1
|
King EM, Tkachuk S, Tseng A. Aging on antiretrovirals: reviewing the need for pharmacologic data in elderly people with HIV. AIDS 2024; 38:1609-1616. [PMID: 38953894 PMCID: PMC11296272 DOI: 10.1097/qad.0000000000003973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 06/19/2024] [Accepted: 06/24/2024] [Indexed: 07/04/2024]
Affiliation(s)
- Elizabeth Marie King
- Women's Health Research Institute, British Columbia (BC) Women's Hospital, Vancouver
- Simon Fraser University, Faculty of Health Sciences, Burnaby
- Oak Tree Clinic, BC Women's Hospital
| | - Stacey Tkachuk
- Oak Tree Clinic, BC Women's Hospital
- Faculty of Pharmaceutical Sciences, UBC, Vancouver
| | - Alice Tseng
- Immunodeficiency Clinic, Toronto General Hospital
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
2
|
Calza L, Giglia M, Colangeli V, Bon I, Vitale S, Viale P. Improvement in insulin sensitivity after switching from an integrase inhibitor-based regimen to doravirine/tenofovir disoproxil fumarate/lamivudine in people with significant weight gain. HIV Med 2024; 25:919-926. [PMID: 38570897 DOI: 10.1111/hiv.13644] [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: 01/25/2024] [Accepted: 03/25/2024] [Indexed: 04/05/2024]
Abstract
OBJECTIVES We performed an observational, retrospective, cohort study to assess changes in insulin sensitivity after a switch from dolutegravir/lamivudine (DOL/3TC) or bictegravir/emtricitabine/tenofovir alafenamide (BIC/F/TAF) to doravirine/tenofovir disoproxil fumarate/3TC (DOR/TDF/3TC) in virologically suppressed people living with HIV with recent significant weight gain. METHODS All non-diabetic patients with HIV treated with DOL/3TC or BIC/F/TAF for ≥12 months, with HIV RNA <20 copies/mL, and with a weight increase ≥3 kg in the last year, who underwent a switch to DOR/TDF/3TC were enrolled into the study. Serum levels of glucose, insulin, and homeostasis model assessment of insulin resistance (HOMA-IR) index were evaluated every 6 months during a 12-month follow-up. RESULTS Overall, 81 patients were enrolled: 41 were treated with DOL/3TC and 40 with BIC/F/TAF. At baseline, median HOMA-IR index was 3.18 and insulin resistance (HOMA-IR index >2.5) was present in 49 subjects (60%). At 12 months after the switch to DOR/TDF/3TC, change in mean serum glucose concentration was not significant, but the reduction in median concentration of insulin was significant (-3.54 mcrUI/L [interquartile range -4.22 to -2.87]; p = 0.012), associated with a significant reduction in mean HOMA-IR index (-0.54 [interquartile range -0.91 to -0.18]; p = 0.021). A significant reduction in total and low-density lipoprotein cholesterol was also reported, whereas decreases in mean body weight and mean body mass index were not significant. CONCLUSIONS In our retrospective study in virologically suppressed people living with HIV treated with DOL/3TC or BIC/F/TAF and with recent weight gain, the switch to DOR/TDF/3TC led to a significant improvement in insulin sensitivity and plasma lipids, with a trend to decreased body weight.
Collapse
Affiliation(s)
- Leonardo Calza
- Infectious Diseases Unit, IRCCS Policlinico di Sant'Orsola, University of Bologna, Bologna, Italy
| | - Maddalena Giglia
- Infectious Diseases Unit, IRCCS Policlinico di Sant'Orsola, University of Bologna, Bologna, Italy
| | - Vincenzo Colangeli
- Infectious Diseases Unit, IRCCS Policlinico di Sant'Orsola, University of Bologna, Bologna, Italy
| | - Isabella Bon
- Microbiology Unit, IRCCS Policlinico di Sant'Orsola, University of Bologna, Bologna, Italy
| | - Salvatore Vitale
- Hospital Pharmacy, IRCCS Policlinico di Sant'Orsola, University of Bologna, Bologna, Italy
| | - Pierluigi Viale
- Infectious Diseases Unit, IRCCS Policlinico di Sant'Orsola, University of Bologna, Bologna, Italy
| |
Collapse
|
3
|
Soulie C, Balde A, Fofana D, Charpentier C, Bonnafous P, Sourice J, De Monte A, Avettand-Fenoel V, Le Guillou-Guillemette H, Bocket L, Raymond S, Marque Juillet S, Trabaud MA, Montes B, Maillard A, Hartard C, Alessandri-Gradt E, Brochot E, Signori-Schmuck A, Assoumou L, Marcelin AG. DORAVIR: a French national survey of people with HIV-1 treated with an antiretroviral regimen including doravirine. J Antimicrob Chemother 2024; 79:1974-1984. [PMID: 38884154 DOI: 10.1093/jac/dkae194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 05/23/2024] [Indexed: 06/18/2024] Open
Abstract
BACKGROUND Doravirine is the latest NNRTI to be approved for the treatment of HIV-1 and has a different resistance profile from first-generation NNRTIs. Our aim was to investigate the virological efficacy of antiretroviral treatment including doravirine in people living with HIV-1 (PLWHIV), the factors associated with virological failure (VF) and those associated with the emergence of reverse transcriptase (RT) mutations in the case of VF. METHODS A retrospective national survey of PLWHIV who were either naive or experienced on antiretroviral treatment including doravirine was conducted. VF was defined as two consecutive plasma viral loads (VLs) of ≥50 copies/mL or one VL of ≥200 copies/mL. Genotypic resistance tests were interpreted using the Stanford (v9.4.1) and ANRS (v33) algorithms. RESULTS Of the 589 PLWHIV treated with a doravirine-containing regimen, 8.5% were naive and 91.5% had prior antiretroviral experience; 56.9% were infected with HIV-1 B subtype. Overall, 88.3% and 85.1% of participants were virologically controlled at Month (M)3 and M6 of doravirine treatment, respectively. In multivariable analysis, CRF02_AG subtype, higher zenith plasma HIV-1 RNA VL, doravirine initiation in the context of failure and baseline V179D mutation presence were associated with VF. Among 88 PLWHIV who experienced virological failure at M6, 15.9% had a median of 2 (IQR 1-3) HIV RT mutations. In multivariable analysis, the only factor associated with the occurrence of mutations was a genotypic sensitivity score that was not fully sensitive. CONCLUSIONS This study is one of the largest to characterize the virological efficacy of doravirine-containing regimens in clinical practice and to identify factors associated with VF or emergence of resistance mutations that should be considered in clinical management.
Collapse
Affiliation(s)
- Cathia Soulie
- INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, laboratoire de virologie, Paris, France
| | - Aliou Balde
- INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | - Djeneba Fofana
- INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Universitaire Saint Antoine, laboratoire de virologie, Paris, France
| | - Charlotte Charpentier
- INSERM UMR 1137 IAME, Université Paris Cité, AP-HP Nord Hôpital Bichat-Claude-Bernard, laboratoire de virologie, Paris, France
| | - Pascale Bonnafous
- INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, laboratoire de virologie, Paris, France
| | | | | | - Véronique Avettand-Fenoel
- INSERM, U1016; CNRS, UMR8104, Université Paris Cité, Paris, France
- Hôpital Necker, APHP GHU Centre-Université Paris Cité, laboratoire de virologie, Paris, France
| | | | - Laurence Bocket
- CHU Lille, Univ. Lille, laboratoire de virologie, Lille, France
| | - Stéphanie Raymond
- INSERM UMR 1291, CHU Toulouse Purpan, laboratoire de virologie, Toulouse, France
| | | | - Mary-Anne Trabaud
- Hospices civils de Lyon, Hôpital de la Croix Rousse, service de virologie, Institut des Agents Infectieux, Lyon, France
| | - Brigitte Montes
- CHU Montpellier, laboratoire de virologie, Univ Montpellier, Montpellier, France
| | - Anne Maillard
- CHU de Rennes, laboratoire de virologie, Rennes, France
| | | | | | | | - Anne Signori-Schmuck
- Service de virologie, Univ. Grenoble Alpes, CHU Grenoble Alpes, Grenoble, France
| | - Lambert Assoumou
- INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | - Anne-Geneviève Marcelin
- INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, laboratoire de virologie, Paris, France
| |
Collapse
|
4
|
Giammarino F, de Salazar A, Malet I, Viñuela L, Fuentes A, Saladini F, Bartolini N, Charpentier C, Lambert-Niclot S, Sterrantino G, Colao MG, Micheli V, Bertoli A, Fabeni L, Teyssou E, Delgado R, Falces-Romero I, Aguilera A, Gomes P, Paraskevis D, Santoro MM, Ceccherini-Silberstein F, Marcelin AG, Moreno C, Zazzi M, García F. Prevalence and Phenotypic Susceptibility to Doravirine of the HIV-1 Reverse Transcriptase V106I Polymorphism in B and Non-B Subtypes. J Infect Dis 2024; 229:1796-1802. [PMID: 38206187 DOI: 10.1093/infdis/jiae010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/29/2023] [Accepted: 01/10/2024] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Limited data are available regarding the susceptibility of the reverse transcriptase V106 polymorphism to doravirine. METHODS Doravirine susceptibility was measured in site-directed mutants (SDMs) containing V106I, V106A, V106M, and Y188L mutations in subtype B (NL4-3, HXB2) and CRF02_AG background and in recombinant viruses with RT harboring V106I alone derived from 50 people with HIV. RESULTS HIV-1 B subtype was detected in 1523 of 2705 cases. Prevalence of V106I was 3.2% in B and 2.5% in non-B subtypes, and was higher in subtype F (8.1%) and D (14.3%). Fold-changes (FC) in susceptibility for SDMs were below doravirine biological cutoff (3.0) for V106I, but not for V106A, V106M, and Y188L. Clinically derived viruses tested included 22 B (median FC, 1.2; interquartile range [IQR], 0.9-1.6) and 28 non-B subtypes (median FC, 1.8; IQR, 0.9-3.0). Nine (18%) viruses showed FC values equal or higher than the doravirine biological FC cutoff. CONCLUSIONS The prevalence of the HIV-1 RT V106I polymorphism in MeditRes HIV consortium remains low, but significantly more prevalent in subtypes D and F. V106I minimally decreased the susceptibility to doravirine in SDMs and most clinical isolates. Reduced susceptibility seems to occur at increased frequency in subtype F1; however, the clinical impact remains to be investigated. CLINICAL TRIALS REGISTRATION NCT04894357.
Collapse
Affiliation(s)
| | - Adolfo de Salazar
- Clinical Microbiology, Hospital Universitario Clinico San Cecilio, Granada, Spain
- Instituto de Investigación Biosanitaria (ibs.Granada), Granada, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Isabelle Malet
- Laboratoire de Virologie, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Laura Viñuela
- Clinical Microbiology, Hospital Universitario Clinico San Cecilio, Granada, Spain
- Instituto de Investigación Biosanitaria (ibs.Granada), Granada, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Ana Fuentes
- Clinical Microbiology, Hospital Universitario Clinico San Cecilio, Granada, Spain
- Instituto de Investigación Biosanitaria (ibs.Granada), Granada, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Francesco Saladini
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Niccolò Bartolini
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Charlotte Charpentier
- Service de Virologie, Université Paris Cité, INSERM, IAME, UMR 1137, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, Paris, France
| | - Sidonie Lambert-Niclot
- Laboratoire de Virologie, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France
| | - Gaetana Sterrantino
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Maria Grazia Colao
- Laboratory of Microbiology and Virology, Careggi Hospital, Florence, Italy
| | - Valeria Micheli
- Department of Clinical Microbiology, Virology, and Bioemergencies, Sacco University Hospital, Milan, Italy
| | - Ada Bertoli
- Laboratory of Virology, University Hospital Tor Vergata, Rome, Italy
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Lavinia Fabeni
- Virology and Biosafety Laboratories Unit, Lazzaro Spallanzani-IRCCS, National Institute for Infectious Diseases, Rome, Italy
| | - Elisa Teyssou
- Laboratoire de Virologie, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Rafael Delgado
- Clinical Microbiology Service, Instituto de Investigación, Hospital 12 de Octubre, Madrid, Spain
| | - Iker Falces-Romero
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Clinical Microbiology Service, Hospital La Paz, Madrid, Spain
| | - Antonio Aguilera
- Clinical Microbiology Service, Hospital Clínico Universitario de Santiago, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain
| | - Perpetua Gomes
- Egas Moniz Center for Interdisciplinary Research, Egas Moniz School of Health and Science, Almada, Portugal
- Laboratório de Biología Molecular, Centro Hospitalar Lisboa Ocidental-Hospital Egas Moniz, Lisboa, Portugal
| | - Dimitrios Paraskevis
- Department of Hygiene, Epidemiology, and Medical Statistics, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria M Santoro
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | | | - Anne-Genevieve Marcelin
- Laboratoire de Virologie, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Cristina Moreno
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain
| | - Maurizio Zazzi
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Federico García
- Clinical Microbiology, Hospital Universitario Clinico San Cecilio, Granada, Spain
- Instituto de Investigación Biosanitaria (ibs.Granada), Granada, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
5
|
Choy CY, Wong CS, Kumar PA, Olszyna DP, Teh YE, Chien MFJ, Kurup A, Koh YL, Ho LP, Law HL, Chua NGS, Yong HYJ, Archuleta S. Recommendations for the use of antiretroviral therapy in adults living with human immunodeficiency virus in Singapore. Singapore Med J 2024; 65:259-273. [PMID: 35366662 PMCID: PMC11182460 DOI: 10.11622/smedj.2021174] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 07/06/2021] [Indexed: 11/18/2022]
Abstract
ABSTRACT Since the advent of combination antiretroviral therapy (ART), the mortality attributable to human immunodeficiency virus (HIV) infection has decreased by 80%. Newer antiretroviral agents are highly efficacious, have minimal side effects as compared to older drugs, and can be formulated as combination tablets to reduce patients' pill burden. Despite these advances, 680,000 people worldwide died of acquired immunodeficiency syndrome-related illnesses in 2020. The National ART and Monitoring Recommendations by the National HIV Programme have been created to guide physicians on the prescribing of ART based on the patients' needs. These recommendations are based on international guidelines and tailored to the local context and unique domestic considerations. We hoped that with the publication of these recommendations, the care of people living with HIV can be enhanced, bringing us closer to ending HIV in our lifetime.
Collapse
Affiliation(s)
- Chiaw Yee Choy
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
- National Centre for Infectious Diseases, Singapore
| | - Chen Seong Wong
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
- National Centre for Infectious Diseases, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - P Arun Kumar
- National Centre for Infectious Diseases, Singapore
| | - Dariusz Piotr Olszyna
- Division of Infectious Diseases, University Medicine Cluster, National University Hospital, Singapore
| | - Yii Ean Teh
- Department of Infectious Diseases, Singapore General Hospital, Singapore
| | | | - Asok Kurup
- Infectious Diseases Care Pte Ltd, Mount Elizabeth Medical Centre, Singapore
| | - Yin Ling Koh
- The Novena Medical Specialists, Mount Elizabeth Novena Specialist Centre, Singapore
| | - Lai Peng Ho
- Department of Care and Counselling, Tan Tock Seng Hospital, Singapore
| | - Hwa Lin Law
- Department of Pharmacy, Tan Tock Seng Hospital, Singapore
| | | | | | - Sophia Archuleta
- National Centre for Infectious Diseases, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Infectious Diseases, University Medicine Cluster, National University Hospital, Singapore
| |
Collapse
|
6
|
O'Halloran C, Gilleece Y, Leung S, Canuto V, McAlpine C, Ross S, Norcross C, Gaffney S, Siani N, Hickey W, Moore A, Rajkovic-Hooley O, Milinkovic A. Real world utilisation of doravirine among people living with human immunodeficiency virus in England (DRIVE-REAL). Int J STD AIDS 2024; 35:206-216. [PMID: 37970812 DOI: 10.1177/09564624231215977] [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] [Indexed: 11/19/2023]
Abstract
BACKGROUND Doravirine is a non-nucleoside reverse transcriptase inhibitor recommended for the treatment of virologically suppressed and treatment naïve people living with HIV. The DRIVE-REAL study aimed to describe the characteristics, treatment patterns, and virological outcomes of doravirine users in a real-world cohort in the UK. METHODS A retrospective, observational, multi-centre chart review was conducted for 300 adults living with HIV initiating doravirine-containing antiretroviral therapy. RESULTS At baseline 83% of individuals were male, 45% aged ≥50 years, 65% white ethnicity. Median time since HIV diagnosis was 12 years. 96% were antiretroviral therapy-experienced, 87% had a HIV viral load <50 copies/ml, and 15% had resistance to at least one antiretroviral drug. 66% had comorbidities, most commonly depression (26%), and 70% were taking at least one co-medication. At six months, 94% (n = 283/300) were still receiving doravirine. Viral load data were available for n = 266/300 individuals and 95% (n = 253/266) had viral load <50 copies/ml. CONCLUSIONS Individuals initiating doravirine in this cohort are predominantly treatment-experienced white middle-aged males, with a high frequency of comorbidities and co-medication. The majority of individuals at 6 months remained on doravirine and maintained or achieved HIV viral suppression. This study provides epidemiologic characteristics that can inform clinical care and subsequent hypothesis-testing studies.
Collapse
Affiliation(s)
| | - Yvonne Gilleece
- HIV and Sexual Health, Brighton & Sussex Medical School and University Hospitals Sussex NHS Trust, Brighton, UK
| | - Suki Leung
- St Stephen's Centre, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Veronica Canuto
- St Stephen's Centre, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Connor McAlpine
- College London and Mortimer Market Centre, Centre for Clinical Research in Infection and Sexual Health University, London, UK
| | - Sophie Ross
- HIV and Sexual Health, Brighton & Sussex Medical School and University Hospitals Sussex NHS Trust, Brighton, UK
| | - Claire Norcross
- HIV and Sexual Health, Brighton & Sussex Medical School and University Hospitals Sussex NHS Trust, Brighton, UK
| | | | - Nipur Siani
- Medical Affairs (HIV), MSD (UK) Limited, London, UK
| | | | - Adam Moore
- Adelphi Real World (ARW), Bollington, UK
| | | | - Ana Milinkovic
- St Stephen's Centre, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- Imperial College London, London, UK
| |
Collapse
|
7
|
Mody A, Sohn AH, Iwuji C, Tan RKJ, Venter F, Geng EH. HIV epidemiology, prevention, treatment, and implementation strategies for public health. Lancet 2024; 403:471-492. [PMID: 38043552 DOI: 10.1016/s0140-6736(23)01381-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/28/2023] [Accepted: 06/29/2023] [Indexed: 12/05/2023]
Abstract
The global HIV response has made tremendous progress but is entering a new phase with additional challenges. Scientific innovations have led to multiple safe, effective, and durable options for treatment and prevention, and long-acting formulations for 2-monthly and 6-monthly dosing are becoming available with even longer dosing intervals possible on the horizon. The scientific agenda for HIV cure and remission strategies is moving forward but faces uncertain thresholds for success and acceptability. Nonetheless, innovations in prevention and treatment have often failed to reach large segments of the global population (eg, key and marginalised populations), and these major disparities in access and uptake at multiple levels have caused progress to fall short of their potential to affect public health. Moving forward, sharper epidemiologic tools based on longitudinal, person-centred data are needed to more accurately characterise remaining gaps and guide continued progress against the HIV epidemic. We should also increase prioritisation of strategies that address socio-behavioural challenges and can lead to effective and equitable implementation of existing interventions with high levels of quality that better match individual needs. We review HIV epidemiologic trends; advances in HIV prevention, treatment, and care delivery; and discuss emerging challenges for ending the HIV epidemic over the next decade that are relevant for general practitioners and others involved in HIV care.
Collapse
Affiliation(s)
- Aaloke Mody
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA.
| | - Annette H Sohn
- TREAT Asia, amfAR, The Foundation for AIDS Research, Bangkok, Thailand
| | - Collins Iwuji
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Brighton, UK; Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Rayner K J Tan
- University of North Carolina Project-China, Guangzhou, China; Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Francois Venter
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Elvin H Geng
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
| |
Collapse
|
8
|
Lanting VR, Oosterhof P, Ait Moha D, van Heerde R, Kleene MJT, Stalenhoef JE, de Regt MJA, Vrouenraets SME, van den Berk GEL, Brinkman K. Switching to Doravirine in cART-Experienced Patients: An Effective and Highly Tolerated Option With Substantial Cost Savings. J Acquir Immune Defic Syndr 2024; 95:190-196. [PMID: 37963350 DOI: 10.1097/qai.0000000000003337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/10/2023] [Indexed: 11/16/2023]
Abstract
BACKGROUND Doravirine is a non-nucleoside reverse transcriptase inhibitor with demonstrated efficacy as a third agent in treatment-naive and treatment-experienced people living with HIV (PLWH) in registration studies. However, limited real-world data are available. METHODS By searching electronic health care records, PLWH using doravirine-based regimens were selected with at least 1 year of follow-up after their first prescription. All stable PLWH who were switched to a doravirine-based regimen were included in the analysis. The primary outcome was the durability of a doravirine-based regimen 1 year after prescription. Reasons for stopping were also collected. Secondary outcomes for PLWH continuing a doravirine-based regimen after 1 year were routine laboratory assessment, body mass index, and differences in medication costs compared with their previous cART. RESULTS A total of 687 patients (92% men) were included from September 2019 to August 2022: 97.7% switched to doravirine/tenofovir/lamivudine (DOR/TDF/3TC). After 1 year, 94/687 (13.6%) PLWH stopped this therapy. The main reason for discontinuation was patient-reported adverse events in 70/687 (10.2%). Medical reasons for discontinuation included increased alanine tranaminase levels in 6/687 (0.9%), decreased estimated glomerular filtration rate in 3/687 (0.4%), and precautions after diagnosis of osteoporosis in 2/687 (0.3%) patients. Virologic failure occurred in 4/687 cases (0.6%), and 1 case demonstrated resistance mutations. The secondary outcomes demonstrated a statistically significant increase in alanine tranaminase levels and decrease in LDL-c levels. The switch to a doravirine-based regimen in the Netherlands reduced medication costs by 27%. CONCLUSIONS This study demonstrated that switching to a doravirine-based regimen, mostly DOR/TDF/3TC, was highly effective and generally well tolerated, with substantial cost savings.
Collapse
Affiliation(s)
- Vincent R Lanting
- Department of Internal Medicine, OLVG Hospital, Amsterdam, the Netherlands; and
| | - Piter Oosterhof
- Department of Clinical Pharmacology, OLVG Hospital, Amsterdam, the Netherlands
| | - Daoud Ait Moha
- Department of Internal Medicine, OLVG Hospital, Amsterdam, the Netherlands; and
| | - Roos van Heerde
- Department of Internal Medicine, OLVG Hospital, Amsterdam, the Netherlands; and
| | - Marie José T Kleene
- Department of Internal Medicine, OLVG Hospital, Amsterdam, the Netherlands; and
| | | | - Marieke J A de Regt
- Department of Internal Medicine, OLVG Hospital, Amsterdam, the Netherlands; and
| | | | | | - Kees Brinkman
- Department of Internal Medicine, OLVG Hospital, Amsterdam, the Netherlands; and
| |
Collapse
|
9
|
Orkin C, Molina JM, Cahn P, Lombaard J, Supparatpinyo K, Kumar S, Campbell H, Wan H, Teal V, Jin Xu Z, Asante-Appiah E, Sklar P, Teppler H, Lahoulou R. Safety and efficacy of doravirine as first-line therapy in adults with HIV-1: week 192 results from the open-label extensions of the DRIVE-FORWARD and DRIVE-AHEAD phase 3 trials. Lancet HIV 2024; 11:e75-e85. [PMID: 38141637 DOI: 10.1016/s2352-3018(23)00258-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 08/31/2023] [Accepted: 09/27/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND In two phase 3 trials for first-line therapy in adults with HIV-1, doravirine showed non-inferior efficacy, a favourable safety profile, and a superior lipid profile to darunavir and efavirenz through to 48 and 96 weeks. Here we report 192-week results from both studies. METHODS DRIVE-FORWARD and DRIVE-AHEAD are multicentre, double-blind, randomised, active comparator-controlled, phase 3 trials of first-line antiretroviral treatment in adults with HIV-1. Eligible participants (aged ≥18 years) were naive to antiretroviral therapy, had plasma HIV-1 RNA 1000 copies per mL or more at screening, had no known resistance to any of the trial drugs, and had creatinine clearance 50 mL per min or more. DRIVE-FORWARD was conducted at 125 sites in 15 countries and compared doravirine (100 mg) with ritonavir-boosted darunavir (ritonavir [100 mg] and darunavir [800 mg]), each administered orally once daily with two nucleoside or nucleotide reverse transcriptase inhibitors (tenofovir disoproxil fumarate [300 mg] and emtricitabine [200 mg] or abacavir sulfate [600 mg] and lamivudine [300 mg]). DRIVE-AHEAD was conducted at 126 sites in 23 countries and compared doravirine (100 mg), lamivudine (300 mg), and tenofovir disoproxil fumarate (300 mg) with that of efavirenz (600 mg), emtricitabine (200 mg), and tenofovir disoproxil fumarate (300 mg), all administered orally once daily. DRIVE-FORWARD enrolment was between Dec 1, 2014, and June 1, 2020, and DRIVE-AHEAD enrolment was between June 10, 2015, and Aug 10, 2020. After the 96-week double-blind phase, eligible participants could enter an open-label extension and either continue doravirine or switch from comparator to doravirine for an additional 96 weeks. Efficacy (HIV-1 RNA <50 copies per mL) and safety assessments (adverse events and changes in laboratory parameters) were pooled. The DRIVE-FORWARD and DRIVE-AHEAD trials were registered with ClinicalTrials.gov, NCT02275780 and NCT02403674. FINDINGS Of 1494 participants treated in the double-blind phase (1261 [84%] male and 233 [16%] female), 550 continued doravirine and 502 switched to doravirine in the extension. Using the FDA snapshot approach, HIV-1 RNA less than 50 copies per mL was maintained in 457 (83%) of 550 participants who continued doravirine and 404 (80%) of 502 participants who switched to doravirine. Protocol-defined virological failure and development of resistance were low, occurring mainly before week 96. Two (<1%) of 550 participants who continued doravirine reported serious drug-related adverse events, and three (1%) who continued doravirine and one (<1%) of 502 who switched to doravirine discontinued due to drug-related adverse events. Participants continuing or switching to doravirine showed generally favourable lipid profiles, little weight gain, and small decreases in estimated glomerular filtration rates, with no discontinuations due to increased creatinine or renal adverse events. INTERPRETATION Favourable efficacy and safety profiles for doravirine at week 96 were maintained through to week 192 in participants who continued or switched to doravirine, supporting use of doravirine for long-term first-line HIV-1 treatment and for virologically suppressed adults switching therapy. FUNDING Merck Sharp & Dohme, a subsidiary of Merck & Co, Rahway, NJ, USA.
Collapse
Affiliation(s)
| | - Jean-Michel Molina
- University of Paris, Department of Infectious Diseases, St-Louis and Lariboisière Hospitals, Assistance Publique Hôpitaux de Paris, and University of Paris Cité, Paris, France
| | - Pedro Cahn
- Fundación Huesped, Buenos Aires, Argentina
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Erlandson KM, Mohaweche R, Morrow M, Mawhinney S, Khuu V, Boyd M, Balasubramanyam A, Melanson EL, Lake JE. Energy balance and body composition after switch between integrase strand transfer inhibitors and doravirine among people with HIV. J Antimicrob Chemother 2024; 79:179-185. [PMID: 38000089 PMCID: PMC10761240 DOI: 10.1093/jac/dkad363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Integrase strand transfer inhibitors (INSTIs) are associated with excessive weight gain among a subset of persons with HIV (PWH), due to unclear mechanisms. We assessed energy intake (EI) and expenditure (EE) following switch off and onto INSTIs. METHODS PWH with >10% weight gain on an INSTI-based regimen switched INSTI to doravirine for 12 weeks, then back to INSTI for 12 weeks while keeping their remaining regimen stable. Twenty-four-hour EE, EI and weight were measured on INSTI, following switch to doravirine, and upon INSTI restart. Mixed models analysed changes over time. RESULTS Among 18 participants, unadjusted 24 h EE decreased by 83 (95% CI -181 to 14) kcal following switch to doravirine, and by 2 (-105 to 100) kcal after INSTI restart; energy balance (EE-EI) increased by 266 (-126 to 658) kcal from Week 0 to Week 12, and decreased by 3 (-429 to 423) kcal from Week 12 to Week 24. Trends toward weight loss occurred following switch to doravirine [mean -1.25 (-3.18 to 0.69) kg] and when back on INSTI [-0.47 (-2.45 to 1.52) kg]. Trunk fat decreased on doravirine [-474 (-1398 to 449) g], with some regain following INSTI restart [199 (-747 to 1145) g]. Fat-free mass decreased on doravirine [-491 (-1399 to 417) g] and increased slightly after INSTI restart [178 (-753 to 1108) g]. CONCLUSIONS Among PWH with >10% weight gain on an INSTI, switch to doravirine was associated with a trend towards decreases in 24 h EE, weight, trunk fat mass and fat-free mass. Observed changes were not significant, but suggest a mild weight-suppressive effect of doravirine among PWH.
Collapse
Affiliation(s)
- Kristine M Erlandson
- Department of Medicine, University of Colorado Anschutz Medical Campus, 12700 E. 19th Avenue, Aurora, CO 80045, USA
| | - Ruda Mohaweche
- Department of Medicine, UTHealth Houston, Houston, TX, USA
| | - Mary Morrow
- Department of Medicine, University of Colorado Anschutz Medical Campus, 12700 E. 19th Avenue, Aurora, CO 80045, USA
| | - Samantha Mawhinney
- Department of Medicine, University of Colorado Anschutz Medical Campus, 12700 E. 19th Avenue, Aurora, CO 80045, USA
| | - Vincent Khuu
- Department of Medicine, University of Colorado Anschutz Medical Campus, 12700 E. 19th Avenue, Aurora, CO 80045, USA
| | - Mallory Boyd
- Department of Medicine, University of Colorado Anschutz Medical Campus, 12700 E. 19th Avenue, Aurora, CO 80045, USA
| | | | - Edward L Melanson
- Department of Medicine, University of Colorado Anschutz Medical Campus, 12700 E. 19th Avenue, Aurora, CO 80045, USA
| | - Jordan E Lake
- Department of Medicine, UTHealth Houston, Houston, TX, USA
| |
Collapse
|
11
|
Rungmaitree S, Aurpibul L, Best BM, Li X, Warshaw MG, Wan H, Tobin NH, Jumes P, Leavitt R, McCarthy K, Scheckter R, Ounchanum P, Violari A, Teppler H, Campbell H, Krotje C, Townley E, Moye J, Melvin AJ. Efficacy, Safety, and Tolerability of Doravirine/Lamivudine/Tenofovir Disoproxil Fumarate Fixed-Dose Combination Tablets in Adolescents Living With HIV: Results Through Week 96 from IMPAACT 2014. J Pediatric Infect Dis Soc 2023; 12:602-609. [PMID: 37815035 DOI: 10.1093/jpids/piad078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 09/27/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND IMPAACT 2014 study is a phase I/II, multicenter, open-label, nonrandomized study of doravirine (DOR) co-formulated with lamivudine (3TC) and tenofovir disoproxil fumarate (TDF) as fixed-dose combination (DOR FDC) in adolescents with HIV-1. We report the efficacy, safety, and tolerability of DOR FDC through 96 weeks. METHODS Participants were adolescents aged 12 to <18 years who weighed at least 45 kg and who were either antiretroviral (ARV)-naïve or virologically suppressed without documented resistance mutations to DOR/3TC/TDF. The efficacy endpoint was the proportion of participants with HIV-1 RNA <40 copies/mL assessed at weeks 48 and 96 using the observed failure approach. Safety and tolerability outcomes were incidence of adverse events (AEs) and treatment discontinuations. RESULTS A total of 45 adolescents, median age 15 (range, 12-17) years, 58% females, were enrolled and 2 (4.4%) participants were ARV naïve. Of the 45 participants, 42 (93.3%) completed the study and 41 (91.1%) completed the study treatment. At week 48, 41/42 (97.6%; 95% confidence interval [CI], 87.4-99.9) and week 96, 37/40 (92.5%; 95% CI, 79.6-98.4) participants had achieved or maintained HIV-1 RNA <40 copies/mL. There were no treatment-related discontinuations due to AEs and no drug-related AEs ≥grade 3 or deaths. CONCLUSIONS We found once-daily dosing of DOR FDC to be safe and well tolerated for maintaining viral suppression through 96 weeks in adolescents living with HIV-1.
Collapse
Affiliation(s)
- Supattra Rungmaitree
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Linda Aurpibul
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Brookie M Best
- Skaggs School of Pharmacy and Pharmaceutical Sciences and Pediatrics Department, School of Medicine-Rady Children's Hospital San Diego, University of California San Diego, San Diego, California, USA
| | - Xiang Li
- Frontier Science Technology and Research Foundation, Madison, Wisconsin, USA
| | - Meredith G Warshaw
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Hong Wan
- Merck & Co., Inc., Rahway, New Jersey, USA
| | - Nicole H Tobin
- Department of Pediatrics, Division of Pediatric Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | | | | | | | | | | | - Avy Violari
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | | | | | | | - Ann J Melvin
- Department of Pediatrics, Division of Pediatric Infectious Disease, University of Washington and Seattle Children's Research Institute, Seattle, Washington, USA
| |
Collapse
|
12
|
Inciarte A, Ugarte A, Martínez-Rebollar M, Torres B, Fernández E, Berrocal L, Laguno M, De la Mora L, De Lazzari E, Callau P, Chivite I, González-Cordón A, Solbes E, Rico V, Barrero L, Blanco JL, Martínez E, Ambrosioni J, Mallolas J. Doravirine/Lamivudine/Tenofovir Disoproxil Fumarate for Nonoccupational HIV-1 Postexposure Prophylaxis: A Prospective Open-Label Trial (DORAVIPEP). Open Forum Infect Dis 2023; 10:ofad374. [PMID: 37539061 PMCID: PMC10394723 DOI: 10.1093/ofid/ofad374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 07/14/2023] [Indexed: 08/05/2023] Open
Abstract
Background New regimens may provide better tolerability, convenience, and safety for nonoccupational human immunodeficiency virus (HIV) postexposure prophylaxis (PEP). For this reason, we evaluated the single-tablet regimen of doravirine/lamivudine/tenofovir disoproxil fumarate (DOR/3TC/TDF) for 28 days. Methods This was a prospective, open-label, single-arm trial including individuals with potential HIV-1 exposure within 72 hours. The primary endpoint was noncompletion of PEP at day 28. Secondary endpoints were adverse effects, adherence, and rate of seroconversion. We performed follow-up at day 7, week 4, and week 12. Results Between September 2019 and March 2022, the study enrolled 399 individuals. Median age was 30 (interquartile range [IQR], 27-36) years, and 91% (n = 364) were male. The mode of exposure was sex between men in 84% (n = 331) of cases; risk assessment for HIV-1 transmission was considered as "high" in 97% (n = 385) of the participants. Median time from exposure to consultation was 24 (IQR, 13-40) hours. Noncompletion of PEP was 29% (n = 114) (95% confidence interval [CI], 24%-33%) and 20% (n = 72) (95% CI, 16%-25%) per modified intention-to-treat. Main reasons for noncompletion were loss to follow-up (n = 104 [91%]) and intolerance (n = 8 [7%]). Older age was associated with a lower risk of premature discontinuation (OR, 0.94; P < .001). One hundred twenty-three (31%) participants reported adverse events, mostly mild and self-limited (82%); discontinuation occurred in 8 cases (2%). Adherence to PEP in the assessed users was 96%. There were no HIV seroconversions. Conclusions DOR/3TC/TDF is a well-tolerated option for nonoccupational PEP. Clinical Trials Registration. NCT04233372.
Collapse
Affiliation(s)
- Alexy Inciarte
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
- Fundació de Recerca Clínic Barcelona, Institut d’Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain
- University of Barcelona, Faculty of Medicine, Barcelona, Spain
| | - Ainoa Ugarte
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - María Martínez-Rebollar
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
- University of Barcelona, Faculty of Medicine, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
| | - Berta Torres
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
- Fundació de Recerca Clínic Barcelona, Institut d’Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain
- University of Barcelona, Faculty of Medicine, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
| | - Emma Fernández
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Leire Berrocal
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
- Fundació de Recerca Clínic Barcelona, Institut d’Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain
| | - Montserrat Laguno
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
- Fundació de Recerca Clínic Barcelona, Institut d’Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain
- University of Barcelona, Faculty of Medicine, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
| | - Lorena De la Mora
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
- University of Barcelona, Faculty of Medicine, Barcelona, Spain
| | - Elisa De Lazzari
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
- Fundació de Recerca Clínic Barcelona, Institut d’Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain
- University of Barcelona, Faculty of Medicine, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
| | - Pilar Callau
- Fundació de Recerca Clínic Barcelona, Institut d’Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain
| | - Iván Chivite
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Ana González-Cordón
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Estela Solbes
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Verónica Rico
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Laura Barrero
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - José Luis Blanco
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
- University of Barcelona, Faculty of Medicine, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
| | - Esteban Martínez
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
- Fundació de Recerca Clínic Barcelona, Institut d’Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain
- University of Barcelona, Faculty of Medicine, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
| | - Juan Ambrosioni
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
- Fundació de Recerca Clínic Barcelona, Institut d’Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain
- University of Barcelona, Faculty of Medicine, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
| | - Josep Mallolas
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
- Fundació de Recerca Clínic Barcelona, Institut d’Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain
- University of Barcelona, Faculty of Medicine, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
| |
Collapse
|
13
|
Maggi P, Ricci ED, Martinelli CV, De Socio GV, Squillace N, Molteni C, Masiello A, Orofino G, Menzaghi B, Bellagamba R, Vichi F, Celesia BM, Madeddu G, Pellicanò GF, Carleo MA, Cascio A, Parisini A, Taramasso L, Valsecchi L, Calza L, Rusconi S, Sarchi E, Martini S, Bargiacchi O, Falasca K, Cenderello G, Ferrara S, Di Biagio A, Bonfanti P. Lipids and Transaminase in Antiretroviral-Treatment-Experienced People Living with HIV, Switching to a Doravirine-Based vs. a Rilpivirine-Based Regimen: Data from a Real-Life Setting. Viruses 2023; 15:1612. [PMID: 37515298 PMCID: PMC10383194 DOI: 10.3390/v15071612] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/19/2023] [Accepted: 07/21/2023] [Indexed: 07/30/2023] Open
Abstract
Doravirine (DOR) is a newly approved non-nucleoside reverse transcriptase inhibitor (NNRTI). We aimed to investigate, in a real-life setting, how switching to a DOR-based regimen rather than a rilpivirine (RPV)-based regimen impacted metabolic and hepatic safety. The analysis included 551 antiretroviral treatment (ART)-experienced people living with HIV (PLWH), starting RPV-based or DOR-based regimens with viral load < 200 copies/mL, baseline (T0), and at least one control visit (6-month visit, T1). We enrolled 295 PLWH in the RPV and 256 in the DOR cohort. At T1, total cholesterol (TC), low-density lipoprotein-C (LDL-C), and triglycerides significantly decreased in both DOR and RPV cohorts, while high-density lipoprotein-C (HDL-C) only decreased in RPV-treated people. Consistently, the TC/HDL-C ratio declined more markedly in the DOR (-0.36, p < 0.0001) than in the RPV cohort (-0.08, p = 0.25) (comparison p = 0.39). Similar trends were observed when excluding the PLWH on lipid-lowering treatment from the analysis. People with normal alanine aminotransferase (ALT) levels showed a slight ALT increase in both cohorts, and those with baseline ALT > 40 IU/L experienced a significant decline (-14 IU/L, p = 0.008) only in the DOR cohort. Lipid profile improved in both cohorts, and there was a significant reduction in ALT in PLWH with higher-than-normal baseline levels on DOR-based ART.
Collapse
Affiliation(s)
- Paolo Maggi
- Infectious Diseases Unit, AORN Sant'Anna e San Sebastiano, 81100 Caserta, Italy
| | | | | | | | - Nicola Squillace
- Infectious Diseases Unit, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Chiara Molteni
- Unit of Infectious Diseases, A. Manzoni Hospital, 23900 Lecco, Italy
| | - Addolorata Masiello
- Infectious Diseases Unit, AORN Sant'Anna e San Sebastiano, 81100 Caserta, Italy
| | - Giancarlo Orofino
- Division I of Infectious and Tropical Diseases, ASL Città di Torino, 10149 Torino, Italy
| | - Barbara Menzaghi
- Unit of Infectious Diseases, ASST della Valle Olona, 21052 Busto Arsizio, Italy
| | - Rita Bellagamba
- National Institute for Infectious Diseases Lazzaro Spallanzani Institute for Hospitalization and Care Scientific, Lazio, 00161 Roma, Italy
| | - Francesca Vichi
- SOC 1 USLCENTRO Firenze, Unit of Infectious Diseases, Santa Maria Annunziata Hospital, 50012 Florence, Italy
| | | | - Giordano Madeddu
- Unit of Infectious Diseases, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Giovanni Francesco Pellicanò
- Unit of Infectious Diseases, Department of Human Pathology of the Adult and the Developmental Age 'G. Barresi', University of Messina, 98125 Messina, Italy
| | - Maria Aurora Carleo
- Infectious Diseases and Gender Medicine Unit, Cotugno Hospital, AO dei Colli, 80131 Naples, Italy
| | - Antonio Cascio
- Unit of Infectious Diseases, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy
| | - Andrea Parisini
- Department of Infectious Diseases, Galliera Hospital, 16128 Genoa, Italy
| | - Lucia Taramasso
- Clinic of Infectious Diseases, IRCCS Policlinico San Martino Hospital, University of Genoa, 16132 Genoa, Italy
| | - Laura Valsecchi
- 1st Department of Infectious Diseases, ASST Fatebenefratelli Sacco, 20157 Milan, Italy
| | - Leonardo Calza
- Infectious Diseases Unit, IRCCS Policlinico Sant' Orsola, Department of Medical Surgical Science, University of Bologna, 40138 Bologna, Italy
| | - Stefano Rusconi
- Infectious Diseases Unit, Ospedale Civile di Legnano, ASST Ovest Milanese, and DIBIC Luigi Sacco, Università degli Studi di Milano, 20025 Legnano, Italy
| | - Eleonora Sarchi
- Infectious Diseases Unit, Santi Antonio e Biagio e Cesare Arrigo Hospital, 15121 Alessandria, Italy
| | - Salvatore Martini
- Infectious Disease Unit, University Hospital Luigi Vanvitelli, 80138 Naples, Italy
| | - Olivia Bargiacchi
- Unit of Infectious Diseases, Ospedale Maggiore della Carità, 28100 Novara, Italy
| | - Katia Falasca
- Clinic of Infectious Diseases, Department of Medicine and Science of Aging, G. D'Annunzio University, Chieti-Pescara, 66100 Chieti, Italy
| | | | - Sergio Ferrara
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy
| | - Antonio Di Biagio
- Clinic of Infectious Diseases, IRCCS Policlinico San Martino Hospital, University of Genoa, 16132 Genoa, Italy
| | - Paolo Bonfanti
- Infectious Diseases Unit, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
- School of Surgery and Medicine, University of Milano-Bicocca, 20126 Milan, Italy
| |
Collapse
|
14
|
Su B, Gao G, Wang M, Lu Y, Li L, Chen C, Chen Y, Song C, Yu F, Li Y, Liu Y, Luo Y, He H, Cheng C, Xu L, Zhang T, Sun L, Liu A, Xia W, Qin Y, Zhao Q, Wei H, Cai W, Chen Y, Zhang F, Wu H. Efficacy and safety of ainuovirine versus efavirenz combination therapies with lamivudine/tenofovir disoproxil fumarate for medication of treatment-naïve HIV-1-positive adults: week 48 results of a randomized controlled phase 3 clinical trial followed by an open-label setting until week 96. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 36:100769. [PMID: 37547039 PMCID: PMC10398592 DOI: 10.1016/j.lanwpc.2023.100769] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 03/29/2023] [Indexed: 08/08/2023]
Abstract
Background Ainuovirine (ANV) is a new non-nucleoside reverse transcriptase inhibitor (NNRTI), which was initially synthesized in Korea and later further developed in both Korea and China. Methods A randomized, double-blind, double-dummy, positive parallel group, non-inferiority, phase 3 trial was conducted in 7 sites across China. Eligible HIV-1-positive antiretroviral therapy (ART)-naïve adults aged 18-65 years were randomly assigned in a 1:1 ratio to receive tenofovir disoproxil fumarate and lamivudine (TDF+3TC) in combination with either ANV (ANV group) or efavirenz (EFV group) for up to 48 weeks. Subsequently, participants in both groups received one of the two drug combinations according to their choice until week 96 in an observational study under an open-label setting. The primary endpoint was the proportion of participants achieving HIV RNA <50 copies/mL at week 48, with non-inferiority pre-specified at a margin of 10%. The secondary efficacy endpoints were logarithmic changes in HIV RNA, percentage of participants with HIV RNA levels ≤400 copies/mL and changes in the CD4 T-cell count after 48 and 96 weeks of treatment, as well as the percentage of participants with HIV RNA levels <50 copies/mL at 96 weeks of treatment. Safety endpoints were the incidence of adverse events and laboratory abnormalities evaluated according to the Division of AIDS criteria. This study was registered with the Chinese Clinical Trial Registry (Registration number: ChiCTR1800019041). Findings Between November 27, 2018 and March 11, 2021, a total of 826 participants were screened, and 630 were finally enrolled and randomly assigned (1:1) to either ANV (n = 315) or EFV (n = 315) groups. The mean age was 30.6 ± 9.4 years and most participants were male (94.6%). At week 48, 274 (87.0%) of 315 participants in the ANV group and 288 (91.7%) of 314 in the EFV group achieved HIV-1 RNA <50 copies/mL and non-inferiority was established (difference: -4.7%, 95% CI: -9.6 to 0.1%). In the period, 293 participants continued to take the ANV regimen and 287 switched from the EFV to the ANV regimen. During the open-label period, 92.5% (271/293) of participants in the continued ANV group and 95.1% (273/287) in the ANV to EFV transfer group remained virologically suppressed (HIV-1 RNA <50 copies/mL) at week 96 (p = 0.189). The incidence of NNRTI treatment-related adverse events (TEAEs) at week 48 was 67.6% in 315 participants in the ANV group, which was significantly lower than in 91.4% of 314 participants in the EFV group (p < 0.001). The most common TEAEs (weeks 0-48) were dizziness (10.5%) and dyslipidemia (22.2%) in the ANV group vs. 51.0% and 34.4% in the EFV group, respectively, followed by transaminase elevation (9.2% vs. 29.0%), γ-glutamyl transferase elevation (8.3% vs. 19.1%), and rash (7.9% vs. 18.8%) (all p < 0.001). After switching from EFV to ANV, TEAEs in the former EFV participants were significantly reduced in the following observational period of 48-96 weeks. Interpretation The week 48 results indicated that the efficacy of ANV was non-inferior to EFV when combined with two NRTIs. The per-protocol risk difference at week 48 for the primary endpoint also supported non-inferiority. TEAEs in ANV treated participants were less frequent with regard to liver toxicity, dyslipidemia, neuropsychiatric symptoms and rash compared to the EFV group during the first 48 weeks of therapy. The effects were maintained during the 48-96 weeks of therapy. Funding Jiangsu Aidea Pharmaceutical Co., Ltd.
Collapse
Affiliation(s)
- Bin Su
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, China
| | - Guiju Gao
- Clinical and Research Center for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, China
| | - Min Wang
- Institute of HIV/AIDS, The First Hospital of Changsha, Changsha, Hunan, 410005, China
| | - Yanqiu Lu
- Department of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing, 400036, China
| | - Linghua Li
- Infectious Disease Center, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, 510060, China
| | - Chen Chen
- Department of Infectious Disease, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, 210003, China
| | - Yuanyuan Chen
- Department of Infectious Diseases, Infectious Disease Hospital of Henan Province, Zhengzhou, Henan, 450015, China
| | - Chuan Song
- Clinical and Research Center for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, China
| | - Fengting Yu
- Clinical and Research Center for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, China
| | - Ying Li
- Institute of HIV/AIDS, The First Hospital of Changsha, Changsha, Hunan, 410005, China
| | - Yixin Liu
- Institute of HIV/AIDS, The First Hospital of Changsha, Changsha, Hunan, 410005, China
| | - Yang Luo
- Department of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing, 400036, China
| | - Haolan He
- Infectious Disease Center, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, 510060, China
| | - Cong Cheng
- Department of Infectious Disease, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, 210003, China
| | - Lixia Xu
- Department of Infectious Diseases, Infectious Disease Hospital of Henan Province, Zhengzhou, Henan, 450015, China
| | - Tong Zhang
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, China
| | - Lijun Sun
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, China
| | - An Liu
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, China
| | - Wei Xia
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, China
| | - Yuanyuan Qin
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, China
- Department of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing, 400036, China
| | - Qingxia Zhao
- Department of Infectious Diseases, Infectious Disease Hospital of Henan Province, Zhengzhou, Henan, 450015, China
| | - Hongxia Wei
- Department of Infectious Disease, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, 210003, China
| | - Weiping Cai
- Infectious Disease Center, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, 510060, China
| | - Yaokai Chen
- Department of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing, 400036, China
| | - Fujie Zhang
- Clinical and Research Center for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, China
| | - Hao Wu
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, China
| |
Collapse
|
15
|
Perez-Molina JA, Crespillo-Andújar C, Zamora J, Fernández-Félix BM, Gaetano-Gil A, López-Bernaldo de Quirós JC, Serrano-Villar S, Moreno S, Álvarez-Díaz N, Berenguer J. Contribution of Low CD4 Cell Counts and High Human Immunodeficiency Virus (HIV) Viral Load to the Efficacy of Preferred First-Line Antiretroviral Regimens for Treating HIV Infection: A Systematic Review and Meta-Analysis. Clin Infect Dis 2023; 76:2027-2037. [PMID: 36975712 DOI: 10.1093/cid/ciad177] [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: 01/30/2023] [Revised: 03/17/2023] [Accepted: 03/23/2023] [Indexed: 03/29/2023] Open
Abstract
We assessed whether low CD4 count and high viral load (VL) affect the response to currently preferred ART. We performed a systematic review of randomized, controlled clinical trials that analyzed preferred first-line ART and a subgroup analysis by CD4 count (≤ or >200 CD4/μL) or VL (≤ or >100 000 copies/mL). We computed the odds ratio (OR) of treatment failure (TF) for each subgroup and individual treatment arm. Patients with ≤200 CD4 cells or VL ≥100 000 copies/mL showed an increased likelihood of TF at 48 weeks: OR, 1.94; 95% confidence interval (CI): 1.45-2.61 and OR, 1.75; 95% CI: 1.30-2.35, respectively. A similar increase in the risk of TF was observed at 96 weeks. There was no significant heterogeneity regarding integrase strand transfer inhibitor or nucleoside reverse transcriptase inhibitor backbone. Our results show that CD4 <200 cells/μL and VL ≥100,000 copies/mL impair ART efficacy in all preferred regimens.
Collapse
Affiliation(s)
- Jose A Perez-Molina
- Infectious Diseases Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Clara Crespillo-Andújar
- Infectious Diseases Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Javier Zamora
- Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal, Madrid, Spain
- CIBERESP, Instituto de Salud Carlos III, Madrid, Spain
- Institute of Metabolism and Systems Research, WHO Collaborating Center for Global Women's Health, University of Birmingham, Birmingham, United Kingdom
| | - Borja M Fernández-Félix
- Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal, Madrid, Spain
- CIBERESP, Instituto de Salud Carlos III, Madrid, Spain
| | - Andrea Gaetano-Gil
- Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal, Madrid, Spain
- CIBERESP, Instituto de Salud Carlos III, Madrid, Spain
| | - Juan C López-Bernaldo de Quirós
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
- HIV Unit, Hospital Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Gregorio Marañón, Madrid, Spain
| | - Sergio Serrano-Villar
- Infectious Diseases Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Santiago Moreno
- Infectious Diseases Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Juan Berenguer
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
- HIV Unit, Hospital Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Gregorio Marañón, Madrid, Spain
| |
Collapse
|
16
|
Maggi P, Ricci ED, Cicalini S, Pellicanò GF, Celesia BM, Vichi F, Cascio A, Sarchi E, Orofino G, Squillace N, Madeddu G, De Socio GV, Bargiacchi O, Molteni C, Masiello A, Saracino A, Menzaghi B, Falasca K, Taramasso L, Di Biagio A, Bonfanti P. Lipids and transaminase elevations in ARV-experienced PLWH switching to a doravirine-based regimen from rilpivirine or other regimens. BMC Infect Dis 2023; 23:227. [PMID: 37059996 PMCID: PMC10103465 DOI: 10.1186/s12879-023-08191-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/22/2023] [Indexed: 04/16/2023] Open
Abstract
BACKGROUND Doravirine (DOR) is a newly approved antiretroviral belonging to the class of non-nucleoside reverse transcriptase inhibitors (NNRTI), well tolerated and leading to an improved lipid profile in antiretroviral experienced people living with HIV (PLWH). We aimed at evaluating if the lipid-lowering effect is linked to the drug class, using real-life data from the SCOLTA cohort. METHODS We compared the lipid profile modifications in experienced PLWH switching to a DOR-based regimen from rilpivirine or another NNRTI-based regimen or from an integrase strand transferase (INSTI)-based regimen. T0 and T1 were defined as the baseline and 6-month follow-up respectively. Data were collected at baseline and prospectively every six months and changes from baseline were compared using a multivariable linear model. RESULTS In 107 PLWH, enrolled in the SCOLTA DOR cohort, with undetectable HIV-RNA at baseline, 32.7% switched from RPV-based regimens (DOR1), 29.9% from other NNRTI-including regimens (DOR2) and 37.4% switched from INSTI-including regimens (DOR3). At T1, TC significantly decreased in DOR2 (-15 mg/dL) and DOR3 (-23 mg/dL), and significantly more in DOR3 than in DOR1 (-6 mg/dL) (p = 0.016). HDL-C declined in DOR2 (-2 mg/dL) whereas it increased in DOR1 (+ 3 mg/dL) (p = 0.042) and remained stable in DOR3. LDL-C significantly decreased from baseline in DOR2 (-12 mg/dL) and DOR3 (-22 mg/dL) and was different between DOR1 (-8 mg/dL) and DOR3 (p = 0.022). TC/HDL ratio showed a significant decline in the DOR3 group (-0.45), although similar to DOR1 (-0.23, p = 0.315) and DOR2 (-0.19, p = 0.254). Triglycerides did not noticeably change. ALT significantly decreased in PLWH with a baseline level > 40 UI/mL. CONCLUSIONS PLWH on doravirine treatment showed different trends in blood lipids according to their previous regimen. In PLWH switching from RPV, minimal modifications were seen, whereas in those switching from other NNRTIs and from INSTI-including regimens, we observed an overall improvement in lipid profile, seemingly independent of the "statin effect" of TDF.
Collapse
Affiliation(s)
- Paolo Maggi
- Infectious Diseases Unit, AORN Sant'Anna e San Sebastiano, Caserta, Italy
| | | | - Stefania Cicalini
- National Institute for Infectious Diseases Lazzaro Spallanzani Institute for Hospitalization and Care Scientific, Roma, Lazio, Italy
| | - Giovanni Francesco Pellicanò
- Unit of Infectious Diseases, Department of Human Pathology of the Adult and the Developmental Age 'G. Barresi', University of Messina, Messina, Italy
| | | | - Francesca Vichi
- Unit of Infectious Diseases, USLCENTRO FIRENZE, Santa Maria Annunziata Hospital, Florence, Italy
| | - Antonio Cascio
- Unit of Infectious Diseases, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Eleonora Sarchi
- Infectious Diseases Unit, S.Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Giancarlo Orofino
- Division I of Infectious and Tropical Diseases, ASL Città di Torino, Torino, Italy
| | - Nicola Squillace
- Infectious Disease Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Giordano Madeddu
- Unit of Infectious Diseases, Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | | | - Olivia Bargiacchi
- Unit of Infectious Diseases, Ospedale Maggiore della Carità, Novara, Italy
| | - Chiara Molteni
- Unit of Infectious Diseases, A. Manzoni Hospital, Lecco, Italy
| | | | - Annalisa Saracino
- Department of Biomedical Sciences and Human Oncology, Clinic of Infectious Diseases, University of Bari Aldo Moro, Bari, Italy
| | - Barbara Menzaghi
- Unit of Infectious Diseases, ASST della Valle Olona - Busto Arsizio (VA), Busto Arsizio VA, Italy
| | - Katia Falasca
- Clinic of Infectious Diseases, Department of Medicine and Science of Aging, G. D'Annunzio University, Chieti-Pescara, Chieti, Italy
| | - Lucia Taramasso
- Infectious Diseases, San Martino Hospital Genoa, University of Genoa, Genoa, Italy
| | - Antonio Di Biagio
- Infectious Diseases, San Martino Hospital Genoa, University of Genoa, Genoa, Italy
| | - Paolo Bonfanti
- Infectious Disease Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza - University of Milano-Bicocca, Monza, Italy
| |
Collapse
|
17
|
Melvin AJ, Yee KL, Gray KP, Yedla M, Wan H, Tobin NH, Teppler H, Campbell H, McCarthy K, Scheckter R, Aurpibul L, Ounchanum P, Rungmaitree S, Cassim H, McFarland E, Flynn P, Cooper E, Krotje C, Townley E, Moye J, Best BM. Pharmacokinetics, Tolerability, and Safety of Doravirine and Doravirine/Lamivudine/Tenofovir Disoproxil Fumarate Fixed-Dose Combination Tablets in Adolescents Living With HIV: Week 24 Results From IMPAACT 2014. J Acquir Immune Defic Syndr 2023; 92:153-161. [PMID: 36215957 PMCID: PMC9839475 DOI: 10.1097/qai.0000000000003116] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 09/28/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND We studied the pharmacokinetics (PK) and safety of 100-mg doravirine and doravirine/lamivudine/tenofovir disoproxil fumarate fixed-dose combination (100/300/300 mg DOR FDC) treatment in adolescents with HIV-1. METHODS Adolescents ages 12 to younger than 18 years were enrolled in 2 sequential cohorts. Cohort 1 evaluated intensive PK and short-term safety of 100-mg single-dose doravirine in adolescents ≥35 kg. Cohort 2 participants either initiated treatment with DOR FDC (antiretroviral (ARV)-naïve) or switched to DOR FDC from a previous ARV regimen (virologically suppressed). The first 10 Cohort 2 participants had intensive PK evaluations, and safety, sparse PK, and HIV RNA were assessed through week 24. RESULTS Fifty-five adolescents, median age 15.0 years and baseline weight 51.5 kg, were enrolled. Nine participants completed Cohort 1 PK assessments (8 of the 9 participants weighed ≥45 kg) and 45 initiated study drug in Cohort 2. The doravirine geometric mean (GM) AUC 0-∞ was 34.8 μM∙hour, and the GM C 24 was 514 nM after a single dose, with a predicted steady-state GM C 24,ss,pred of 690 nM. Cohort 2 enrolled adolescents weighing ≥45 kg. Plasma concentrations of doravirine, tenofovir, and lamivudine achieved by Cohort 2 participants were similar to those reported in adults. No drug-related serious or grade 3 or 4 adverse events occurred. Forty-two of 45 participants (93.3%; 95% CI: [81.7, 98.6]) achieved or maintained HIV-1 RNA <40 copies/mL. CONCLUSIONS Doravirine and DOR FDC achieved target PK in adolescents with HIV-1. DOR FDC was well-tolerated and maintained excellent virologic efficacy through 24 weeks, offering a favorable option for adolescents.
Collapse
Affiliation(s)
- Ann J Melvin
- Department of Pediatrics, Division of Pediatric Infectious Disease, University of Washington and Seattle Children's Research Institute, Seattle, WA
| | | | - Kathryn P Gray
- Harvard T.H. Chan School of Public Health, Boston, MA
- Frontier Science Technology and Research Foundation, Brookline, MA
| | - Mounika Yedla
- Frontier Science Technology and Research Foundation, Brookline, MA
| | | | - Nicole H Tobin
- Department of Pediatrics, Division of Pediatric Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, CA
| | | | | | | | | | - Linda Aurpibul
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | | | | | - Hassena Cassim
- PHRU, Chris Hani Baragwanath Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Elizabeth McFarland
- Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Denver, CO
| | - Patricia Flynn
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN
| | - Ellen Cooper
- Boston Medical Center, Boston University School of Medicine, Boston, MA
| | | | | | | | - Brookie M Best
- Skaggs School of Pharmacy and Pharmaceutical Sciences and Pediatrics Department, School of Medicine-Rady Children's Hospital San Diego, University of California San Diego, San Diego, CA
| |
Collapse
|
18
|
Gandhi RT, Bedimo R, Hoy JF, Landovitz RJ, Smith DM, Eaton EF, Lehmann C, Springer SA, Sax PE, Thompson MA, Benson CA, Buchbinder SP, Del Rio C, Eron JJ, Günthard HF, Molina JM, Jacobsen DM, Saag MS. Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults: 2022 Recommendations of the International Antiviral Society-USA Panel. JAMA 2023; 329:63-84. [PMID: 36454551 DOI: 10.1001/jama.2022.22246] [Citation(s) in RCA: 191] [Impact Index Per Article: 191.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Importance Recent advances in treatment and prevention of HIV warrant updated recommendations to guide optimal practice. Objective Based on a critical evaluation of new data, to provide clinicians with recommendations on use of antiretroviral drugs for the treatment and prevention of HIV, laboratory monitoring, care of people aging with HIV, substance use disorder and HIV, and new challenges in people with HIV, including COVID-19 and monkeypox virus infection. Evidence Review A panel of volunteer expert physician scientists were appointed to update the 2020 consensus recommendations. Relevant evidence in the literature (PubMed and Embase searches, which initially yielded 7891 unique citations, of which 834 were considered relevant) and studies presented at peer-reviewed scientific conferences between January 2020 and October 2022 were considered. Findings Initiation of antiretroviral therapy (ART) is recommended as soon as possible after diagnosis of HIV. Barriers to care should be addressed, including ensuring access to ART and adherence support. Integrase strand transfer inhibitor-containing regimens remain the mainstay of initial therapy. For people who have achieved viral suppression with a daily oral regimen, long-acting injectable therapy with cabotegravir plus rilpivirine given as infrequently as every 2 months is now an option. Weight gain and metabolic complications have been linked to certain antiretroviral medications; novel strategies to ameliorate these complications are needed. Management of comorbidities throughout the life span is increasingly important, because people with HIV are living longer and confronting the health challenges of aging. In addition, management of substance use disorder in people with HIV requires an evidence-based, integrated approach. Options for preexposure prophylaxis include oral medications (tenofovir disoproxil fumarate or tenofovir alafenamide plus emtricitabine) and, for the first time, a long-acting injectable agent, cabotegravir. Recent global health emergencies, like the SARS-CoV-2 pandemic and monkeypox virus outbreak, continue to have a major effect on people with HIV and the delivery of services. To address these and other challenges, an equity-based approach is essential. Conclusions and Relevance Advances in treatment and prevention of HIV continue to improve outcomes, but challenges and opportunities remain.
Collapse
Affiliation(s)
- Rajesh T Gandhi
- Massachusetts General Hospital and Harvard Medical School, Boston
| | - Roger Bedimo
- University of Texas Southwestern Medical Center, Dallas
| | - Jennifer F Hoy
- The Alfred Hospital and Monash University, Melbourne, Australia
| | | | - Davey M Smith
- University of California San Diego School of Medicine
| | | | - Clara Lehmann
- University of Cologne and German Center for Infection Research (DZIF), Bonn-Cologne
| | - Sandra A Springer
- Yale University School of Medicine, New Haven, Connecticut
- The Veterans Administration Connecticut Healthcare System, West Haven
| | - Paul E Sax
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | | | - Carlos Del Rio
- Emory University School of Medicine and Grady Health System, Atlanta, Georgia
| | - Joseph J Eron
- The University of North Carolina School of Medicine at Chapel Hill
| | - Huldrych F Günthard
- University Hospital Zurich and Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Jean-Michel Molina
- University of Paris Cité, Saint-Louis and Lariboisière Hospitals, Assistance Publique Hopitaux de Paris, France
| | | | | |
Collapse
|
19
|
Bareng OT, Seselamarumo S, Seatla KK, Choga WT, Bakae B, Maruapula D, Kelentse N, Moraka NO, Mokaleng B, Mokgethi PT, Ditlhako TR, Pretorius-Holme M, Mbulawa MB, Lebelonyane R, Bile EC, Gaolathe T, Shapiro R, Makhema JM, Lockman S, Essex M, Novitsky V, Mpoloka SW, Moyo S, Gaseitsiwe S. Doravirine-associated resistance mutations in antiretroviral therapy naïve and experienced adults with HIV-1 subtype C infection in Botswana. J Glob Antimicrob Resist 2022; 31:128-134. [PMID: 35973671 PMCID: PMC9750894 DOI: 10.1016/j.jgar.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/25/2022] [Accepted: 08/09/2022] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES There are limited data on the prevalence of doravirine (DOR)-associated drug resistance mutations in people with HIV (PWH) in Botswana. This cross-sectional, retrospective study aimed to explore the prevalence of DOR-associated resistance mutations among ART-naïve and -experienced PWH in Botswana enrolled in the population-based Botswana Combination Prevention Project (BCPP). METHODS A total of 6078 HIV-1C pol sequences were analysed for DOR-associated resistance mutations using the Stanford HIV drug resistance database, and their levels were predicted according to the Stanford DRM penalty scores and resistance interpretation. Virologic failure was defined as HIV-1 RNA load (VL) >400 copies/mL. RESULTS Among 6078 PWH, 5999 (99%) had known ART status, and 4529/5999 (79%) were on ART at time of sampling. The suppression rate among ART-experienced was 4517/4729 (96%). The overall prevalence of any DOR-associated resistance mutations was 181/1473 (12.3% [95% confidence interval {CI}: 10.7-14.1]); by ART status: 42/212 (19.8% [95% CI: 14.7-25.4]) among ART-failing individuals (VL ≥400 copies/mL) and 139/1261 (11.0% [95% CI: 9.3-12.9]) among ART-naïve individuals (P < 0.01). Intermediate DOR-associated resistance mutations were observed in 106/1261 (7.8% [95% CI: 6.9-10.1]) in ART-naïve individuals and 29/212 (13.7% [95% CI: 9.4-8.5]) among ART-experienced participants (P < 0.01). High-level DOR-associated resistance mutations were observed in 33/1261 (2.6% [95% CI: 1.8-3.7]) among ART-naïve and 13/212 (6.1% [95% CI: 3.6-10.8]) among ART-failing PWH (P < 0.01). PWH failing ART with at least one EFV/NVP-associated resistance mutation had high prevalence 13/67 (19.4%) of high-level DOR-associated resistance mutations. CONCLUSION DOR-associated mutations were rare (11.0%) among ART-naive PWH but present in 62.7% of Botswana individuals who failed NNRTI-based ART with at least one EFV/NVP-associated resistance mutation. Testing for HIV drug resistance should underpin the use of DOR in PWH who have taken first-generation NNRTIs.
Collapse
Affiliation(s)
- Ontlametse T Bareng
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana; Department of Medical Sciences, Faculty of Allied Health Professions, University of Botswana, Gaborone, Botswana
| | - Sekgabo Seselamarumo
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana; Department of Biological Sciences, Faculty of Science, University of Botswana, Gaborone, Botswana
| | - Kaelo K Seatla
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana; Department of Medical Sciences, Faculty of Allied Health Professions, University of Botswana, Gaborone, Botswana
| | - Wonderful T Choga
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana; Division of Human Genetics, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Blessing Bakae
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Dorcas Maruapula
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana; Department of Biological Sciences, Faculty of Science, University of Botswana, Gaborone, Botswana
| | - Nametso Kelentse
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana; Department of Medical Sciences, Faculty of Allied Health Professions, University of Botswana, Gaborone, Botswana
| | - Natasha O Moraka
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana; Division of Medical Virology, Stellenbosch University, Cape Town, South Africa
| | - Baitshepi Mokaleng
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana; Department of Medical Sciences, Faculty of Allied Health Professions, University of Botswana, Gaborone, Botswana
| | - Patrick T Mokgethi
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana; Department of Biological Sciences, Faculty of Science, University of Botswana, Gaborone, Botswana
| | | | - Molly Pretorius-Holme
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | | | | | - Ebi Celestin Bile
- FHI 360, Department of Clinical Sciences, Durham, North Carolina, USA
| | | | - Roger Shapiro
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana; Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Joseph M Makhema
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana; Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Shahin Lockman
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana; Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA; Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Max Essex
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana; Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Vlad Novitsky
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana; Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Sununguko W Mpoloka
- Department of Biological Sciences, Faculty of Science, University of Botswana, Gaborone, Botswana
| | - Sikhulile Moyo
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana; Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Simani Gaseitsiwe
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana; Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
| |
Collapse
|
20
|
Garcia M, Martellosio JP, Giraud V, Béraud G, Catroux M, Roblot F, Le Moal G. Efficacy and Safety of Doravirine-Based Regimens in Real Life: A Prospective Monocentric French Study. AIDS Res Hum Retroviruses 2022; 38:779-781. [PMID: 36097760 DOI: 10.1089/aid.2022.0058] [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: 01/25/2023] Open
Abstract
Doravirine (DOR) efficacy and safety have been evaluated in adult naive or treated patients starting a DOR-based regimen between September 15, 2019, and December 31, 2020. Medical history and examination, laboratory results, and tolerance were assessed during the 48 weeks of follow-up. Among the 77 patients included, virological control (VC) was noticed for 66 patients at baseline. Median age was 51 years, and 62% were men. The most common reason for initiating a DOR-based therapy was toxicity (44; 67%) and, especially, weight gain. A virological suppression (VS) was maintained in 55 (83%) patients of the VC group and noticed in 9 (82%) of the non-VC patients at week 48, by intention-to-treat analysis. On treatment analysis, 98% and 100% patients achieved VS in the VC and non-VC groups, respectively. The renal and metabolic tolerance were good. DOR-based regimens appear to be a safe and relevant strategy to circumvent drug interactions and drugs with a poor metabolic tolerance profile.
Collapse
Affiliation(s)
- Magali Garcia
- Service de Virologie et Mycobactériologie, CHU de Poitiers, Poitiers, France.,Laboratoire Inflammation, Tissus Epithéliaux et Cytokines, UR 15560, Université de Poitiers, Poitiers, France
| | | | - Valentin Giraud
- Service de Médecine Interne et Maladies Infectieuses, CHU de Poitiers, Poitiers, France
| | - Guillaume Béraud
- Service de Médecine Interne et Maladies Infectieuses, CHU de Poitiers, Poitiers, France
| | - Mélanie Catroux
- Service de Médecine Interne et Maladies Infectieuses, CHU de Poitiers, Poitiers, France
| | - France Roblot
- Service de Médecine Interne et Maladies Infectieuses, CHU de Poitiers, Poitiers, France.,Laboratoire Pharmacologie des Antimicrobiens, INSERM, U1070, Université de Poitiers, Poitiers, France
| | - Gwénael Le Moal
- Service de Médecine Interne et Maladies Infectieuses, CHU de Poitiers, Poitiers, France
| |
Collapse
|
21
|
Molina JM, Yazdanpanah Y, Afani Saud A, Bettacchi C, Chahin Anania C, Klopfer SO, Grandhi A, Eves K, Hepler D, Robertson MN, Hwang C, Hanna GJ, Correll T. Brief Report: Efficacy and Safety of Oral Islatravir Once Daily in Combination With Doravirine Through 96 Weeks for Treatment-Naive Adults With HIV-1 Infection Receiving Initial Treatment With Islatravir, Doravirine, and Lamivudine. J Acquir Immune Defic Syndr 2022; 91:68-72. [PMID: 35972855 PMCID: PMC9377497 DOI: 10.1097/qai.0000000000002879] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 11/08/2021] [Indexed: 12/02/2022]
Abstract
BACKGROUND Islatravir (MK-8591) is a nucleoside reverse transcriptase translocation inhibitor in development for treatment and prevention of HIV-1. We present efficacy and safety data for islatravir and doravirine (DOR) through 96 weeks of the phase 2b trial (NCT03272347). METHODS In this randomized, double-blind, dose-ranging trial, participants initially received islatravir (0.25, 0.75, or 2.25 mg) with doravirine (100 mg) and lamivudine (3TC, 300 mg) or a fixed-dose combination of doravirine, 3TC, and tenofovir disoproxil fumarate (DOR/3TC/TDF) daily. Beginning at week 24, participants receiving islatravir stopped 3TC if HIV-1 RNA from the prior visit was <50 copies per milliliter and continued taking the assigned islatravir dose (still blinded) with doravirine. All islatravir groups transitioned to open-label use of 0.75 mg between weeks 60 and 84. Efficacy end points at week 96 included the proportion of participants maintaining HIV-1 RNA of <50 copies per milliliter (FDA Snapshot). Safety was assessed by adverse event (AE) reporting. RESULTS One hundred twenty-one treatment-naive participants received the study drugs and were included in the analyses. Through week 96, HIV-1 RNA<50 copies per milliliter was maintained in 86.2% (25/29), 90.0% (27/30), and 67.7% (21/31) of participants in the 0.25-, 0.75-, and 2.25-mg islatravir groups, respectively, 81.1% (73/90) of the combined islatravir group, and 80.6% (25/31) of the DOR/3TC/TDF group. One participant in the 2.25-mg islatravir group had Protocol-Defined Virologic Failure after week 48. Drug-related AE rates were higher for DOR/3TC/TDF participants (22.6%) compared with islatravir (combined 7.8%). Two participants (2.2%) receiving islatravir with doravirine and one (3.2%) receiving DOR/3TC/TDF discontinued because of an AE. CONCLUSIONS Treatment regimens containing islatravir and doravirine maintained viral suppression through week 96 and were well tolerated regardless of dose.
Collapse
Affiliation(s)
- Jean-Michel Molina
- Department of Infectious Diseases, St-Louis and Lariboisière Hospitals, APHP, University of Paris, INSERM U944
| | - Yazdan Yazdanpanah
- Department of Infectious Diseases, Bichat Claude Barnard Hospital, APHP, University of Paris, Inserm U1137
| | | | | | - Carolina Chahin Anania
- Department of Infectious Diseases, Hospital Hernán Henríquez Aravena of Temuco, Temuco, Chile; and
| | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Takahashi K, Ishii R, Maruo K, Gosho M. Statistical tests for two-stage adaptive seamless design using short- and long-term binary outcomes. Stat Med 2022; 41:4130-4142. [PMID: 35713225 DOI: 10.1002/sim.9500] [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: 05/26/2021] [Revised: 04/20/2022] [Accepted: 05/30/2022] [Indexed: 11/09/2022]
Abstract
The adaptive seamless design combining phases II and III into a single trial has been shown growing interest for improving the efficiency of drug development, becoming the most frequent adaptive design type. It typically consists of two stages, the trial objectives being often different in each stage. The primary objectives are to select optimal experimental treatment group(s) in the first stage and compare the efficacy between the selected treatment and control groups in the second stage. In this article, we focus on a two-stage adaptive seamless design, for which treatment selection is based on the short-term binary endpoint and treatment comparison is based on the long-term binary endpoint. We thus propose an exact conditional test as a final analysis, based on the bivariate binomial distribution and given the selected treatment with the most promising short-term endpoint response rate from an interim analysis. Additionally, the mid- p $$ p $$ approach is incorporated to improve conservativeness for an exact test. Simulation studies were conducted to compare the proposed methods with a method based on the combination test. The proposed exact method controlled for type I error rate at the nominal level, regardless of the number of initial treatments or the correlation between short- and long-term endpoints. In terms of the treatment comparison power, the proposed methods are more powerful than that based on the combination test in the scenarios, with only one treatment being effective.
Collapse
Affiliation(s)
- Kenichi Takahashi
- Japan Development, MSD K. K., Tokyo, Japan.,Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - Ryota Ishii
- Department of Biostatistics, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kazushi Maruo
- Department of Biostatistics, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Masahiko Gosho
- Department of Biostatistics, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| |
Collapse
|
23
|
Doravirine and Islatravir Have Complementary Resistance Profiles and Create a Combination with a High Barrier to Resistance. Antimicrob Agents Chemother 2022; 66:e0222321. [PMID: 35491829 DOI: 10.1128/aac.02223-21] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Doravirine (DOR), a non-nucleoside reverse transcriptase inhibitor (NNRTI), was approved for treatment of HIV-1 infection in 2018. In the pivotal phase 3 trials, DRIVE-FORWARD and DRIVE-AHEAD, 7 out of 747 (0.9%) treatment-naive participants treated with DOR plus two nucleos(t)ide reverse transcriptase inhibitors (NRTIs) met protocol-defined virologic failure criteria and showed phenotypic resistance to DOR at week 48. The most common DOR resistance-associated mutation (RAM) detected in 5 of the 7 resistant isolates was F227C. Six isolates bearing NRTI RAMs (M184V and/or K65R) were resistant to lamivudine (3TC) and emtricitabine (FTC) but not to other approved NRTIs. All DOR-resistant isolates were susceptible or hypersusceptible (fold change of <0.25) to islatravir (ISL), a nucleoside reverse transcriptase translocation inhibitor (NRTTI). Isolate hypersusceptibility to ISL required F227C, in contrast to zidovudine, an NRTI, which required M184V. Based on the frequent emergence of F227C, we hypothesized that DOR and ISL would create a combination (DOR/ISL) with a high barrier to resistance. In de novo resistance selection studies in MT4-GFP cells (MT4 cells engineered to express green fluorescent protein), DOR/ISL synergistically prevented viral breakthrough at a threshold of 2× the half-maximal inhibitory concentration (IC50). DOR/ISL exhibited a higher barrier to resistance than DOR/3TC and dolutegravir (DTG)/3TC. Resistance analysis showed no emergence of substitutions at F227, an observation consistent with its ability to confer hypersusceptibility to ISL. Overall, the data demonstrate that DOR/ISL creates a 2-drug combination with a higher barrier to resistance, consistent with the reported clinical activity.
Collapse
|
24
|
Zhang K, Zhang Y, Zhou J, Xu L, Zhou C, Chen G, Huang X. Comparison of the Efficacy and Safety of a Doravirine-Based, Three-Drug Regimen in Treatment-Naïve HIV-1 Positive Adults: A Bayesian Network Meta-Analysis. Front Pharmacol 2022; 13:676831. [PMID: 35517782 PMCID: PMC9065253 DOI: 10.3389/fphar.2022.676831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/14/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction: Extensive use of antiretroviral therapy has remarkably improved the survival rates of people living with HIV. Doravirine (DOR) is a newly-approved antiretroviral belonging to the class of non-nucleoside reverse transcriptase inhibitors. Here, we compared the efficacy and safety of DOR + tenofovir dipivoxil fumarate (TDF)+Lamivudine (3TC)/Emtritabine (FTC) with traditional triple therapies in treatment-naïve HIV-1-positive adults. Methods: Randomized controlled trials involving treatment-naïve HIV-1-positive adults that met inclusion criteria were systematically retrieved and data on the following outcomes extracted: virological suppression, adverse events, severe adverse events, and drug-related adverse events. A Bayesian network meta-analysis was then performed on the data. Results: This study included a total of 39 randomized controlled trials involving 26 antiretroviral therapies and 21,110 HIV1-positive patients. At week 48, relative to the other 25 regimens included in the network of virological suppression, DOR + TDF+3TC/FTC exhibited superiority to some efavirenz, nevirapine, atazanavir, or lopinavir-based regimens, including efavirenz + abacavir+3TC [Odd Ratio (OR) = 0.52, 95% confidence interval (CrI) = 0.35–0.77]. At week 48, the performance of DOR + TDF+3TC/FTC was relatively similar to all other analyzed regimens in terms of adverse events. The DOR + TDF+3TC/FTC regimen performed better in terms of severe adverse events and drug-related adverse events. Conclusion: The network meta-analysis showed that DOR + TDF+3TC/FTC has good efficacy and safety at 48 weeks. Systematic Review Registration: Open Science Framework, https://osf.io/6ybp7.
Collapse
Affiliation(s)
- Ke Zhang
- Department of Dermatology, The Affiliated Hospital of Qingdao University, Qingdao, China
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Yang Zhang
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of HIV/AIDS Research, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Jing Zhou
- Infectious Disease Department, University of Chinese Academy of Sciences Shenzhen Hospital (Guangming), Shenzhen, China
| | - Lulu Xu
- Department of Dermatology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Chi Zhou
- Department of Dermatology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Guanzhi Chen
- Department of Dermatology, The Affiliated Hospital of Qingdao University, Qingdao, China
- *Correspondence: Guanzhi Chen, ; Xiaojie Huang,
| | - Xiaojie Huang
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
- *Correspondence: Guanzhi Chen, ; Xiaojie Huang,
| |
Collapse
|
25
|
Li G, Wang Y, De Clercq E. Approved HIV reverse transcriptase inhibitors in the past decade. Acta Pharm Sin B 2022; 12:1567-1590. [PMID: 35847492 PMCID: PMC9279714 DOI: 10.1016/j.apsb.2021.11.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 10/13/2021] [Accepted: 11/08/2021] [Indexed: 01/09/2023] Open
Abstract
HIV reverse transcriptase (RT) inhibitors are the important components of highly active antiretroviral therapies (HAARTs) for anti-HIV treatment and pre-exposure prophylaxis in clinical practice. Many RT inhibitors and their combination regimens have been approved in the past ten years, but a review on their drug discovery, pharmacology, and clinical efficacy is lacking. Here, we provide a comprehensive review of RT inhibitors (tenofovir alafenamide, rilpivirine, doravirine, dapivirine, azvudine and elsulfavirine) approved in the past decade, regarding their drug discovery, pharmacology, and clinical efficacy in randomized controlled trials. Novel RT inhibitors such as islatravir, MK-8504, MK-8507, MK8583, IQP-0528, and MIV-150 will be also highlighted. Future development may focus on the new generation of novel antiretroviral inhibitors with higher bioavailability, longer elimination half-life, more favorable side-effect profiles, fewer drug-drug interactions, and higher activities against circulating drug-resistant strains.
Collapse
Key Words
- 3TC, (−)-2′,3′-dideoxy-3′-thiacytidine (common name, lamivudine)
- ABC, abacavir
- ATV, atazanavir
- AZT, 3′-azido-3′-deoxy-thymidine (common name, zidovudine)
- BIC, bictegravir
- CAB, cabotegravir
- CC50, the 50% cytotoxic concentration
- COBI, cobicistat
- Clinical efficacy
- DOR, doravirine
- DPV, dapivirine
- DRV, darunavir
- DTG, dolutegravir
- EACS, European AIDS Clinical Society
- EC50, half maximal effective concentration
- EFV, efavirenz
- ESV, elsulfavirine
- EVG, elvitegravir
- F, bioavailability
- FDA, US Food and Drug Administration
- FTC, (−)-2′,3′-dideoxy-5-fluoro-3′-thiacytidine (common name, emtricitabine)
- HAART
- HAART, highly active antiretroviral therapy
- HIV treatment
- HIV, human immunodeficiency virus
- IAS-USA, International Antiviral Society-USA
- IC50, half maximal inhibitory concentration
- MSM, men who have sex with men
- NNRTI
- NNRTI, non-nucleoside reverse transcriptase inhibitor
- NRTI
- NRTI, nucleoside/nucleotide reverse transcriptase inhibitor
- RPV, rilpivirine
- TAF, tenofovir alafenamide
- TDF, tenofovir disoproxil fumarate
- t1/2, elimination half-life
Collapse
Affiliation(s)
- Guangdi Li
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha 410078, China
| | - Yali Wang
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha 410078, China
| | - Erik De Clercq
- Rega Institute for Medical Research, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven B-3000, Belgium
| |
Collapse
|
26
|
Leone M, Giani L, Phaka M, Uluduz D, Tayyar Ş, Kamponda M, Tolno VT, Guidotti G, Marazzi MC, Steiner TJ. Burden of headache in a HIV-positive population of sub-Saharan Africa. Cephalalgia 2022; 42:918-925. [PMID: 35331013 PMCID: PMC9315167 DOI: 10.1177/03331024221088994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND About 26 million people are living with HIV in sub-Saharan Africa. The DREAM programme in sub-Saharan Africa provides free healthcare for HIV/AIDS and a range of chronic non-communicable diseases. HIV is a risk factor for neurological non-communicable diseases including stroke and epilepsy, which themselves are associated with headache, and HIV may be a direct risk factor for headache. We investigated the prevalence and burden of headache in a HIV+ population in sub-Saharan Africa. METHODS At the DREAM Centre in Blantyre, Malawi, a low-income country with a population of 19 million and 9.2% HIV prevalence, a structured questionnaire was administered by a trained lay interviewer to consecutively attending HIV+ patients aged 6-65 years. All were monitored with regular viral load detection. RESULTS Of 513 eligible patients invited, 498 were included (mean age 34.1 ± 12.8 years; 72% females; 15 declined). All were on antiretroviral treatment, with viral load undetectable in 83.9%. The 1-year prevalence of headache was 80.3% (females 83.6%, males 71.9%); 3.8% had ≥15 headache days/month, 1.4% had probable medication-overuse headache. Mean overall headache frequency was 4.4 ± 5.4 days/month. Those reporting headache lost means of 2.3% of paid workdays and 3.3% of household workdays because of headache. Only one third had sought advice for their headache. CONCLUSIONS Headache is very prevalent among HIV+ patients in Malawi, imposing additional burden and costs on individuals and the community. Management of headache disorders should be implemented in HIV centres, as it is for other chronic non-communicable diseases.
Collapse
Affiliation(s)
- Massimo Leone
- Neuroalgology Unit, Foundation IRCCS Carlo Besta Neurological Institute, Milan, Italy
| | - Luca Giani
- Neurorehabilitation Department, IRCCS Istituti Clinici Scientifici Maugeri di Milano, Milan, Italy
| | - Monica Phaka
- DREAM Program, Health Department, Blantyre, Malawi
| | - Derya Uluduz
- Neurology Department, Istanbul University Cerrahpaşa Medical Faculty, Istanbul, Turkey
| | - Şaşmaz Tayyar
- Public Health Department, Mersin University School of Medicine, Mersin, Turkey
| | | | | | - Giovanni Guidotti
- Health Department, Azienda Sanitaria Locale (ASL) Roma 1, Regione Lazio, Rome, Italy
| | | | - Timothy J Steiner
- Division of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Brain Sciences, Imperial College London, London, UK
| |
Collapse
|
27
|
Turvey SL, Saxinger L, Mason AL. Apples to Apples? A Comparison of Real-World Tolerability of Antiretrovirals in Patients with Human Immunodeficiency Virus Infection and Patients with Primary Biliary Cholangitis. Viruses 2022; 14:v14030516. [PMID: 35336923 PMCID: PMC8949089 DOI: 10.3390/v14030516] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/07/2022] [Accepted: 03/01/2022] [Indexed: 12/26/2022] Open
Abstract
We previously characterized a human betaretrovirus and linked infection with the development of primary biliary cholangitis (PBC). There are in vitro and in vivo data demonstrating that antiretroviral therapy used to treat human immunodeficiency virus (HIV) can be repurposed to treat betaretroviruses. As such, PBC patients have been treated with nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs), alone and in combination with a boosted protease inhibitor or an integrase strand transfer inhibitor in case studies and clinical trials. However, a randomized controlled trial using combination antiretroviral therapy with lopinavir was terminated early because 70% of PBC patients discontinued therapy because of gastrointestinal side effects. In the open-label extension, patients tolerating combination therapy underwent a significant reduction in serum liver parameters, whereas those on NRTIs alone rebounded to baseline. Herein, we compare clinical experience in the experimental use of antiretroviral agents in patients with PBC with the broader experience of using these agents in people living with HIV infection. While the incidence of gastrointestinal side effects in the PBC population appears somewhat increased compared to those with HIV infection, the clinical improvement observed in patients with PBC suggests that further studies using the newer and better tolerated antiretroviral agents are warranted.
Collapse
Affiliation(s)
- Shannon L. Turvey
- Division of Infectious Diseases, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2E1, Canada; (S.L.T.); (L.S.)
| | - Lynora Saxinger
- Division of Infectious Diseases, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2E1, Canada; (S.L.T.); (L.S.)
| | - Andrew L. Mason
- Division of Gastroenterology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2E1, Canada
- Correspondence: ; Tel.: +1-780-492-8176; Fax: +1-780-492-1655
| |
Collapse
|
28
|
Wang Z, Cherukupalli S, Xie M, Wang W, Jiang X, Jia R, Pannecouque C, De Clercq E, Kang D, Zhan P, Liu X. Contemporary Medicinal Chemistry Strategies for the Discovery and Development of Novel HIV-1 Non-nucleoside Reverse Transcriptase Inhibitors. J Med Chem 2022; 65:3729-3757. [PMID: 35175760 DOI: 10.1021/acs.jmedchem.1c01758] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Currently, HIV-1 non-nucleoside reverse transcriptase inhibitors (NNRTIs) are a major component of the highly active anti-retroviral therapy (HAART) regimen. However, the occurrence of drug-resistant strains and adverse reactions after long-term usage have inevitably compromised the clinical application of NNRTIs. Therefore, the development of novel inhibitors with distinct anti-resistance profiles and better pharmacological properties is still an enormous challenge. Herein, we summarize state-of-the-art medicinal chemistry strategies for the discovery of potent NNRTIs, such as structure-based design strategies, contemporary computer-aided drug design, covalent-binding strategies, and the application of multi-target-directed ligands. The strategies described here will facilitate the identification of promising HIV-1 NNRTIs.
Collapse
Affiliation(s)
- Zhao Wang
- Department of Medicinal Chemistry, Key Laboratory of Chemical Biology (Ministry of Education), School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, 44 West Culture Road, 250012 Jinan, Shandong, P.R. China
| | - Srinivasulu Cherukupalli
- Department of Medicinal Chemistry, Key Laboratory of Chemical Biology (Ministry of Education), School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, 44 West Culture Road, 250012 Jinan, Shandong, P.R. China
| | - Minghui Xie
- Department of Medicinal Chemistry, Key Laboratory of Chemical Biology (Ministry of Education), School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, 44 West Culture Road, 250012 Jinan, Shandong, P.R. China
| | - Wenbo Wang
- Department of Medicinal Chemistry, Key Laboratory of Chemical Biology (Ministry of Education), School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, 44 West Culture Road, 250012 Jinan, Shandong, P.R. China
| | - Xiangyi Jiang
- Department of Medicinal Chemistry, Key Laboratory of Chemical Biology (Ministry of Education), School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, 44 West Culture Road, 250012 Jinan, Shandong, P.R. China
| | - Ruifang Jia
- Department of Medicinal Chemistry, Key Laboratory of Chemical Biology (Ministry of Education), School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, 44 West Culture Road, 250012 Jinan, Shandong, P.R. China
| | - Christophe Pannecouque
- Rega Institute for Medical Research, Laboratory of Virology and Chemotherapy, K.U. Leuven, Herestraat 49 Postbus 1043 (09.A097), B-3000 Leuven, Belgium
| | - Erik De Clercq
- Rega Institute for Medical Research, Laboratory of Virology and Chemotherapy, K.U. Leuven, Herestraat 49 Postbus 1043 (09.A097), B-3000 Leuven, Belgium
| | - Dongwei Kang
- Department of Medicinal Chemistry, Key Laboratory of Chemical Biology (Ministry of Education), School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, 44 West Culture Road, 250012 Jinan, Shandong, P.R. China.,China-Belgium Collaborative Research Center for Innovative Antiviral Drugs of Shandong Province, 44 West Culture Road, 250012 Jinan, Shandong, P.R. China
| | - Peng Zhan
- Department of Medicinal Chemistry, Key Laboratory of Chemical Biology (Ministry of Education), School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, 44 West Culture Road, 250012 Jinan, Shandong, P.R. China.,China-Belgium Collaborative Research Center for Innovative Antiviral Drugs of Shandong Province, 44 West Culture Road, 250012 Jinan, Shandong, P.R. China
| | - Xinyong Liu
- Department of Medicinal Chemistry, Key Laboratory of Chemical Biology (Ministry of Education), School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, 44 West Culture Road, 250012 Jinan, Shandong, P.R. China.,China-Belgium Collaborative Research Center for Innovative Antiviral Drugs of Shandong Province, 44 West Culture Road, 250012 Jinan, Shandong, P.R. China
| |
Collapse
|
29
|
Kaur N, Sharma P, Aditya A, Shanavas A. Taking leads out of nature, can nano deliver us from COVID-like pandemics? Biomed Phys Eng Express 2022; 8. [PMID: 35078168 DOI: 10.1088/2057-1976/ac4ec8] [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: 10/19/2021] [Accepted: 01/25/2022] [Indexed: 11/11/2022]
Abstract
The COVID-19 crisis has alerted the research community to re-purpose scientific tools that can effectively manage emergency pandemic situations. Researchers were never so desperate to discover a 'magic bullet' that has significant clinical benefits with minimal or no side effects. At the beginning of the pandemic, due to restricted access to traditional laboratory techniques, many research groups delved into computational screening of thousands of lead molecules that could inhibit SARS-CoV-2 at one or more stages of its infectious cycle. Several in silico studies on natural derivatives point out their potency against SARS-CoV-2 proteins. However, theoretical predictions and existing knowledge on related molecules reflect their poor oral bioavailability due to biotransformation in the gut and liver. Nanotechnology has evolved into a key field for precise and controlled delivery of various drugs that lack aqueous solubility, have low oral bioavailability and possess pronounced toxicity in their native form. In this review, we discuss various nanoformulations of natural products with favorable ADME properties, and also briefly explore nano-drug delivery to lungs, the primary site of SARS-CoV-2 infection. Natural products are also envisioned to augment nanotechnology-based 1) personnel protective equipment for ex vivo viral inactivation and 2) wearable sensors that perform rapid and non-invasive analysis of volatile organic compounds in exhaled breath of the infected person after therapeutic food consumption.
Collapse
Affiliation(s)
- Navneet Kaur
- Institute of Nano Science and Technology, Sector 81, Knowledge city, Mohali, 140306, INDIA
| | - Priyanka Sharma
- Institute of Nano Science and Technology, Sector 81, Knowledge city, Mohali, 140306, INDIA
| | - Adrija Aditya
- Institute of Nano Science and Technology, Sector 81, Knowledge city, Mohali, 140306, INDIA
| | - Asifkhan Shanavas
- Institute of Nano Science and Technology, Sector 81, Knowledge city, Mohali, 140306, INDIA
| |
Collapse
|
30
|
Sun Z, Lan Y, Liang S, Wang J, Ni M, Zhang X, Yu F, Chen M, Zhang H, Yan L, Cai W, Lan G, Ma Y, Zhang F. OUP accepted manuscript. J Antimicrob Chemother 2022; 77:1119-1124. [PMID: 35134966 DOI: 10.1093/jac/dkac016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 12/28/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Zhuoqun Sun
- Peking University Ditan Teaching Hospital, Beijing, China
- Capital Medical University Affiliated Beijing Ditan Hospital, Beijing, China
| | - Yun Lan
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Shujia Liang
- Guangxi Key Laboratory of Major Infectious Disease Prevention and Control and Biosafety Emergency Response, Guangxi Center for Disease Control and Prevention, Nanning, China
| | - Jing Wang
- Chongqing Public Health Medical Center, Chongqing, China
| | - Mingjian Ni
- Xinjiang Center for Disease Control and Prevention, Xinjiang, China
| | - Xia Zhang
- Medical Laboratory Science Department of Weifang Medical College, Shandong, China
| | - Fengting Yu
- Capital Medical University Affiliated Beijing Ditan Hospital, Beijing, China
| | - Meiling Chen
- Capital Medical University Affiliated Beijing Ditan Hospital, Beijing, China
| | - Hanxi Zhang
- Capital Medical University Affiliated Beijing Ditan Hospital, Beijing, China
| | - Liting Yan
- Capital Medical University Affiliated Beijing Ditan Hospital, Beijing, China
| | - Weiping Cai
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Guanghua Lan
- Guangxi Key Laboratory of Major Infectious Disease Prevention and Control and Biosafety Emergency Response, Guangxi Center for Disease Control and Prevention, Nanning, China
| | - Ye Ma
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Fujie Zhang
- Peking University Ditan Teaching Hospital, Beijing, China
- Capital Medical University Affiliated Beijing Ditan Hospital, Beijing, China
| |
Collapse
|
31
|
Abstract
PURPOSE OF REVIEW We reviewed evidence concerning the novel nonnucleoside reverse transcriptase inhibitor doravirine, aiming to identify situations where it may be selected in preference to integrase inhibitors. RECENT FINDINGS Doravirine is licenced for the treatment of HIV-1 in North America and Europe. In two multicentre randomized controlled trials, noninferiority with comparator drugs efavirenz and darunavir/ritonavir was observed at 96 weeks. Doravirine is associated with a lower incidence of neuropsychiatric side effects relative to efavirenz, and favourable lipid changes relative to darunavir over 96 weeks. A lower incidence of weight gain, relative to indirect comparisons with integrase inhibitors, was observed. Doravirine has a high genetic barrier to resistance with retained activity in the presence of single NNRTI mutations K103N, Y181C and G190A. Primary drug resistance is infrequent and may be higher in South Africa relative to European populations. Doravirine may be used in renal or hepatic impairment and has a low potential for drug-drug interactions. SUMMARY Doravirine is a well tolerated and effective agent in ART-naive patients. Direct comparison with integrase inhibitors, and evidence on the outcomes of treatment with doravirine in the presence of prior NNRTI experience are required to better elucidate which patients will benefit most from doravirine therapy.
Collapse
Affiliation(s)
| | - Saye Khoo
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| |
Collapse
|
32
|
|
33
|
Impact of HIV-1 Resistance-Associated Mutations on Susceptibility to Doravirine: Analysis of Real-World Clinical Isolates. Antimicrob Agents Chemother 2021; 65:e0121621. [PMID: 34570651 PMCID: PMC8597775 DOI: 10.1128/aac.01216-21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Clinical management of human immunodeficiency virus type-1 (HIV-1) infection may be negatively impacted by either acquired or transmitted drug resistance. Here, we aim to extend our understanding of the impact of resistance-associated mutations (RAMs) on the susceptibility of clinical isolates to the nonnucleoside reverse transcriptase inhibitor (NNRTI) doravirine. Clinical isolates from people living with HIV-1 undergoing routine testing for susceptibility to doravirine and other approved NNRTIs (etravirine, rilpivirine, efavirenz, and nevirapine) were collected from August 2018 to August 2019. Susceptibility in the presence/absence of NNRTI and nucleos(t)ide reverse transcriptase inhibitor (NRTI) mutations was determined using cutoffs for relative fold change in inhibition (ratio of the 50% inhibitory concentration [IC50] of patient virus compared with the IC50 of a wild-type reference strain). Biological cutoffs of 3- to 15-fold change were investigated for doravirine, with preestablished cutoffs used for the other NNRTIs. Of 4,070 clinical isolates, 42.9% had ≥1 NNRTI RAM. More isolates were susceptible to doravirine (92.5-96.7%) than to etravirine (91.5%), rilpivirine (89.5%), efavirenz (81.5%), or nevirapine (77.5%). Based on a 3-fold cutoff, doravirine susceptibility was retained in 44.7-65.8% of isolates resistant to another NNRTI and 28.5% of isolates resistant to all other tested NNRTIs. The presence of NRTI RAMs, including thymidine analog mutations, was associated with doravirine hypersusceptibility in some isolates, particularly in the absence of NNRTI RAMs. These results support the favorable resistance profile of doravirine and are of particular importance given the challenge posed by both acquired and transmitted resistance.
Collapse
|
34
|
Farinacci D, Ciccullo A, Lombardi F, Moschese D, D’Angelillo A, Iannone V, Lamanna F, Passerotto RA, Giambenedetto SD. Evaluation of doravirine-based regimen population target in a large Italian clinical center. Antivir Ther 2021; 26:79-83. [DOI: 10.1177/13596535211056556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Doravirine (DOR) is a non-nucleoside reverse transcriptase inhibitor (NNRTI) approved for HIV-1 infection treatment. Because of its genetic barrier, DOR appears to be a good alternative in switch strategies compared to other NNRTI. Our aim was to evaluate the percentage of people living with HIV (PLWHIV) followed in our center who could be eligible to a DOR-based regimen. Methods We collected data from all treatment-experienced PLWHIV, never exposed to DOR and with a demonstrated virological suppression. We analyzed previous genotypic analyses, clinical history, and previous exposure to NNRTIs. Results We analyzed data from 653 patients, whose characteristics are shown in Table 1. 59% of them presented no resistance mutation (RAM) at genotypic analysis. The most common DOR-related RAM were V106A, Y181V, and Y188L. We also analyzed RAM that can possibly interfere with combination therapy (mostly K65R and M184V). In the end, 81.8% of our patients results to be eligible for a DOR-based therapy regimen. Conclusions DOR represents a good option for switch strategies in virological suppressed PLWHIV. It seems to have a higher genetic barrier and a lower risk for resistance mutation development compared to other NNRTI. In our cohort, we found 81.8% of patients who could be eligible for a regimen containing DOR and almost 2/3 of patients who can be treated with the fixed-dose combination DOR/3TC/TDF.
Collapse
Affiliation(s)
- Damiano Farinacci
- Istituto Clinica di Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Arturo Ciccullo
- UOC Malattie Infettive, Ospedale S. Salvatore, L’Aquila, Rome, Italy
| | - Francesca Lombardi
- Istituto Clinica di Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Davide Moschese
- UOC Malattie Infettive, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Anna D’Angelillo
- Istituto Clinica di Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Valentina Iannone
- Istituto Clinica di Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Lamanna
- Istituto Clinica di Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Rosa Anna Passerotto
- Istituto Clinica di Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Simona Di Giambenedetto
- Istituto Clinica di Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy
- UOC Malattie Infettive, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| |
Collapse
|
35
|
Scheibe K, Urbańska A, Jakubowski P, Hlebowicz M, Bociąga-Jasik M, Raczyńska A, Szymczak A, Szetela B, Łojewski W, Parczewski M. Low prevalence of doravirine-associated resistance mutations among polish human immunodeficiency-1 (HIV-1)–infected patients. Antivir Ther 2021; 26:69-78. [DOI: 10.1177/13596535211043044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Doravirine (DOR) is a novel non-nucleoside reverse transcriptase inhibitor (NNRTI) that retains activity against common NNRTI resistance mutations. In this study, we aimed to investigate the prevalence of DOR resistance mutations compared with that of resistance mutations for other NNRTIs among HIV-1-infected treatment‐experienced and -naïve patients from Poland. Methods Resistance to DOR and other NNRTIs was assessed in two datasets: 1760 antiretroviral treatment-naïve HIV-1 patients and 200 treatment‐experienced patients. All 1960 sequences were derived from the patients using bulk sequencing. For resistance analyses, Stanford HIV drug resistance database scores were used. Results Overall, DOR resistance was present in 32 patients (1.62%), of whom 13 (0.74%) were naïve and 19 (9.50%) were treatment-experienced. The most common DOR resistance mutations observed among the naïve patients were A98G and K101E (0.2% each), and those among cART-experienced patients were L100I (2.0%), K101E, V108I, H221Y, and P225H (1.5% each). Furthermore, among the naïve patients, less common resistance to DOR (0.7%) compared with that to nevirapine (NVP) (2.1%; p = 0.0013) and rilpivirine (5.40%; p < 0.0001) was observed. For sequences obtained from treatment-experienced patients, the frequency of resistance to DOR (9.5%) was lower than that for efavirenz (25.5%; p < 0.0001) and NVP (26.0%; p < 0.0001). Conclusions The frequency of transmitted drug resistance to DOR is low, allowing for effective treatment of antiretroviral treatment-naïve patients and rapid treatment initiation. In cART-experienced patients, this agent remains an attractive NNRTI option with a higher genetic barrier to resistance.
Collapse
Affiliation(s)
- Kaja Scheibe
- Department of Infectious, Tropical Diseases and Immune Deficiency, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Anna Urbańska
- Department of Infectious, Tropical Diseases and Immune Deficiency, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | | | - Maria Hlebowicz
- Department of Infectious Diseases, Medical University of Gdansk, Gdańsk, Poland
| | - Monika Bociąga-Jasik
- Department of Infectious and Tropical Diseases, Jagiellonian University Medical College, Kraków, Poland
| | - Aleksandra Raczyńska
- Department of Infectious and Tropical Diseases, Jagiellonian University Medical College, Kraków, Poland
| | - Aleksandra Szymczak
- Department of Infectious Diseases, Liver Diseases and Acquired Immune Deficiencies, Wroclaw Medical University, Wrocław, Poland
| | - Bartosz Szetela
- Department of Infectious Diseases, Liver Diseases and Acquired Immune Deficiencies, Wroclaw Medical University, Wrocław, Poland
| | - Władysław Łojewski
- Department of Infectious Diseases, Regional Hospital in Zielona Gora, Zielona Góra, Poland
| | - Miłosz Parczewski
- Department of Infectious, Tropical Diseases and Immune Deficiency, Pomeranian Medical University in Szczecin, Szczecin, Poland
| |
Collapse
|
36
|
Huang B, Ginex T, Luque FJ, Jiang X, Gao P, Zhang J, Kang D, Daelemans D, De Clercq E, Pannecouque C, Zhan P, Liu X. Structure-Based Design and Discovery of Pyridyl-Bearing Fused Bicyclic HIV-1 Inhibitors: Synthesis, Biological Characterization, and Molecular Modeling Studies. J Med Chem 2021; 64:13604-13621. [PMID: 34496571 DOI: 10.1021/acs.jmedchem.1c00987] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Two series of new pyridyl-bearing fused bicyclic analogues designed to target the dual-tolerant regions of the non-nucleoside reverse transcriptase inhibitor (NNRTI)-binding pocket were synthesized and evaluated for their anti-HIV activities. Several compounds, such as 6, 14, 15, 21, 30, and 33, were found to be potent inhibitors against the wild-type (WT) HIV-1 strain or multiple NNRTI-resistant strains at low nanomolar levels. Detailed structure-activity relationships were obtained by utilizing the variation of moieties within the corresponding pharmacophores. In vitro metabolic stability profiles and some drug-like properties of selected compounds were assessed, furnishing the preliminary structure-metabolic stability relationships. Furthermore, molecular modeling studies elucidated the binding modes of compounds 6, 15, 21, and 30 in the binding pocket of WT, E138K, K103N, or Y181C HIV-1 RTs. These promising compounds can be used as lead compounds and warrant further structural optimization to yield more active HIV-1 inhibitors.
Collapse
Affiliation(s)
- Boshi Huang
- Department of Medicinal Chemistry, Key Laboratory of Chemical Biology (Ministry of Education), School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, 44 West Culture Road, 250012 Jinan, Shandong, PR China
| | - Tiziana Ginex
- Department of Nutrition, Food Science and Gastronomy, Faculty of Pharmacy, Campus Torribera, Institute of Biomedicine (IBUB) and Institute of Theoretical and Computational Chemistry (IQTCUB), University of Barcelona, Santa Coloma de Gramenet, 08921 Barcelona, Spain
| | - F Javier Luque
- Department of Nutrition, Food Science and Gastronomy, Faculty of Pharmacy, Campus Torribera, Institute of Biomedicine (IBUB) and Institute of Theoretical and Computational Chemistry (IQTCUB), University of Barcelona, Santa Coloma de Gramenet, 08921 Barcelona, Spain
| | - Xiangyi Jiang
- Department of Medicinal Chemistry, Key Laboratory of Chemical Biology (Ministry of Education), School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, 44 West Culture Road, 250012 Jinan, Shandong, PR China
| | - Ping Gao
- Department of Medicinal Chemistry, Key Laboratory of Chemical Biology (Ministry of Education), School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, 44 West Culture Road, 250012 Jinan, Shandong, PR China
| | - Jian Zhang
- Department of Medicinal Chemistry, Key Laboratory of Chemical Biology (Ministry of Education), School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, 44 West Culture Road, 250012 Jinan, Shandong, PR China
| | - Dongwei Kang
- Department of Medicinal Chemistry, Key Laboratory of Chemical Biology (Ministry of Education), School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, 44 West Culture Road, 250012 Jinan, Shandong, PR China.,China-Belgium Collaborative Research Center for Innovative Antiviral Drugs of Shandong Province, 44 West Culture Road, 250012 Jinan, Shandong, PR China
| | - Dirk Daelemans
- Laboratory of Virology and Chemotherapy, Rega Institute for Medical Research, K.U.Leuven, Herestraat 49 Postbus 1043 (09.A097), B-3000 Leuven, Belgium
| | - Erik De Clercq
- Laboratory of Virology and Chemotherapy, Rega Institute for Medical Research, K.U.Leuven, Herestraat 49 Postbus 1043 (09.A097), B-3000 Leuven, Belgium
| | - Christophe Pannecouque
- Laboratory of Virology and Chemotherapy, Rega Institute for Medical Research, K.U.Leuven, Herestraat 49 Postbus 1043 (09.A097), B-3000 Leuven, Belgium
| | - Peng Zhan
- Department of Medicinal Chemistry, Key Laboratory of Chemical Biology (Ministry of Education), School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, 44 West Culture Road, 250012 Jinan, Shandong, PR China.,China-Belgium Collaborative Research Center for Innovative Antiviral Drugs of Shandong Province, 44 West Culture Road, 250012 Jinan, Shandong, PR China
| | - Xinyong Liu
- Department of Medicinal Chemistry, Key Laboratory of Chemical Biology (Ministry of Education), School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, 44 West Culture Road, 250012 Jinan, Shandong, PR China.,China-Belgium Collaborative Research Center for Innovative Antiviral Drugs of Shandong Province, 44 West Culture Road, 250012 Jinan, Shandong, PR China
| |
Collapse
|
37
|
Tiraboschi J, Scévola S, Dilly Penchala S, Challenger E, Else L, Prieto P, Saumoy M, Imaz A, Silva-Klug A, Niubó J, Soriano I, Khoo S, Rigo-Bonin R, Podzamczer D. Doravirine Achieves Adequate CSF Exposure and is Mostly Unbound to Proteins. Clin Infect Dis 2021; 74:1855-1858. [PMID: 34549268 DOI: 10.1093/cid/ciab835] [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: 06/23/2021] [Indexed: 11/12/2022] Open
Abstract
We determined total and unbound concentrations of Doravirine (DOR) in cerebrospinal fluid (CSF) and blood plasma. Total and unbound DOR concentrations in CSF exceeded the EC50 value against wild-type virus (5.1 ng/mL) in all subjects suggesting that DOR may contribute to inhibit viral replication in this compartment.
Collapse
Affiliation(s)
- Juan Tiraboschi
- HIV and STI Unit. Infectious Disease Service. Hospital Universitari de Bellvitge-IDIBELL. Universitat de Barcelona. L'Hospitalet de Llobregat Barcelona, Spain
| | - Sofia Scévola
- HIV and STI Unit. Infectious Disease Service. Hospital Universitari de Bellvitge-IDIBELL. Universitat de Barcelona. L'Hospitalet de Llobregat Barcelona, Spain
| | - Sujan Dilly Penchala
- Department of Molecular and Clinical Pharmacology. University of Liverpool, Liverpool, UK
| | - Elisabeth Challenger
- Department of Molecular and Clinical Pharmacology. University of Liverpool, Liverpool, UK
| | - Laura Else
- Department of Molecular and Clinical Pharmacology. University of Liverpool, Liverpool, UK
| | - Paula Prieto
- HIV and STI Unit. Infectious Disease Service. Hospital Universitari de Bellvitge-IDIBELL. Universitat de Barcelona. L'Hospitalet de Llobregat Barcelona, Spain
| | - Maria Saumoy
- HIV and STI Unit. Infectious Disease Service. Hospital Universitari de Bellvitge-IDIBELL. Universitat de Barcelona. L'Hospitalet de Llobregat Barcelona, Spain
| | - Arkaitz Imaz
- HIV and STI Unit. Infectious Disease Service. Hospital Universitari de Bellvitge-IDIBELL. Universitat de Barcelona. L'Hospitalet de Llobregat Barcelona, Spain
| | - Ana Silva-Klug
- HIV and STI Unit. Infectious Disease Service. Hospital Universitari de Bellvitge-IDIBELL. Universitat de Barcelona. L'Hospitalet de Llobregat Barcelona, Spain
| | - Jordi Niubó
- Microbiology Service. Hospital Universitari de Bellvitge. L'Hospitalet de Llobregat Barcelona, Spain
| | - Irene Soriano
- HIV and STI Unit. Infectious Disease Service. Hospital Universitari de Bellvitge-IDIBELL. Universitat de Barcelona. L'Hospitalet de Llobregat Barcelona, Spain
| | - Saye Khoo
- Department of Molecular and Clinical Pharmacology. University of Liverpool, Liverpool, UK
| | - Raul Rigo-Bonin
- Pharmacology Service, Bellvitge University Hospital, Barcelona, Spain
| | - Daniel Podzamczer
- HIV and STI Unit. Infectious Disease Service. Hospital Universitari de Bellvitge-IDIBELL. Universitat de Barcelona. L'Hospitalet de Llobregat Barcelona, Spain
| | | |
Collapse
|
38
|
Antela A, Rivero A, Llibre JM, Moreno S. Redefining therapeutic success in HIV patients: an expert view. J Antimicrob Chemother 2021; 76:2501-2518. [PMID: 34077524 PMCID: PMC8446931 DOI: 10.1093/jac/dkab168] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Thanks to advances in the field over the years, HIV/AIDS has now become a manageable chronic condition. Nevertheless, a new set of HIV-associated complications has emerged, related in part to the accelerated ageing observed in people living with HIV/AIDS, the cumulative toxicities from exposure to antiretroviral drugs over decades and emerging comorbidities. As a result, HIV/AIDS can still have a negative impact on patients' quality of life (QoL). In this scenario, it is reasonable to believe that the concept of therapeutic success, traditionally associated with CD4 cell count restoration and HIV RNA plasma viral load suppression and the absence of drug resistances, needs to be redefined to include other factors that reach beyond antiretroviral efficacy. With this in mind, a group of experts initiated and coordinated the RET Project, and this group, using the available evidence and their clinical experience in the field, has proposed new criteria to redefine treatment success in HIV, arranged into five main concepts: rapid initiation, efficacy, simplicity, safety, and QoL. An extensive review of the literature was performed for each category, and results were discussed by a total of 32 clinicians with experience in HIV/AIDS (4 coordinators + 28 additional experts). This article summarizes the conclusions of these experts and presents the most updated overview on the five topics, along with a discussion of the experts' main concerns, conclusions and/or recommendations on the most controversial issues.
Collapse
Affiliation(s)
- Antonio Antela
- Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Antonio Rivero
- Hospital Universitario Reina Sofía, Cordoba, Spain
- Universidad de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba, Córdoba, Spain
| | - Josep M Llibre
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Santiago Moreno
- Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, Madrid, Spain
| |
Collapse
|
39
|
Hagins D, Kumar P, Saag M, Wurapa AK, Brar I, Berger D, Osiyemi O, Hileman CO, Ramgopal MN, McDonald C, Blair C, Andreatta K, Collins SE, Brainard DM, Martin H. Switching to Bictegravir/Emtricitabine/Tenofovir Alafenamide in Black Americans With HIV-1: A Randomized Phase 3b, Multicenter, Open-Label Study. J Acquir Immune Defic Syndr 2021; 88:86-95. [PMID: 34397746 PMCID: PMC8357046 DOI: 10.1097/qai.0000000000002731] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 03/17/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND With the highest rates of HIV/AIDS in the United States, Black Americans are still underrepresented in HIV medical research. SETTING BRAAVE (NCT03631732) is a randomized, phase 3b, multicenter, open-label US study. METHODS Adults identifying as Black or African American and virologically suppressed on 2 nucleoside reverse transcriptase inhibitors (NRTIs) plus third agent were randomized (2:1) to switch to open-label bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) once daily or stay on baseline regimen (SBR) for 24 weeks, after which SBR had delayed switch to B/F/TAF. Resistance to non-NRTIs, protease inhibitors, and/or NRTIs was permitted; integrase strand transfer inhibitor resistance was exclusionary. Primary endpoint was proportion of participants with HIV-1 RNA ≥50 copies/mL at week 24 (snapshot algorithm; noninferiority margin of 6%). RESULTS Of 558 screened, 495 were randomized/treated (B/F/TAF n = 330; SBR n = 165). Overall, 32% were ciswomen, 2% transwomen, and 10% had an M184V/I mutation. At week 24, 0.6% on B/F/TAF vs 1.8% on SBR had HIV-1 RNA ≥50 copies/mL (difference -1.2%; 95% confidence interval -4.8% to 0.9%), demonstrating noninferiority of B/F/TAF vs SBR. Proportions with HIV-1 RNA <50 copies/mL at week 24 were 96% B/F/TAF and 95% SBR and remained high at week 48. No participant had treatment-emergent resistance to study drug. Treatments were well tolerated. Study drug-related adverse events, mostly grade 1, occurred in 10% of participants on B/F/TAF through week 48 and led to discontinuation in 9 participants through week 48. CONCLUSIONS For Black Americans with HIV, switching to B/F/TAF was noninferior to continuing a variety of regimens, including those with pre-existing NRTI mutations.
Collapse
Affiliation(s)
| | - Princy Kumar
- Department of Medicine, Georgetown University, Washington, DC
| | - Michael Saag
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | | | - Indira Brar
- Department of Medicine, Henry Ford Hospital, Detroit, MI
| | | | | | | | | | - Cheryl McDonald
- Tarrant County Infectious Disease Associates, Fort Worth, TX; and
| | | | | | | | | | | |
Collapse
|
40
|
Shin YH, Park CM, Yoon CH. An Overview of Human Immunodeficiency Virus-1 Antiretroviral Drugs: General Principles and Current Status. Infect Chemother 2021; 53:29-45. [PMID: 34409780 PMCID: PMC8032919 DOI: 10.3947/ic.2020.0100] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 02/22/2021] [Indexed: 12/11/2022] Open
Abstract
Treatment with highly active antiretroviral therapy (HAART) can prolong a patient's life-span by disrupting pivotal steps in the replication cycle of the human immunodeficiency virus-1 (HIV-1). However, drug resistance is emerging as a major problem worldwide due to the prolonged period of treatment undergone by HIV-1 patients. Since the approval of zidovudine in 1987, over thirty antiretroviral drugs have been categorized into the following six distinct classes based on their biological function and resistance profiles: (1) nucleoside analog reverse-transcriptase inhibitors; (2) non–nucleoside reverse transcriptase inhibitors; (3) integrase strand transferase inhibitors; (4) protease inhibitors; (5) fusion inhibitors; and (6) co-receptor antagonists. Additionally, several antiretroviral drugs have been developed recently, such as a long active drug, humanized antibody and pro-drug metabolized into an active form in the patient's body. Although plenty of antiretroviral drugs are beneficially used to treat patients with HIV-1, the ongoing efforts to develop antiretroviral drugs have overcome the drug resistances, adverse effects, and limited adherence of drugs observed in previous drugs to some extent. Furthermore, studies focused on agents targeting latent HIV-1 reservoirs should be strengthened, as that may lead to eradication of HIV-1.
Collapse
Affiliation(s)
- Young Hyun Shin
- Division of Chronic Viral Disease Research, Center for Emerging Virus Research, Korea National Institute of Health, Chungbuk, Korea
| | - Chul Min Park
- Center for Convergent Research of Emerging Virus Infection, Korea Research Institute of Chemical Technology, Daejeon, Korea
| | - Cheol Hee Yoon
- Division of Chronic Viral Disease Research, Center for Emerging Virus Research, Korea National Institute of Health, Chungbuk, Korea.
| |
Collapse
|
41
|
Orkin C, Squires KE, Molina JM, Sax PE, Sussmann O, Lin G, Kumar S, Hanna GJ, Hwang C, Martin E, Teppler H. Doravirine/Lamivudine/Tenofovir Disoproxil Fumarate (TDF) Versus Efavirenz/Emtricitabine/TDF in Treatment-naive Adults With Human Immunodeficiency Virus Type 1 Infection: Week 96 Results of the Randomized, Double-blind, Phase 3 DRIVE-AHEAD Noninferiority Trial. Clin Infect Dis 2021; 73:33-42. [PMID: 33336698 PMCID: PMC8246893 DOI: 10.1093/cid/ciaa822] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Indexed: 01/12/2023] Open
Abstract
Background Doravirine (DOR) is a nonnucleoside reverse-transcriptase inhibitor. In the phase 3 DRIVE-AHEAD trial in treatment-naive adults with human immunodeficiency virus type 1 (HIV-1) infection, DOR demonstrated noninferior efficacy compared with efavirenz (EFV) and superior profiles for neuropsychiatric tolerability and lipids at 48 weeks. We present data through week 96. Methods DRIVE-AHEAD is a phase 3, multicenter, double-blind, noninferiority trial in antiretroviral treatment-naive adults with HIV-1 RNA ≥1000 copies/mL. Participants were randomized to a daily fixed-dose tablet of DOR (100 mg), lamivudine (3TC; 300 mg) and tenofovir disoproxil fumarate (TDF; 300 mg) (DOR/3TC/TDF) or EFV (600 mg), emtricitabine (FTC; 200 mg) and TDF (300 mg) (EFV/FTC/TDF). The efficacy end point of interest at week 96 was the proportion of participants with HIV-1 RNA levels <50 copies/mL (Food and Drug Administration Snapshot Approach) with a predefined noninferiority margin of 10% to support week 48 results. Safety end points of interest included prespecified neuropsychiatric adverse events and the mean change in fasting lipids at week 96. Results Of 734 participants randomized, 728 received study drugs and were included in analyses. At week 96, HIV-1 RNA <50 copies/mL was achieved by 77.5% of DOR/3TC/TDF vs 73.6% of EFV/FTC/TDF participants, with a treatment difference of 3.8% (95% confidence interval, –2.4% to 10%). Virologic failure rates were low and similar across treatment arms, with no additional resistance to DOR observed between weeks 48 and 96. Prespecified neuropsychiatric adverse events and rash were less frequent in DOR/3TC/TDF than in EFV/FTC/TDF participants through week 96. At week 96, fasting low-density lipoprotein cholesterol and non–high-density lipoprotein cholesterol (HDL-C) levels increased in the EFV/FTC/TDF group but not in the DOR/3TC/TDF group; the mean changes from baseline in total cholesterol/HDL-C ratio were similar. Clinical Trials Registration NCT02403674.
Collapse
Affiliation(s)
- Chloe Orkin
- Queen Mary University of London, London, United Kingdom
| | - Kathleen E Squires
- Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Merck & Co., Inc., Kenilworth, New Jersey, USA
| | - Jean-Michel Molina
- University of Paris Diderot, Hôpital Saint-Louis, Assistance Publique Hôpitaux de Paris, INSERM, Paris, France
| | - Paul E Sax
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Otto Sussmann
- Asistencia Cientifica de Alta Complejidad SAS, Bogota, Colombia
| | - Gina Lin
- Merck & Co., Inc., Kenilworth, New Jersey, USA
| | | | | | - Carey Hwang
- Merck & Co., Inc., Kenilworth, New Jersey, USA
| | | | | |
Collapse
|
42
|
Matthews RP, Jackson Rudd D, Fillgrove KL, Zhang S, Tomek C, Stoch SA, Iwamoto M. A Phase 1 Study to Evaluate the Drug Interaction Between Islatravir (MK-8591) and Doravirine in Adults Without HIV. Clin Drug Investig 2021; 41:629-638. [PMID: 34151413 PMCID: PMC8245385 DOI: 10.1007/s40261-021-01046-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND OBJECTIVES Islatravir (MK-8591) is a novel nucleoside analogue in development for the treatment and prevention of HIV-1 infection. Doravirine is a non-nucleoside reverse transcriptase inhibitor indicated for the treatment of HIV-1 infection. This study evaluated the pharmacokinetics, safety, and tolerability of islatravir and doravirine coadministration in a double-blind, placebo-controlled, randomized, fixed-sequence study. METHODS Adult participants without HIV infection were administered oral doravirine 100 mg (n = 10) or placebo (n = 4) once daily (QD) for 5 days, immediately followed by oral islatravir 2.25 mg (n = 10) or placebo QD (n = 4) for 14 days; islatravir 2.25 mg and doravirine 100 mg QD, or placebo QD, were then coadministered for 5 days. Pharmacokinetic and safety data were collected. RESULTS Doravirine geometric least-squares mean ratios (90% confidence intervals (CIs)) of (doravirine + islatravir)/doravirine for the area under the plasma drug concentration-time curve over 24 h (AUC0-24h), maximum plasma concentration (Cmax), and plasma concentration at 24 h post-dose (C24h) were not meaningfully impacted. Islatravir geometric least-squares mean ratios (90% CI) of (islatravir + doravirine)/islatravir for AUC0-24h and Cmax were both close to unity, 1.06 (1.01, 1.12) and 1.08 (0.91, 1.27), respectively. All study regimens were generally well tolerated. CONCLUSION These results indicate that coadministration of islatravir and doravirine had no clinically meaningful effect on the pharmacokinetics of either drug, and support further clinical investigation of islatravir in combination with doravirine for the treatment of HIV-1 infection.
Collapse
|
43
|
Guerrero-Beltrán C, Martínez-Sanz J, Álvarez M, Olalla J, García-Álvarez M, Iribarren JA, Masiá M, Montero M, García-Bujalance S, Blanco JR, Rivero M, García-Fraile LJ, Espinosa N, Rodríguez C, Aguilera A, Vidal-Ampurdanes MC, Martínez M, Iborra A, Imaz A, Gómez-Sirvent JL, Peraire J, Portilla J, Caballero E, Alejos B, García F, Moreno S. The algorithm used for the interpretation of doravirine transmitted drug resistance strongly influences clinical practice and guideline recommendations. J Antimicrob Chemother 2021; 75:1294-1300. [PMID: 32030406 DOI: 10.1093/jac/dkaa009] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 12/31/2019] [Accepted: 01/05/2020] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES We report the results of the reverse transcriptase (RT)/protease (PR) transmitted drug resistance (TDR) prevalence study in 2018, focusing on doravirine resistance-associated mutations and the differences observed when Stanford or French National Agency for AIDS Research (ANRS)/Spanish Network of AIDS Research (RIS)/IAS-USA resistance interpretation algorithms are used to describe clinically relevant resistance. METHODS We used the WHO 2009 list to investigate the prevalence of NNRTI, NRTI and PI TDR, in treatment-naive HIV-1-infected patients, adding mutations E138A/G/K/Q/R, V106I, V108I, V179L, G190Q, H221Y, F227C/L/V, M230IDR, L234I, P236L and Y318F in RT. The prevalence of doravirine resistance-associated mutations, as described by Soulie et al. in 2019, was evaluated. Clinically relevant TDR was investigated using the latest versions of ANRS, RIS, IAS-USA and Stanford algorithms. RESULTS NNRTI mutations were detected in 82 of 606 (13.5%) patients. We found 18 patients (3.0%) with NRTI mutations and 5 patients (0.8%) with PI mutations. We detected 11 patients harbouring doravirine resistance-associated mutations (prevalence of 1.8%). Furthermore, we observed important differences in clinically relevant resistance to doravirine when ANRS/RIS (0.7%), IAS-USA (0.5%) or Stanford algorithms (5.0%) were used. V106I, which was detected in 3.8% of the patients, was the main mutation driving these differences. V106I detection was not associated with any of the clinical, demographic or virological characteristics of the patients. CONCLUSIONS The prevalence of NRTI and PI TDR remains constant in Spain. Doravirine TDR is very infrequent by RIS/ANRS/IAS-USA algorithms, in contrast with results using the Stanford algorithm. Further genotype-phenotype studies are necessary to elucidate the role of V106I in doravirine resistance.
Collapse
Affiliation(s)
- Carlos Guerrero-Beltrán
- Hospital Universitario San Cecilio, Instituto de Investigación Biosanitaria Ibs, Granada, Spain
| | | | - Marta Álvarez
- Hospital Universitario San Cecilio, Instituto de Investigación Biosanitaria Ibs, Granada, Spain
| | | | | | | | - Mar Masiá
- Hospital General Universitario de Elche, Universidad Miguel Hernández, Elche, Spain
| | | | | | | | | | | | | | | | - Antonio Aguilera
- Complexo Hospitalario Santiago Compostela, Universidad de Santiago de Compostela, Santiago de Compostela, Spain
| | | | | | | | - Arkaitz Imaz
- Hospital Universitario de Bellvitge, Barcelona, Spain
| | | | - Joaquim Peraire
- Hospital Universitari de Tarragona Joan XXIII, IISPV, Universitat Rovira i Virgili, Tarragona, Spain
| | | | | | | | - Federico García
- Hospital Universitario San Cecilio, Instituto de Investigación Biosanitaria Ibs, Granada, Spain
| | | | | |
Collapse
|
44
|
Ciccullo A, Baldin G, Putaggio C, Di Giambenedetto S, Borghetti A. Comparative safety review of recommended, first-line single-tablet regimens in patients with HIV. Expert Opin Drug Saf 2021; 20:1317-1332. [PMID: 34018892 DOI: 10.1080/14740338.2021.1931115] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction Different single-tablet regimens (STRs), containing one or two nucleoside reverse transcriptase inhibitors (NRTIs) plus an anchor drug, are available for the use in naïve, HIV-infected patients. Despite some restrictions in the use of particular regimens in certain situations (e.g., HBV coinfection), International guidelines do not provide indications to prefer any regimen over others concerning the tolerability profile. We aimed to assess advantages and disadvantages of the most prescribed STRs.Areas covered An extensive review of articles published in English language was conducted on PubMed, looking for evidence about STRs in naïve, HIV-infected population. Safety outcomes of registrational trials were assessed, giving priority to studies directly comparing STRs included in our research (abacavir/lamivudine/dolutegravir, tenofovir alafenamide/emtricitabine/bictegravir, lamivudine/dolutegravir, tenofovir alafenamide/emtricitabine/darunavir/cobicistat, tenovofir disoproxil fumarate/lamivudine/doravirine). Data from cohort studies and meta-analyses were also assessed, extrapolating the main evidence about the combinations of interest.Expert opinion Integrase inhibitors (InsTIs)-based regimens have few interruptions for adverse events and few drug-related adverse events, with tenofovir alafenamide/emtricitabine/dolutegravir and lamivudine/dolutegravir being the most tolerable ones. However, neuropsychiatric adverse events and metabolic issues could prompt the alternative use of darunavir or doravirine-based combinations, even if a superior safety profile of these combinations over InSTIs has yet to be demonstrated.
Collapse
Affiliation(s)
| | - Gianmaria Baldin
- Mater Olbia Hospital, Olbia, Italia.,UOC Malattie Infettive, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italia
| | - Cristina Putaggio
- Dipartimento di Sicurezza e Bioetica Sezione Malattie Infettive, Università Cattolica Del Sacro Cuore, Roma, Italy
| | - Simona Di Giambenedetto
- UOC Malattie Infettive, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italia.,Dipartimento di Sicurezza e Bioetica Sezione Malattie Infettive, Università Cattolica Del Sacro Cuore, Roma, Italy
| | - Alberto Borghetti
- UOC Malattie Infettive, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italia
| |
Collapse
|
45
|
Molina JM, Yazdanpanah Y, Afani Saud A, Bettacchi C, Chahin Anania C, DeJesus E, Olsen Klopfer S, Grandhi A, Eves K, Robertson MN, Correll T, Hwang C, Hanna GJ, Sklar P. Islatravir in combination with doravirine for treatment-naive adults with HIV-1 infection receiving initial treatment with islatravir, doravirine, and lamivudine: a phase 2b, randomised, double-blind, dose-ranging trial. Lancet HIV 2021; 8:e324-e333. [PMID: 34000227 DOI: 10.1016/s2352-3018(21)00021-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Islatravir is a nucleoside reverse transcriptase translocation inhibitor in development for the treatment and prevention of HIV-1 infection. We aimed to assess the efficacy and safety of islatravir-based regimens for the treatment of HIV-1. METHODS We did a phase 2b, randomised, double-blind, comparator-controlled, dose-ranging trial at 24 clinics or hospitals in four countries (Chile, France, the UK, and the USA). Treatment-naive adults (≥18 years) with plasma HIV-1 RNA concentrations of at least 1000 copies per mL, CD4 T-cell counts of at least 200 cells per mL, and a calculated creatinine clearance of at least 50 mL/min (all within 60 days before study treatment) were eligible for inclusion. Participants were randomly assigned (1:1:1:1) with a block size of four via an interactive voice and web response system to receive oral treatment with one of three doses of islatravir (0·25 mg, 0·75 mg, or 2·25 mg) plus doravirine (100 mg) and lamivudine (300 mg) or to doravirine (100 mg) plus lamivudine (300 mg) plus tenofovir disoproxil fumarate (TDF; 300 mg) once daily with placebo (part 1). Treatment groups were stratified according to screening HIV-1 RNA concentration (≤100 000 copies per mL or >100 000 copies per mL). After at least 24 weeks of treatment, participants taking islatravir who achieved an HIV-1 RNA concentration lower than 50 copies per mL switched to a two-drug regimen of islatravir and doravirine (part 2). All participants and study investigators were masked to treatment in part 1; in part 2, the islatravir dose was masked to all participants and investigators, but the other drugs were given open label. The primary efficacy outcomes were the proportions of participants with an HIV-1 RNA concentration lower than 50 copies per mL at weeks 24 and 48 (US Food and Drug Administration snapshot approach). The primary safety outcomes were the number of participants experiencing adverse events and the number of participants discontinuing study drug owing to adverse events. All participants who received at least one dose of any study drug were included in the analyses. This trial is ongoing, but closed to enrolment of new participants; herein, we report study findings through 48 weeks of treatment. This trial is registered with ClinicalTrials.gov, NCT03272347. FINDINGS Between Nov 27, 2017, and April 25, 2019, 121 participants (mean age 31 years [SD 10·9], 112 [93%] male, 92 [76%] white, 27 [22%] with HIV-1 RNA concentration >100 000 copies per mL) were randomly assigned: 29 to the 0·25 mg, 30 to the 0·75 mg, and 31 to the 2·25 mg islatravir groups, and 31 to the doravirine, lamivudine, and TDF group. At week 24, 26 (90%) of 29 participants in the 0·25 mg islatravir group, 30 (100%) of 30 in the 0·75 mg islatravir group, and 27 (87%) of 31 in the 2·25 mg islatravir group achieved HIV-1 RNA concentrations lower than 50 copies per mL compared with 27 (87%) of 31 in the doravirine plus lamivudine plus TDF group (difference 2·8%, 95% CI -14·9 to 20·4, for the 0·25 mg islatravir group; 12·9%, -1·6 to 27·5, for the 0·75 mg islatravir group; and 0·3%, -17·9 to 18·5, for the 2·25 mg islatravir group). At week 48, these data were 26 (90%) of 29 in the 0·25 mg islatravir group, 27 (90%) of 30 in the 0·75 mg islatravir group, and 24 (77%) of 31 in the 2·25 mg islatravir group compared with 26 (84%) of 31 in the doravirine plus lamivudine plus TDF group (difference 6·1%, 95% CI -12·4 to 24·4, for the 0·25 mg islatravir group; 6·2%, -12·2 to 24·6, for the 0·75 mg islatravir group; and -6·1%, -27·1 to 14·8, for the 2·75 mg islatravir group). 66 (73%) of participants in the islatravir groups combined and 24 (77%) of those in the doravirine plus lamivudine plus TDF group reported at least one adverse event. Two participants in the 2·25 mg islatravir group and one participant in the doravirine plus lamivudine plus TDF group discontinued owing to an adverse event. No deaths were reported up to week 48. INTERPRETATION Treatment regimens containing islatravir and doravirine showed antiviral efficacy and were well tolerated regardless of dose. Doravirine in combination with islatravir has the potential to be a potent two-drug regimen that warrants further clinical development. FUNDING Merck, Sharp, & Dohme Corp, a subsidiary of Merck & Co., Inc.
Collapse
Affiliation(s)
- Jean-Michel Molina
- Department of Infectious Diseases, St-Louis and Lariboisière Hospitals, APHP, University of Paris, Inserm U944, Paris, France
| | - Yazdan Yazdanpanah
- Infectious Diseases Department, Bichat Claude Barnard Hospital, APHP, University of Paris, Inserm U1137, Paris, France
| | | | | | - Carolina Chahin Anania
- Department of Infectious Diseases, Hospital Hernán Henríquez Aravena of Temuco, Temuco, Chile
| | - Edwin DeJesus
- Department of Infectious Diseases, Orlando Immunology Center, Orlando, FL, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Steegen K, Moorhouse M, Wensing AMJ, Venter WDF, Hans L. Is there a role for doravirine in African HIV treatment programmes? A large observational resistance study in South Africa. J Int AIDS Soc 2021; 24:e25706. [PMID: 33943000 PMCID: PMC8094661 DOI: 10.1002/jia2.25706] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 03/05/2021] [Accepted: 03/17/2021] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Dolutegravir has replaced efavirenz in most low- and middle-income countries, due to better tolerability and formidable resistance profile, but dolutegravir side effects suggest alternatives are needed. We evaluated doravirine resistance in South Africa as a first step to assess whether doravirine may replace dolutegravir. METHODS A retrospective dataset was analysed for predicted doravirine susceptibility, including sequences obtained from three patient groups. First, data from 277 patients initiating antiretroviral treatment (ART) were collected between February 2013 and October 2014 as part of a national survey. Second, data from 788 patients experiencing NNRTI-based ART failure were obtained between February 2013 and October 2014 as part of a national survey. Third, data derived from 584 patients who had genotypic drug resistance testing requested after NNRT-based failure as part of individual patient management between January 2016 and December 2019. Pol sequences were generated using validated population-based in-house genotyping and submitted to Stanford HIVdb v8.9. RESULTS AND DISCUSSION Less than 5% of patients initiating ART presented with genotypic doravirine resistance, whereas most patients experiencing NNRTI-based ART failure presented with predicted intermediate (41.0%) or high-level resistance (43.8%) to doravirine. High-level resistance to doravirine was commonly predicted by the presence of at least three DRMs (79.7%). The predicted resistance profile to doravirine in ART-naïve patients is promising, but less so in those experiencing failure to first-generation NNRTIs. Accumulation of NNRTI DRMs seems to be an important factor in the poor resistance prediction for doravirine. CONCLUSIONS Although doravirine is approved as initial therapy in patients who are ART-naïve, it is currently recommended to obtain a genotype prior to the initiation of ART. Clinical studies are needed to ascertain whether predicted resistance profiles in ART naïve and NNRTI-treated patients translate into poor clinical outcomes, especially in settings where genotypic resistance testing is not available.
Collapse
Affiliation(s)
- Kim Steegen
- Department of Molecular Medicine and HaematologyNational Health Laboratory ServicesJohannesburgSouth Africa
- Department of Molecular Medicine and HaematologyUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Michelle Moorhouse
- Ezintsha, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
- Global Medical AffairsViiV HealthCareJohannesburgSouth Africa
| | - Annemarie MJ Wensing
- Ezintsha, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
- Translational VirologyDepartment of Medical MicrobiologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Willem DF Venter
- Ezintsha, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Lucia Hans
- Department of Molecular Medicine and HaematologyNational Health Laboratory ServicesJohannesburgSouth Africa
- Department of Molecular Medicine and HaematologyUniversity of the WitwatersrandJohannesburgSouth Africa
| |
Collapse
|
47
|
Review of Doravirine Resistance Patterns Identified in Participants During Clinical Development. J Acquir Immune Defic Syndr 2021; 85:635-642. [PMID: 32925358 PMCID: PMC7655028 DOI: 10.1097/qai.0000000000002496] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background: Doravirine (DOR) is a novel non-nucleoside reverse transcriptase inhibitor (NNRTI) approved for the treatment of HIV-1 infection in patients with no known DOR resistance-associated mutations. DOR was rationally designed to address limitations associated with other approved NNRTIs, particularly resistance from common NNRTI resistance-associated mutants containing K103N, Y181C, or G190A reverse transcriptase substitutions. Setting: Data to date from both in vitro studies and clinical trials have been compiled to summarize the resistance profile of DOR. Methods: We analyzed data from in vitro studies and phase 2 and 3 trials to assess the emergence of resistance-associated mutations and their impact on efficacy among participants treated with DOR. Results: DOR exhibited a distinct resistance profile compared with efavirenz and rilpivirine in vitro and in vivo; mutant viruses that were resistant to DOR showed limited cross-resistance to efavirenz and rilpivirine. In clinical trials, the development of DOR resistance-associated substitutions in reverse transcriptase was uncommon. Conclusion: Overall, minimal cross-resistance across NNRTIs was observed for DOR and limited development of DOR-related resistance. These data should assist clinicians in further understanding the resistance profile of DOR, so appropriate treatment decisions can be made for their patients.
Collapse
|
48
|
Nelson M, Winston A, Hill A, Mngqibisa R, Bassa A, Orkin C, Rassool M, Rodgers A, Teal V, Kumar S, Teppler H. Efficacy, safety and central nervous system effects after switch from efavirenz/tenofovir/emtricitabine to doravirine/tenofovir/lamivudine. AIDS 2021; 35:759-767. [PMID: 33587439 DOI: 10.1097/qad.0000000000002804] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Doravirine is an alternative treatment option for individuals who do not tolerate efavirenz. We assessed efficacy, safety, and CNS effects in adults with HIV-1 and CNS complaints who switched from an efavirenz-based regimen to a doravirine-based regimen. DESIGN Multicenter, double-blind, randomized trial (NCT02652260). METHODS Virologically suppressed adults receiving efavirenz/emtricitabine/tenofovir (EFV/FTC/TDF), or its components, with ongoing EFV-associated CNS toxicity grade 2 or higher (DAIDS criteria) were switched to doravirine/lamivudine/tenofovir (DOR/3TC/TDF) on day 1 (Immediate Switch Group [ISG]) or after 12 weeks (Deferred Switch Group [DSG]). CNS toxicity data were collected by self-administered questionnaire. The primary endpoint was the proportion of participants with any grade 2 or higher CNS toxicity at week 12. Secondary endpoints included virologic response and effect on fasting lipids. RESULTS Eighty-six participants (58% men, 56% black, median age 41 years, median 4 years on prior EFV regimen) were enrolled (43 ISG, 43 DSG) and included in the analyses. At week 12, 42% of ISG and 37% of DSG had at least 1 grade 2 or higher CNS toxicity [difference 4.7%, 95% CI (-16 to 25%); P = 0.33]. At 24 weeks postswitch, HIV-1 RNA less than 50 copies/ml was maintained in 95.3% of participants, and fasting lipids were significantly decreased (LDL-cholesterol -11.0, non-HDL-cholesterol -13.2, HDL-cholesterol -7.7, total cholesterol -20.9, and triglycerides -13.0 mg/dl). CONCLUSION In participants who had CNS complaints while receiving EFV/FTC/TDF, improvement in CNS toxicities attributable to EFV was not significantly different after switching to DOR/3TC/TDF compared with remaining on EFV/FTC/TDF. Virologic efficacy was maintained and lipid profiles improved after switching to DOR/3TC/TDF.
Collapse
Affiliation(s)
- Mark Nelson
- Department of HIV Medicine, Chelsea and Westminster Hospital NHS Foundation Trust
- Imperial College London, London
| | | | - Andrew Hill
- Department of Translational Medicine, University of Liverpool, Liverpool, UK
| | | | - Ayesha Bassa
- Mzansi Ethical Research Centre, Middleburg, South Africa
| | | | - Mohammed Rassool
- University of Witwatersrand, Clinical HIV Research Unit, Helen Joseph Hospital, Johannesburg, South Africa
| | | | | | | | | |
Collapse
|
49
|
Waters L, Mehta V, Gogtay J, Boffito M. The evidence for using tenofovir disoproxil fumarate plus lamivudine as a nucleoside analogue backbone for the treatment of HIV. J Virus Erad 2021; 7:100028. [PMID: 33598310 PMCID: PMC7868802 DOI: 10.1016/j.jve.2021.100028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 01/07/2021] [Accepted: 01/15/2021] [Indexed: 11/29/2022] Open
Abstract
This article evaluates the evidence supporting use of the tenofovir disoproxil fumarate (TDF) plus lamivudine (3 TC) combination as a dual nucleoside backbone within a triple drug antiretroviral regimen. Key trials that assess the relative efficacy, safety and resistance profile of 3 TC and emtricitabine (FTC) are discussed. Clinical use of 3 TC and FTC with two tenofovir prodrugs -TDF and tenofovir alafenamide (TAF) - is presented. Recommendations from various international guidelines for the construction of triple and emerging dual regimens are summarised. In conclusion, data suggest the therapeutic equivalence of 3 TC and FTC, especially when 3 TC is combined with TDF.
Collapse
Affiliation(s)
- Laura Waters
- Central and North West London NHS Trust, Mortimer Market Centre, London, UK
| | - Viraj Mehta
- Medical Affairs Department, Cipla Ltd, India
| | | | - Marta Boffito
- Chelsea and Westminster Hospital, London, UK
- Imperial College London, London, UK
| |
Collapse
|
50
|
Afify MA, Ahmed IGG, Alkahtani TA, Altulayhi RI, Alrowili ASM, Ghozy S, Bin-Jumah M, Abdel-Daim MM. Efficacy and safety of doravirine in treatment-naive HIV-1-infected adults: a systematic review and meta-analysis. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:10576-10588. [PMID: 33098001 DOI: 10.1007/s11356-020-11267-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 10/14/2020] [Indexed: 06/11/2023]
Abstract
This research aims to study the safety and efficacy of doravirine in the treatment of HIV-1 (human immunodeficiency virus) patients. We conducted an electronic search in eight databases for the inclusion of eligible studies. We have only included randomized controlled trials (RCTs) that study the safety and efficacy of doravirine in the treatment of HIV-1 adult patients. Six papers were included in this meta-analysis. For network (direct and indirect) estimates, the doravirine 100 mg treatment strategy found to have the highest efficacy (P score = 0.786) followed by doravirine 25 mg (P score = 0.684), efavirenz 600 mg (P score = 0.574), doravirine 200 mg (P score = 0.532), 100 mg ritonavir and plus 800 mg darunavir (P score = 0.416), and placebo (P score = 0.009), respectively. Regarding drug-related AE, the placebo group found to have the highest safety profile with the least AE rates (P score = 0.927) followed by doravirine 100 mg (P score = 0.720), 100 mg ritonavir and plus 800 mg darunavir (P score = 0.717), doravirine 25 mg (P score = 0.336), doravirine 200 mg (P score = 0.258), and efavirenz 600 mg (P score = 0.043), respectively. Nevertheless, there was no significant difference between DOR 100 mg in comparison with 100 mg ritonavir and plus 800 mg darunavir (OR = 1.14; 95% CI = 0.23-5.74), DOR 25 mg (OR = 0.37; 95% CI = 0.06-2.34), DOR 200 mg (OR = 0.89; 95% CI = 0.17-4.59), or efavirenz 600 mg (OR = 0.58; 95% CI = 0.17-1.98). Moreover, the pairwise (direct only) comparisons did not show a significant difference between doravirine (all doses) and other treatment groups. Doravirine could be counted as an efficacious, safe, and well-tolerated treatment option that is preferable to other regimens for the initial therapy of individuals with HIV-1 infection.
Collapse
Affiliation(s)
| | | | | | | | | | - Sherief Ghozy
- Faculty of Medicine, Mansoura University, Mansoura, Egypt.
| | - May Bin-Jumah
- Biology Department, College of Science, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Mohamed M Abdel-Daim
- Department of Zoology, Science College, King Saud University, Riyadh, 11451, Saudi Arabia.
- Pharmacology Department, Faculty of Veterinary Medicine, Suez Canal University, Ismailia, 41522, Egypt.
| |
Collapse
|