of ART are due to the sustained viral load suppression and CD4 T cell gains. Major drawbacks of the first ART regimens were adverse events, and high pill burden, which led to the reduction of drug adherence resulting in frequent treatment discontinuations and the development of drug resistance. Due to increased viral potency of new antiretroviral drugs consideration of a two-drug combination therapy repositioning occurred in an effort to reduce adverse events, drug-drug interactions and cost, while maintaining a sustained antiviral effect. Various combinations of two-drug regimens have been studied, and non-inferiority compared to a three-drug regimen has been shown only for some of them. In addition, a two-drug combination regimen may not be suitable for every patient, especially those who are pregnant, those with tuberculosis or coexisting HBV infection. Furthermore no information has been generated concerning the secondary transmission of HIV from patients who have undetectable plasma viral load on two-drug regimens. Additional studies of two-drug combinations are also necessary to evaluate the debated existence of low viral replication in tissues and on immune activation. While there is no urgent need to routinely switch patients to two-drug combination therapy, due to the availability of drug combinations without significant toxicities, dual regimens represent a suitable option that deserve long-term evaluation before being introduced to clinical practice.
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Affiliation(s)
- S Moreno
- Department of Infectious Diseases, University Hospital Ramón y Cajal, Alcalá University, IRYCIS, Madrid, Spain
| | - C F Perno
- Department of Laboratory Medicine, ASST Niguarda Hospital, University of Milan, Milan, Italy
| | - P W Mallon
- HIV Molecular Research Group, School of Medicine, University College Dublin, Dublin, Ireland
| | - G Behrens
- Department for Rheumatology and Clinical Immunology, Hannover Medical School, Hannover, Germany
| | - P Corbeau
- Institute for Human Genetics, CNRS-Montpellier University UMR9002, Montpellier, France.,Immunology Department, University Hospital, Nîmes, France
| | - J-P Routy
- Division of Hematology and Chronic Viral Infection Service, McGill University Health Centre, Montréal, QC, Canada
| | - G Darcis
- Department of Infectious Diseases, Liege University Hospital, University of Liege, Liège, Belgium
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35
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Stirrup OT, Asboe D, Pozniak A, Sabin CA, Gilson R, Mackie NE, Tostevin A, Hill T, Dunn DT. Continuation of emtricitabine/lamivudine within combination antiretroviral therapy following detection of the M184V/I HIV-1 resistance mutation. HIV Med 2020; 21:309-321. [PMID: 31927793 PMCID: PMC7217157 DOI: 10.1111/hiv.12829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVES The aim of the study was to investigate whether lamivudine (3TC) or emtricitabine (FTC) use following detection of M184V/I is associated with better virological outcomes. METHODS We identified people with viruses harbouring the M184V/I mutation in UK multicentre data sets who had treatment change/initiation within 1 year. We analysed outcomes of viral suppression (< 200 HIV-1 RNA copies/mL) and appearance of new major drug resistance mutations (DRMs) using Cox and Poisson models, with stratification by new drug regimen (excluding 3TC/FTC) and Bayesian implementation, and estimated the effect of 3TC/FTC adjusted for individual and viral characteristics. RESULTS We included 2597 people with the M184V/I resistance mutation, of whom 665 (25.6%) were on 3TC and 458 (17.6%) on FTC. We found a negative adjusted association between 3TC/FTC use and viral suppression [hazard ratio (HR) 0.84; 95% credibility interval (CrI) 0.71-0.98]. On subgroup analysis of individual drugs, there was no evidence of an association with viral suppression for 3TC (n = 184; HR 0.94; 95% CrI 0.73-1.15) or FTC (n = 454; HR 0.99; 95% CrI 0.80-1.19) amongst those on tenofovir-containing regimens, but we estimated a reduced rate of viral suppression for people on 3TC amongst those without tenofovir use (n = 481; HR 0.71; 95% CrI 0.54-0.90). We found no association between 3TC/FTC and detection of any new DRM (overall HR 0.92; 95% CrI 0.64-1.18), but found inconclusive evidence of a lower incidence rate of new DRMs (overall incidence rate ratio 0.69; 95% CrI 0.34-1.11). CONCLUSIONS We did not find evidence that 3TC or FTC use is associated with an increase in viral suppression, but it may reduce the appearance of additional DRMs in people with M184V/I. 3TC was associated with reduced viral suppression amongst people on regimens without tenofovir.
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Affiliation(s)
- OT Stirrup
- Institute for Global HealthUniversity College LondonLondonUK
| | - D Asboe
- Chelsea and Westminster HospitalLondonUK
| | - A Pozniak
- Chelsea and Westminster HospitalLondonUK
- London School of Hygiene & Tropical MedicineLondonUK
| | - CA Sabin
- Institute for Global HealthUniversity College LondonLondonUK
| | - R Gilson
- Institute for Global HealthUniversity College LondonLondonUK
- CNWL Mortimer Market CentreLondonUK
| | - NE Mackie
- Imperial College Healthcare NHS TrustLondonUK
| | - A Tostevin
- Institute for Global HealthUniversity College LondonLondonUK
| | - T Hill
- Institute for Global HealthUniversity College LondonLondonUK
| | - DT Dunn
- Institute for Global HealthUniversity College LondonLondonUK
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36
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Neilan AM, Lu F, Gebo KA, Diaz-Reyes R, Huang M, Parker RA, Karalius B, Patel K, Voss C, Ciaranello AL, Agwu AL. Higher Acuity Resource Utilization With Older Age and Poorer HIV Control in Adolescents and Young Adults in the HIV Research Network. J Acquir Immune Defic Syndr 2020; 83:424-433. [PMID: 31904706 PMCID: PMC7055514 DOI: 10.1097/qai.0000000000002280] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Adolescents and young adults (AYA) with HIV experience poorer health outcomes compared with adults. To improve care for AYA with HIV, information about patterns of costly health care resource utilization is needed. METHODS Among 13-30 year olds in the US HIV Research Network, we stratified outpatient visits, emergency department (ED) visits, and inpatient days/person-year (PY) by HIV acquisition model [perinatal (PHIVY) and nonperinatal (NPHIVY)], age (13-17, 18-23, and 24-30 years), CD4 strata (<200, 200-499, and ≥500 cells/µL), and viral load (VL) suppression (<, ≥400 copies/mL [c/mL]) combined with antiretroviral (ARV) use. RESULTS Among 4540 AYA (PHIVY: 15%; NPHIVY: 85%), mean follow-up was 2.8 years. Among PHIVY, most person-time (PT) was spent between ages 13 and 23 years (13-17 years: 43%; 18-23 years: 45%), CD4 ≥500/µL (61%), and VL <400 c/mL (69%). Among NPHIVY, most PT was spent between ages 24 and 30 years (56%), with CD4 ≥500/µL (54%), and with VL <400 c/mL (67%). PT spent while prescribed ARVs and with VL ≥400 c/mL was 29% (PHIVY) and 24% (NPHIVY). For PHIVY and NPHIVY, outpatient visit rates were higher at younger ages (13-17 years and 18-23 years), lower CD4 (<200 and 200-499/µL), and among those prescribed ARVs. Rates of ED visits and inpatient days were higher during PT spent at older ages (18-23 years and 24-30 years), lower CD4 (<200 and 200-499/µL), and VL ≥400 c/mL. Utilization was higher among PHIVY than NPHIVY (outpatient: 12.1 vs. 6.0/PY; ED: 0.4 vs. 0.3/PY; inpatient: 1.5 vs. 0.8/PY). CONCLUSIONS More ED visits and inpatient days were observed during time spent at older ages, lower CD4 count, and VL ≥400 c/mL. Interventions to improve virologic suppression and immune response may improve outcomes, and thus decrease costly resource utilization, for AYA with HIV.
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Affiliation(s)
- Anne M Neilan
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital, Boston, MA
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Frances Lu
- The Biostatistics Center, Massachusetts General Hospital, Boston, MA
| | - Kelly A Gebo
- Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Mingshu Huang
- The Biostatistics Center, Massachusetts General Hospital, Boston, MA
| | - Robert A Parker
- Harvard Medical School, Boston, MA
- The Biostatistics Center, Massachusetts General Hospital, Boston, MA
| | - Brad Karalius
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA; and
| | - Kunjal Patel
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA; and
- Center for Biostatistics in AIDS Research, Boston, MA
| | - Cindy Voss
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - Andrea L Ciaranello
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Allison L Agwu
- Johns Hopkins University School of Medicine, Baltimore, MD
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Zou X, He J, Zheng J, Malmgren R, Li W, Wei X, Zhang G, Chen X. Prevalence of acquired drug resistance mutations in antiretroviral- experiencing subjects from 2012 to 2017 in Hunan Province of central South China. Virol J 2020; 17:38. [PMID: 32183889 PMCID: PMC7079350 DOI: 10.1186/s12985-020-01311-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 03/05/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND There are few data on the prevalence of acquired drug resistance mutations (ADRs) in Hunan Province, China, that could affect the effectiveness of antiretroviral therapy (ART). OBJECTIVES The main objectives of this study were to determine the prevalence of acquired drug resistance (ADR) the epidemic characteristics of HIV-1-resistant strains among ART-failed HIV patients in Hunan Province, China. METHODS ART-experienced and virus suppression failure subjects in Hunan between 2012 and 2017 were evaluated by genotyping analysis and mutations were scored using the HIVdb.stanford.edu algorithm to infer drug susceptibility. RESULTS The prevalence of HIV-1 ADR were 2.76, 2.30, 2.98, 2.62, 2.23and 2.17%, respectively, from 2012 to 2017. Overall 2295 sequences were completed from 2932 ART-failure patients, and 914 of these sequences were found to have drug resistance mutation. The most common subtype was AE (64.14%), followed by BC (17.91%) and B (11.50%). Among those 914 patients with drug resistance mutations,93.11% had NNRTI-associated drug resistance mutations, 74.40% had NRTI drug resistance mutations (DRMs) and 6.89% had PI DRMs. Dual-class mutations were observed in 591 (64.66%) cases, and triple-class mutations were observed in 43 (4.70%) cases. M184V (62.04%), K103N (41.90%) and I54L (3.83%) were the most common observed mutations, respectively, in NRTI-, NNRTI- and PI-associated drug resistance. 93.76% subjects who had DRMs received the ART first-line regimens. CD4 count, symptoms in the past 3 months, and ART adherence were found to be associated with HIV-1 DR. CONCLUSIONS This study showed that although the prevalence of HIV-acquired resistance in Hunan Province is at a low-level, the long-term and continuous surveillance of HIV ADR in antiretroviral drugs (ARVs) patients is necessary.
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Affiliation(s)
- Xiaobai Zou
- Hunan Provincial Center for Disease Control and Prevention, No.450 Section 1 Furongzhong middle Road, Kaifu District, Changsha, 410005, Hunan Province, China
| | - Jianmei He
- Hunan Provincial Center for Disease Control and Prevention, No.450 Section 1 Furongzhong middle Road, Kaifu District, Changsha, 410005, Hunan Province, China
| | - Jun Zheng
- Hunan Provincial Center for Disease Control and Prevention, No.450 Section 1 Furongzhong middle Road, Kaifu District, Changsha, 410005, Hunan Province, China
| | - Roberta Malmgren
- University of California at Los Angeles, 405 Hilgard Avenue, Los Angeles, CA, 90095, USA
| | - Weisi Li
- Hunan Science and Technology Information Institute, No.59 Bayi Road Furong District, Changsha, 410001, Hunan, China
| | - Xiuqing Wei
- Hunan Provincial Center for Disease Control and Prevention, No.450 Section 1 Furongzhong middle Road, Kaifu District, Changsha, 410005, Hunan Province, China
| | - Guoqiang Zhang
- Hunan Provincial Center for Disease Control and Prevention, No.450 Section 1 Furongzhong middle Road, Kaifu District, Changsha, 410005, Hunan Province, China
| | - Xi Chen
- Hunan Provincial Center for Disease Control and Prevention, No.450 Section 1 Furongzhong middle Road, Kaifu District, Changsha, 410005, Hunan Province, China.
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Ciccullo A, Baldin G, Borghetti A, Di Giambenedetto S. Dolutegravir plus lamivudine for the treatment of HIV-1 infection. Expert Rev Anti Infect Ther 2020; 18:279-292. [PMID: 32067525 DOI: 10.1080/14787210.2020.1729742] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Introduction: Recent data on the 2-drug regimen (2DR) with dolutegravir (DTG) plus lamivudine (3TC) have shown high efficacy and tolerability both in treatment-naïve and experienced HIV-positive patients. Current guidelines recommend DTG+3TC as an alternative to triple antiretroviral therapy (ART) in selected patients to reduce long-term toxicity and costs.Areas covered: This review is intended to provide insight about the efficacy, safety, and tolerability of a 2DR with DTG+3TC in naïve and treatment-experienced patients.Expert opinion: Data from clinical trials and from real-life show that DTG+3TC is an effective and safe switch option for the treatment of experienced patients. In treatment-naïve patients, DTG+3TC has shown non-inferiority compared to standard 3-drug regimens but is less effective in severely immunocompromised naïve patients (i.e. with a CD4+ cell count below 200 cell/mm3); furthermore, current guidelines have upgraded this dual regimen to recommended first-line strategy, but indicate that it should not be used without genotypic resistance results. Moreover, this regimen is not feasible for HBV-coinfected individuals and should not be used during pregnancy. Currently, out of 2-drug regimens, DTG+3TC is one of clinicians' preferred option as it requires no pharmacokinetic booster, has a low risk of drug interaction, and does not require food intake.
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Affiliation(s)
- Arturo Ciccullo
- Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
| | - Gianmaria Baldin
- Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy.,Mater Olbia Hospital, Olbia, Italy
| | - Alberto Borghetti
- UOC Malattie Infettive, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Simona Di Giambenedetto
- Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy.,UOC Malattie Infettive, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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Cutrell J, Jodlowski T, Bedimo R. The management of treatment-experienced HIV patients (including virologic failure and switches). Ther Adv Infect Dis 2020; 7:2049936120901395. [PMID: 32010443 PMCID: PMC6974747 DOI: 10.1177/2049936120901395] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 11/22/2019] [Indexed: 02/06/2023] Open
Abstract
Significant advances in the potency and tolerability of antiretroviral therapy (ART) have led to very high rates of virologic success for most who remain adherent to therapy. As a result, the life expectancy of people living with HIV (PLWH) has increased significantly. PLWH do, however, continue to experience a significantly higher risk of noninfectious comorbidities and chronic age-related complications, including cardiovascular disease and malignancies, which are now the biggest drivers of this excess morbidity and mortality. Therefore, in addition to virologic failure, the management of the treatment-experienced patient increasingly requires optimization of ART to enhance tolerability, avoid drug-drug interactions, and mitigate non-AIDS complications and comorbid conditions. This article will present principles of the management of virologic failure, poor immunologic recovery, and strategies for optimizing ART in the setting of virologic suppression.
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Affiliation(s)
- James Cutrell
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, USA
| | - Tomasz Jodlowski
- Department of Pharmacy, VA North Texas Health Care System, Dallas, USA
| | - Roger Bedimo
- Department of Medicine, VA North Texas Health Care System and the University of Texas Southwestern Medical Center, 4500 South Lancaster Road, 111-D, Dallas, TX 75216, USA
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Boffito M, Waters L, Cahn P, Paredes R, Koteff J, Van Wyk J, Vincent T, Demarest J, Adkison K, Quercia R. Perspectives on the Barrier to Resistance for Dolutegravir + Lamivudine, a Two-Drug Antiretroviral Therapy for HIV-1 Infection. AIDS Res Hum Retroviruses 2020; 36:13-18. [PMID: 31507204 PMCID: PMC6944139 DOI: 10.1089/aid.2019.0171] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
In HIV-1-infected patients, virological failure can occur as a consequence of the mutations that accumulate in the viral genome that allow replication to continue in the presence of antiretrovirals (ARVs). The development of treatment-emergent resistance to an ARV can limit a patient's options for future therapy, prompting the need for ARV regimens that are resilient to the emergence of resistance. The genetic barrier to resistance refers to the number of mutations in an ARV's therapeutic target that are required to confer a clinically meaningful loss of susceptibility to the drug. The emergence of resistance can be affected by pharmacological aspects of the ARV, including its structure, inhibitory quotient, therapeutic index, and pharmacokinetic characteristics. Dolutegravir (DTG) has demonstrated a high barrier to resistance, including when used in a two-drug regimen (2DR) with lamivudine (3TC). In the GEMINI-1 and GEMINI-2 studies, DTG +3TC was noninferior to DTG + emtricitabine/tenofovir disoproxil fumarate in treatment-naive participants, with similar proportions achieving HIV-1 RNA <50 copies/mL through 96 weeks. Furthermore, in the TANGO study, virological suppression was maintained at 48 weeks after switching to DTG +3TC from a tenofovir alafenamide (TAF)-based regimen compared with continuing a TAF-based regimen. Most other 2DRs with successful outcomes compared with three-drug regimens have been based on protease inhibitors (PIs); however, this class is associated with adverse metabolic effects and drug–drug interactions. In this review, we discuss the barrier to resistance in the context of a 2DR in which a boosted PI is replaced with DTG +3TC.
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Affiliation(s)
- Marta Boffito
- Chelsea and Westminister Hospital, London, United Kingdom
| | | | - Pedro Cahn
- Fundación Huésped, Buenos Aires, Argentina
| | | | - Justin Koteff
- ViiV Healthcare, Research Triangle Park, North Carolina
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Masters MC, Krueger KM, Williams JL, Morrison L, Cohn SE. Beyond one pill, once daily: current challenges of antiretroviral therapy management in the United States. Expert Rev Clin Pharmacol 2019; 12:1129-1143. [PMID: 31774001 DOI: 10.1080/17512433.2019.1698946] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Introduction: Modern antiretroviral therapy (ART) has revolutionized HIV treatment. ART regimens are now highly efficacious, well-tolerated, safe, often with one multi-drug pill, once-daily regimens available. However, clinical challenges persist in managing ART in persons with HIV (PWH), such as drug-drug interactions, side effects, pregnancy, co-morbidities, and adherence.Areas Covered: In this review, we discuss the ongoing challenges of ART for adults in the United States. We review the difficulties of initiating ART and maintaining therapy throughout adulthood and discuss new agents and strategies under investigation to address these issues. A PubMed search was utilized to identify relevant publications and guidelines through July 2019.Expert Opinion: Challenges persist in initiation and maintenance of ART. An individual's coexisting medical, social and personal factors must be considered in selecting and continuing ART to ensure safety, tolerability, and efficacy throughout adulthood. Continued development of new therapeutics and novel approaches to ART, such as long acting drugs or dual therapy, are needed to respond to many of these challenges. In addition, future research must address therapeutic disparities for populations historically underrepresented in clinical trials, including women, people aging with HIV, and those with complex comorbidities.
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Affiliation(s)
- Mary Clare Masters
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Karen M Krueger
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Janna L Williams
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lindsay Morrison
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Susan E Cohn
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Does Changing Antiretroviral Therapy in the First Trimester of Pregnancy for Safety Concerns Have an Impact on Viral Suppression? J Acquir Immune Defic Syndr 2019; 80:574-584. [PMID: 30649033 DOI: 10.1097/qai.0000000000001954] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine whether changing antiretroviral therapy (ART) during pregnancy because of concern about fetal risks led to poorer virological outcomes. METHODS All pregnancies in women with HIV-1 infection enrolled in the national multicenter prospective French Perinatal cohort at 14 week gestation or more were included between January 2005 and December 2015, if the mother was on ART at conception with a plasma viral load <50 copies/mL. The reasons for a change in the ART were analyzed according to treatment guidelines at the time of the pregnancy and defined as for safety concerns in the absence of reported maternal intolerance. Virological and pregnancy outcomes were studied by survival analysis and logistic regression adjusted for a propensity score established for each patient according to baseline characteristics. RESULTS Of 7079 pregnancies in the overall cohort, 1797 had ART at conception with a viral load <50 copies/mL before 14 week gestation. Of these, 22 changed regimens in the first trimester for intolerance, and 411 of the remaining 1775 (23%) solely for safety concerns. The proportion of change was higher when the initial treatment was not recommended in the national guidelines (OR adjusted: 23.1 [14.0-38.2]), than when it was an alternative option (ORa: 2.2 [1.3-3.7]), as compared to recommended first-line regimens. Treatment changes for safety concerns did not lead to poorer virological control, compared with pregnancies without such changes (19.3% vs. 15.6%, HRa: 1.0 [0.7-1.4]). CONCLUSIONS Changing ART early in pregnancy to regimens considered safer for pregnancy, and neonatal health did not have a destabilizing effect on viral suppression.
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Pierone G, Henegar C, Fusco J, Vannappagari V, Aboud M, Ragone L, Fusco G. Two-drug antiretroviral regimens: an assessment of virologic response and durability among treatment-experienced persons living with HIV in the OPERA ® Observational Database. J Int AIDS Soc 2019; 22:e25418. [PMID: 31802641 PMCID: PMC6893210 DOI: 10.1002/jia2.25418] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 10/22/2019] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Two-drug regimens (2-DR) have the potential to be a viable solution to the challenges of treatment complexity, cost, adverse effects and contraindications. We sought to describe the real-world use and effectiveness of 2-DR among persons living with HIV (PLHIV) in the United States. METHODS We analysed data for 10,190 treatment-experienced patients from the OPERA® Observational Database initiating a new 2-DR or three-drug regimen (3-DR) between 1 January 2010 and 30 June 2016. Multivariate Cox Proportional Hazards models were used to estimate the association among 2-DR or 3-DR initiation and virologic suppression (viral load (VL) <50 copies/mL), virologic failure (2 VLs > 200 copies/mL or 1 VL > 200 copies/mL + discontinuation) or regimen discontinuation. RESULTS Patients initiating a 2-DR (n = 1337, 13%) were older, and more likely to have a lower CD4 count, a history of AIDS and comorbid conditions than patients initiating a 3-DR. There was no difference between groups in time to virologic suppression (aHR: 1.00 (95% CI: 0.88, 1.13)) among viraemic patients (baseline VL ≥ 50 copies/mL, n = 4180), or time to virologic failure (aHR: 1.15 (95% CI: 0.90, 1.48)) among virologically stable patients (baseline VL < 50 copies/mL, n = 6010). However, time to discontinuation was shorter following 2-DR than 3-DR initiation (aHR: 1.51 (95% CI: 1.41, 1.61)). CONCLUSIONS In this large cohort of treatment-experienced patients, 2-DR prescriptions were common and more frequent among patients with significant comorbidity. Virologic response was similar, but duration of use was shorter with a 2-DR than a 3-DR, suggesting that 2-DRs may be a virologically effective treatment strategy for treatment-experienced PLHIV with existing comorbidities.
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Uptake and effectiveness of two-drug compared with three-drug antiretroviral regimens among HIV-positive individuals in Europe. AIDS 2019; 33:2013-2024. [PMID: 31335807 DOI: 10.1097/qad.0000000000002320] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To assess the use of two-drug antiretroviral regimens (2DR) and virologic and immunologic outcomes compared with three-drug regimens (3DR) in the EuroSIDA cohort. DESIGN Multicentre, prospective cohort study. METHODS Logistic regression was used to analyse the uptake and outcomes among HIV-positive individuals who started or switched to a 2DR compared with those on a 3DR. Virologic outcomes were assessed on-treatment as the proportion of individuals with controlled viral load (<400 copies/ml), or with a composite modified FDA snapshot endpoint (mFDA), with mFDA success defined as controlled viral load at 6 months or 12 months for individuals with a known viral load, no regimen changes, AIDS or death. Immunologic response was defined as a 100 cells/μl or a 25% increase in CD4 cell counts from baseline. RESULTS Between 1 July 2010 and 31 December 2016, 423 individuals started or switched to a 2DR (eight antiretroviral-naive) and 4347 started a 3DR (566 naive). Individuals on 2DR tended to have suppressed viral load, higher CD4 cell counts and more comorbidities at baseline compared with those on 3DR. There were no differences in the proportions of individuals who obtained on-treatment or mFDA success, and no significant differences in the adjusted odds ratios for mFDA success or immunologic responses between the 2DR and 3DR groups at 6 months or 12 months. CONCLUSION In routine clinical practice, 2DR were largely used for virologically suppressed individuals with higher cumulative exposure to antiretrovirals and comorbidities. Virologic and immunologic outcomes were similar among those on 2DR or 3DR, although confounding by indication cannot be fully excluded due to the observational nature of the study.
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Taiwo BO, Marconi VC, Berzins B, Moser CB, Nyaku AN, Fichtenbaum CJ, Benson CA, Wilkin T, Koletar SL, Colasanti J, Acosta EP, Li JZ, Sax PE. Dolutegravir Plus Lamivudine Maintains Human Immunodeficiency Virus-1 Suppression Through Week 48 in a Pilot Randomized Trial. Clin Infect Dis 2019; 66:1794-1797. [PMID: 29293895 DOI: 10.1093/cid/cix1131] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 12/22/2017] [Indexed: 11/13/2022] Open
Abstract
Clinical Trials Registration NCT02263326.
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Affiliation(s)
- Babafemi O Taiwo
- Division of Infectious Diseases, Northwestern University, Chicago, Illinois
| | - Vincent C Marconi
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
| | - Baiba Berzins
- Division of Infectious Diseases, Northwestern University, Chicago, Illinois
| | - Carlee B Moser
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Amesika N Nyaku
- Division of Infectious Diseases, Rutgers University, Newark, New Jersey
| | | | - Constance A Benson
- Division of Infectious Diseases and Global Public Health, University of California, San Diego
| | - Timothy Wilkin
- Division of Infectious Diseases, Weill Cornell Medicine, New York, New York
| | - Susan L Koletar
- Division of Infectious Diseases, The Ohio State University, Columbus
| | - Jonathan Colasanti
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
| | - Edward P Acosta
- Department of Pharmacology and Toxicology, University of Alabama at Birmingham
| | - Jonathan Z Li
- Division of Infectious Diseases, Brigham and Women's Hospital
| | - Paul E Sax
- Harvard Medical School, Boston, Massachusetts
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Pérez-Valero I, Pasquau J, Rubio R, Rivero A, Santos J, Sanz J, Mariño A, Crespo M, Hernández-Quero J, Iribarren JA, Gutiérrez F, Terrón A, Esteban H, Pérez-Molina JA. Neurocognitive safety after 96 weeks on dual therapy with atazanavir/ritonavir plus lamivudine: results of the neurocognitive substudy of the SALT randomized clinical trial. J Antimicrob Chemother 2019; 73:2444-2451. [PMID: 29897573 DOI: 10.1093/jac/dky212] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 05/09/2018] [Indexed: 01/03/2023] Open
Abstract
Background Concerns have been voiced over the capacity of deintensification strategies to preserve neurocognitive function and prevent neurocognitive impairment. Methods We present the 96 week results of a neurocognitive substudy nested within the SALT clinical trial: a randomized, open-label, non-inferiority trial that compares whether atazanavir/ritonavir + lamivudine is non-inferior to atazanavir/ritonavir + two NRTIs in HIV-suppressed patients on stable triple therapy. A global deficit score (GDS) for five neurocognitive tasks was used to assess neurocognitive function. Changes in neurocognitive function (GDS value) were determined at weeks 48 and 96. The effect of atazanavir/ritonavir + lamivudine, adjusted for significant confounders, on the change in neurocognitive function was determined using analysis of covariance (ANCOVA) at week 96. Results The per-protocol analysis included 92 participants (47 atazanavir/ritonavir + lamivudine and 45 atazanavir/ritonavir + two NRTIs). All baseline characteristics were comparable in both groups. At weeks 48 and 96, changes in GDS [week 48, atazanavir/ritonavir + lamivudine -0.3 (95% CI -0.5 to -0.1) versus atazanavir/ritonavir + two NRTIs -0.2 (95% CI -0.4 to 0.0), P = 0.39; week 96, atazanavir/ritonavir + lamivudine -0.3 (95% CI -0.5 to -0.1) versus atazanavir/ritonavir + two NRTIs -0.2 (95% CI -0.4 to -0.1); P = 0.471] were similar. This absence of differences was also observed in all cognitive tasks. Atazanavir/ritonavir + lamivudine did not impact the change in neurocognitive function at week 96; the adjusted effect of atazanavir/ritonavir + lamivudine on GDS change, considering atazanavir/ritonavir + two NRTIs as a reference, was 0.01 (95% CI -0.18 to 0.21) (P = 0.90). Conclusions Neurocognitive function remained stable after 96 weeks, both in the atazanavir/ritonavir + lamivudine and in the atazanavir/ritonavir + two NRTIs arms, provided HIV remained suppressed.
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Affiliation(s)
| | - Juan Pasquau
- Hospital Virgen de las Nieves, Internal Medicine, Granada, Spain
| | - Rafael Rubio
- H.U. Doce de Octubre, Internal Medicine, Madrid, Spain
| | | | - José Santos
- Hospital Virgen de la Victoria, Internal Medicine, Malaga, Spain
| | - Jesus Sanz
- Hospital de Alcala de Henares, Internal Medicine, Alcala de Henares, Spain
| | - Ana Mariño
- Hospital Arquitecto Marcide, Internal Medicine, O Ferrol, Spain
| | - Manel Crespo
- Hospital Vall d'Hebron, Internal Medicine, Barcelona, Spain
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Perez-Molina JA, Pulido F, Di Giambenedetto S, Ribera E, Moreno S, Zamora J, Coscia C, Alejos B, Pitch J, Gatell JM, De Luca A, Arribas JR. Individual patient data meta-analysis of randomized controlled trials of dual therapy with a boosted PI plus lamivudine for maintenance of virological suppression: GeSIDA study 9717. J Antimicrob Chemother 2019; 73:2927-2935. [PMID: 30085184 DOI: 10.1093/jac/dky299] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 06/26/2018] [Indexed: 12/24/2022] Open
Abstract
Background Dual therapy (DT) with a ritonavir-boosted PI (PI/r) plus lamivudine has proven non-inferior (12% margin) to triple therapy (TT) with PI/r plus two nucleos(t)ide reverse transcriptase inhibitors [N(t)RTIs] in four clinical trials. It remains unclear whether DT is non-inferior based on the US FDA endpoint (virological failure with a margin of 4%) or in specific subgroups. Methods We performed a systematic search (January 1990 to March 2017) of randomized controlled trials that compared switching of maintenance ART from TT to DT. The principal investigators were contacted and agreed to share study databases. The primary endpoint was non-inferiority of DT to TT based on the current FDA endpoint (4% non-inferiority margin for virological failure at week 48). We also analysed whether efficacy was modified by gender, active HCV infection and type of PI. Effect estimates and 95% CIs were calculated using generalized estimating equation-based models. Results We found 881 references that yielded eight articles corresponding to four clinical trials (1051 patients). At week 48, 4% of patients on DT versus 3.04% on TT had experienced virological failure (difference 0.9%; 95% CI -1.2% to 3.1%), and 84.7% of patients on DT versus 83.2% on TT had <50 copies of HIV RNA/mL (FDA snapshot algorithm) (difference 1.4%; 95% CI -2.8% to 5.8%). Gender, active HCV infection and type of PI had no effect on differences in treatment efficacy between DT and TT. Conclusions DT was non-inferior to TT using both current and past FDA endpoints. The efficacy of DT was not influenced by gender, active HCV infection status, or type of PI.
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Affiliation(s)
- J A Perez-Molina
- Infectious Diseases Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - F Pulido
- HIV Unit, Hospital Universitario Doce de Octubre, imas12, UCM, Madrid, Spain
| | - S Di Giambenedetto
- Institute of Clinical Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy
| | - E Ribera
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - S Moreno
- Infectious Diseases Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - J Zamora
- Clinical Biostatistics Unit and CIBERESP, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain.,Queen Mary University, London, UK
| | - C Coscia
- Clinical Biostatistics Unit and CIBERESP, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain
| | - B Alejos
- Centro Nacional de Epidemiología, Instituto Carlos III, Madrid, Spain
| | - J Pitch
- Hospital Clínic/Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - J M Gatell
- Hospital Clínic/Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - A De Luca
- UOC Malattie Infettive, Azienda Ospedaliera Universitaria Senese, and Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - J R Arribas
- Hospital Universitario La Paz, IDIPAZ, Madrid, Spain
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Fabbiani M, Gagliardini R, Ciccarelli N, Quiros Roldan E, Latini A, d'Ettorre G, Antinori A, Castagna A, Orofino G, Francisci D, Chinello P, Madeddu G, Grima P, Rusconi S, Del Pin B, Lombardi F, D'Avino A, Focà E, Colafigli M, Cauda R, Di Giambenedetto S, De Luca A. Atazanavir/ritonavir with lamivudine as maintenance therapy in virologically suppressed HIV-infected patients: 96 week outcomes of a randomized trial. J Antimicrob Chemother 2019; 73:1955-1964. [PMID: 29668978 DOI: 10.1093/jac/dky123] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 03/10/2018] [Indexed: 11/14/2022] Open
Abstract
Objectives To investigate the long-term safety and efficacy of a treatment switch to dual ART with atazanavir/ritonavir + lamivudine versus continuing a standard regimen with atazanavir/ritonavir + 2NRTI in virologically suppressed patients. Methods ATLAS-M is a 96 week open-label, randomized, non-inferiority (margin -12%) trial enrolling HIV-infected adults on atazanavir/ritonavir + 2NRTI, with stable HIV-RNA <50 copies/mL and CD4 counts >200 cells/mm3. At baseline, patients were randomized 1:1 to switch to atazanavir/ritonavir + lamivudine or to continue the previous regimen. Here, we report the 96 week efficacy and safety data. The study was registered with ClinicalTrials.gov, number NCT01599364. Results Overall, 266 subjects were enrolled (133 in each arm). At 96 weeks, in the ITT population, patients free of treatment failure totalled 103 (77.4%) with atazanavir/ritonavir + lamivudine and 87 (65.4%) with triple therapy (difference +12.0%, 95% CI +1.2/+22.8, P = 0.030), demonstrating the superiority of dual therapy. Two (1.5%) and 9 (6.8%) virological failures occurred in the dual-therapy arm and the triple-therapy arm, respectively, without development of resistance to any study drug. Clinical adverse events occurred at similar rates in both arms. A higher frequency of grade 3-4 hyperbilirubinemia (66.9% versus 50.4%, P = 0.006) and hypertriglyceridaemia (6.8% versus 1.5%, P = 0.031) occurred with dual therapy, although this never led to treatment discontinuation. A significant improvement in renal function and lumbar spine bone mineral density occurred in the dual-therapy arm. The evolution of CD4, HIV-DNA levels and neurocognitive performance was similar in both arms. Conclusions In this randomized study, a treatment switch to atazanavir/ritonavir + lamivudine was superior over the continuation of atazanavir/ritonavir + 2NRTI in virologically suppressed patients, with a sustained benefit in terms of improved renal function and bone mineral density.
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Affiliation(s)
- Massimiliano Fabbiani
- Department of Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Roberta Gagliardini
- Institute of Clinical Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy.,Infectious Diseases Unit, Siena University Hospital and Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Nicoletta Ciccarelli
- Institute of Clinical Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy
| | - Eugenia Quiros Roldan
- University Division of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy
| | - Alessandra Latini
- Infectious Dermatology and Allergology Unit, IFO S. Gallicano Institute (IRCCS), Rome, Italy
| | | | - Andrea Antinori
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, Rome, Italy
| | - Antonella Castagna
- Department of Infectious and Tropical Diseases, Vita-Salute San Raffaele University, San Raffaele Hospital, Milan, Italy
| | - Giancarlo Orofino
- Infectious and Tropical Diseases Unit, Amedeo di Savoia Hospital, Turin, Italy
| | | | - Pierangelo Chinello
- Systemic Infections and Immunodeficiency Unit, National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, Rome, Italy
| | - Giordano Madeddu
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Pierfrancesco Grima
- Division of Infectious Diseases, 'S. Caterina Novella' Hospital, Galatina, Italy
| | - Stefano Rusconi
- Infectious Disease Unit, DIBIC Luigi Sacco, University of Milan, Milan, Italy
| | - Barbara Del Pin
- Unit of Infectious Diseases, S.M. Annunziata Hospital, Florence, Italy
| | - Francesca Lombardi
- Institute of Clinical Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy
| | - Alessandro D'Avino
- Institute of Clinical Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy
| | - Emanuele Focà
- University Division of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy
| | - Manuela Colafigli
- Infectious Dermatology and Allergology Unit, IFO S. Gallicano Institute (IRCCS), Rome, Italy
| | - Roberto Cauda
- Institute of Clinical Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy
| | | | - Andrea De Luca
- Infectious Diseases Unit, Siena University Hospital and Department of Medical Biotechnologies, University of Siena, Siena, Italy
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Laut K, Shepherd L, Radoi R, Karpov I, Parczewski M, Mussini C, Maltez F, Losso M, Chkhartishvili N, Elinav H, Kovari H, Blaxhult A, Zangerle R, Trofimova T, Inglot M, Zilmer K, Kuzovatova E, Staub T, Raben D, Lundgren J, Mocroft A, Kirk O, On Behalf Of The EuroSIDA Study Group. Persistent disparities in antiretroviral treatment (ART) coverage and virological suppression across Europe, 2004 to 2015. ACTA ACUST UNITED AC 2019; 23. [PMID: 29845931 PMCID: PMC6152212 DOI: 10.2807/1560-7917.es.2018.23.21.1700382] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: Direct comparisons between countries in core HIV care parameters are often hampered by differences in data collection. Aim: Within the EuroSIDA study, we compared levels of antiretroviral treatment (ART) coverage and virological suppression (HIV RNA < 500 copies/mL) across Europe and explored temporal trends. Methods: In three cross-sectional analyses in 2004–05, 2009–10 and 2014–15, we assessed country-specific percentages of ART coverage and virological suppression among those on ART. Temporal changes were analysed using logistic regression. Results: Overall, the percentage of people on ART increased from 2004–05 (67.8%) to 2014–15 (78.2%), as did the percentage among those on ART who were virologically suppressed (75.2% in 2004–05, 87.7% in 2014–15). However, the rate of improvement over time varied significantly between regions (p < 0.01). In 2014–15, six of 34 countries had both ART coverage and virological suppression of above 90% among those on ART. The pattern varied substantially across clinics within countries, with ART coverage ranging from 61.9% to 97.0% and virological suppression from 32.2% to 100%. Compared with Western Europe (as defined in this study), patients in other regions were less likely to be virologically suppressed in 2014–15, with the lowest odds of suppression (adjusted odds ratio = 0.16; 95% confidence interval (CI): 0.13–0.21) in Eastern Europe. Conclusions: Despite overall improvements over a decade, we found persistent disparities in country-specific estimates of ART coverage and virological suppression. Underlying reasons for this variation warrant further analysis to identify a best practice and benchmark HIV care across EuroSIDA.
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Affiliation(s)
- Kamilla Laut
- CHIP, Centre of Excellence for Health, Immunity and Infections, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Leah Shepherd
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, United Kingdom
| | - Roxana Radoi
- Spitalul Clinic de Boli Infectioase si Tropical, "Dr. Victor Babes", Bucharest, Romania
| | - Igor Karpov
- Department of Infectious Diseases, Belarus State Medical University, Minsk, Belarus
| | - Milosz Parczewski
- Department of Infectious, Tropical Diseases and Immune Deficiency, Pomeranian Medical University, Szczecin, Szczecin, Poland
| | - Cristina Mussini
- Clinica delle Malattie Infettive e Tropicali, Università degli Studi di Modena e Reggio Emilia, Modena, Italy
| | - Fernando Maltez
- Hospital de Curry Cabral, Serviço de Doenças Infecciosas, Lisbon, Portugal
| | - Marcelo Losso
- Coordinación de Investigación Clinica Académica en Latinoamérica, Buenos Aires, Argentina
| | | | - Hila Elinav
- Department of Clinical Microbiology and Infectious Diseases, Hadassah Hospital, Jerusalem, Israel
| | - Helen Kovari
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Anders Blaxhult
- Department of Infectious Diseases, Venhälsan, Södersjukhuset, Stockholm, Sweden
| | - Robert Zangerle
- Medical University of Innsbruck, Department of Dermatology, Venereology and Allergology, Innsbruck, Austria
| | - Tatiana Trofimova
- Novgorod Centre for AIDS Prevention and Control, Velikij Novgorod, Russia
| | | | - Kai Zilmer
- Centre of Infectious Diseases, West-Tallin Central Hospital, Tallin, Estonia
| | - Elena Kuzovatova
- Nizhny Novgorod Scientific and Research Institute of Epidemiology and Microbiology named after Academician I.N. Blokhina, Nizhny Novgorod, Russia
| | - Thérèse Staub
- Centre Hospitalier de Luxembourg, Service des Maladies Infectieuses, Luxembourg
| | - Dorthe Raben
- CHIP, Centre of Excellence for Health, Immunity and Infections, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jens Lundgren
- CHIP, Centre of Excellence for Health, Immunity and Infections, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Amanda Mocroft
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, United Kingdom
| | - Ole Kirk
- CHIP, Centre of Excellence for Health, Immunity and Infections, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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