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Bacic Lima D, Solomon DA. Switching Human Immunodeficiency Virus Therapy: Basic Principles and Options. Infect Dis Clin North Am 2024; 38:409-422. [PMID: 38871570 DOI: 10.1016/j.idc.2024.04.002] [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: 06/15/2024]
Abstract
The number of options for effective antiretroviral therapy (ART) is steadily increasing. Although older regimens may achieve the goal of virologic suppression, newer options can offer advantages in safety, tolerability, and convenience. In this article, we offer guiding principles for switching ART, highlighting reasons to pursue a switch and key factors to consider when selecting a new regimen.
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Affiliation(s)
- Danilo Bacic Lima
- Massachusetts General Hospital and Brigham & Women's Hospital; Infectious Diseases Division, Brigham and Women's Hospital, 75 Francis Street, PBB-A4, Boston, MA 02115, USA. https://twitter.com/danbacic
| | - Daniel A Solomon
- Infectious Diseases Division, Brigham and Women's Hospital, 75 Francis Street, PBB-A4, Boston, MA 02115, USA; Harvard Medical School.
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Bailin SS, Koethe JR. Weight Gain and Antiretroviral Therapy. Infect Dis Clin North Am 2024; 38:499-515. [PMID: 38871568 PMCID: PMC11305935 DOI: 10.1016/j.idc.2024.04.005] [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] [Indexed: 06/15/2024]
Abstract
Antiretroviral therapy (ART) agents as a determinant of body weight in ART-naïve and ART-experienced persons with human immunodeficiency virus (HIV) (PWH) has become a major focus area in research and clinical settings. Recent studies demonstrating weight-suppressing properties of efavirenz and tenofovir disoproxil fumarate led to re-evaluation of weight gain studies, and a reassessment of whether other agents are weight promoting versus weight neutral. In this review, the authors synthesize recent literature on factors related to obesity, clinical measurements of adiposity, weight gain in ART-naïve and ART-experienced PWH, metabolic consequences of ART and weight gain, and the clinical management of weight gain in PWH.
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Affiliation(s)
- Samuel S Bailin
- Division of Infectious Diseases, Vanderbilt University Medical Center, 1161 21st Avenue South, A2200 Medical Center North, Nashville, TN 37232, USA.
| | - John R Koethe
- Division of Infectious Diseases, Vanderbilt University Medical Center, 1161 21st Avenue South, A2200 Medical Center North, Nashville, TN 37232, USA
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Saborido-Alconchel A, Serna-Gallego A, Trujillo-Rodriguez M, Muñoz-Muela E, Álvarez-Ríos AI, Lozano C, Llaves-Flores S, Espinosa N, Roca-Oporto C, Herrero M, Sotomayor C, Gutierrez-Valencia A, Lopez-Cortes LF. Long-term effects on immunological, inflammatory markers, and HIV-1 reservoir after switching to a two-drug versus maintaining a three-drug regimen based on integrase inhibitors. Front Immunol 2024; 15:1423734. [PMID: 39055703 PMCID: PMC11269217 DOI: 10.3389/fimmu.2024.1423734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 06/24/2024] [Indexed: 07/27/2024] Open
Abstract
Objective To compare the long-term effects on immune parameters, inflammation, and HIV-1 reservoir after switching to a two-drug (2DR) versus maintaining an integrase inhibitor (InSTI)-based three-drug regimen (3DR). Methods Cross-sectional study in which HIV-1 treatment-naïve people started and maintained an InSTI-based 3DR or, at different times, switched to 2DR (dolutegravir or darunavir/cobicistat + lamivudine). CD4+ and CD8+ T-cell activation and exhaustion, plasma concentrations of hs-CRP, D-dimer, P-selectin, IL-1β, IL-6, TNF-α, IFN-γ, IP-10, sTNFR-I/II, MIP-1α/β, I-FABP, LBP, sCD14, sCD163, MCP-1, and cellular-associated HIV-1-DNA and -RNA were quantified by flow cytometry, different immunoassays, and droplet digital PCR, respectively. The U de Mann-Whitney test evaluated differences between 3DR and 2DR. Immune recovery was evaluated using a general linear model for repeated measures adjusted for different co-variables. Results Fifty participants per group were included. The median time on 3DR was 82 months for the 3DR group and 30 months for the 2DR group, after which it switched to 2DR for a median of 57 months. We did not find differences between both groups in any of the parameters analyzed. Specifically, some values in 3DR and 2DR were hs-CRP, 0.92 mg/L (0.45-2.23) vs. 1.23 (0.61-2.38); D-dimer, 190.0 µg/L (150.0-370.0) vs. 190.0 (150.0-397.5); IL-6, 2.8 pg/mL (1.3-5.3) vs. 3.2 (2.1-4.7); sCD14, 4.5 ng/mL (3.3-6.2) vs. 5.0 (3.6-6.1), respectively, all p ≥ 0.399. Conclusion In the long term, switching to 2DR does not negatively affect immunologic parameters, inflammatory markers, or HIV-1 reservoir. Clinical trial registration identifier NCT04076423.
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Affiliation(s)
- Abraham Saborido-Alconchel
- Clinical Unit of Infectious Diseases, Microbiology and Parasitology, Institute of Biomedicine of Seville/Virgen del Rocio University Hospital/The Spanish National Research Council (CSIC)/University of Seville, Seville, Spain
| | - Ana Serna-Gallego
- Clinical Unit of Infectious Diseases, Microbiology and Parasitology, Institute of Biomedicine of Seville/Virgen del Rocio University Hospital/The Spanish National Research Council (CSIC)/University of Seville, Seville, Spain
| | - María Trujillo-Rodriguez
- Clinical Unit of Infectious Diseases, Microbiology and Parasitology, Institute of Biomedicine of Seville/Virgen del Rocio University Hospital/The Spanish National Research Council (CSIC)/University of Seville, Seville, Spain
| | - Esperanza Muñoz-Muela
- Clinical Unit of Infectious Diseases, Microbiology and Parasitology, Institute of Biomedicine of Seville/Virgen del Rocio University Hospital/The Spanish National Research Council (CSIC)/University of Seville, Seville, Spain
| | - Ana I. Álvarez-Ríos
- Department of Clinical Biochemistry, Institute of Biomedicine of Seville/Virgen del Rocio University Hospital/The Spanish National Research Council (CSIC)/University of Seville, Seville, Spain
| | - Carmen Lozano
- Clinical Unit of Infectious Diseases, Microbiology and Parasitology, Institute of Biomedicine of Seville/Virgen del Rocio University Hospital/The Spanish National Research Council (CSIC)/University of Seville, Seville, Spain
| | - Silvia Llaves-Flores
- Clinical Unit of Infectious Diseases, Microbiology and Parasitology, Institute of Biomedicine of Seville/Virgen del Rocio University Hospital/The Spanish National Research Council (CSIC)/University of Seville, Seville, Spain
| | - Nuria Espinosa
- Clinical Unit of Infectious Diseases, Microbiology and Parasitology, Institute of Biomedicine of Seville/Virgen del Rocio University Hospital/The Spanish National Research Council (CSIC)/University of Seville, Seville, Spain
| | - Cristina Roca-Oporto
- Clinical Unit of Infectious Diseases, Microbiology and Parasitology, Institute of Biomedicine of Seville/Virgen del Rocio University Hospital/The Spanish National Research Council (CSIC)/University of Seville, Seville, Spain
| | - Marta Herrero
- Clinical Unit of Infectious Diseases, Microbiology and Parasitology, Institute of Biomedicine of Seville/Virgen del Rocio University Hospital/The Spanish National Research Council (CSIC)/University of Seville, Seville, Spain
| | - Cesar Sotomayor
- Clinical Unit of Infectious Diseases, Microbiology and Parasitology, Institute of Biomedicine of Seville/Virgen del Rocio University Hospital/The Spanish National Research Council (CSIC)/University of Seville, Seville, Spain
| | - Alicia Gutierrez-Valencia
- Clinical Unit of Infectious Diseases, Microbiology and Parasitology, Institute of Biomedicine of Seville/Virgen del Rocio University Hospital/The Spanish National Research Council (CSIC)/University of Seville, Seville, Spain
- Primary Care Pharmacist Service, Sevilla Primary Care District, Seville, Spain
| | - Luis F. Lopez-Cortes
- Clinical Unit of Infectious Diseases, Microbiology and Parasitology, Institute of Biomedicine of Seville/Virgen del Rocio University Hospital/The Spanish National Research Council (CSIC)/University of Seville, Seville, Spain
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Katlama C, Bisshop F, Bogner J, Pérez Elías MJ, Di Giambenedetto S, Clarke E, Hodder S, Nwokolo N, Ait-Khaled M, Oyee J, Grove R, Wynne B, Okoli C, Jones B, Kisare M. Efficacy and safety of dolutegravir/lamivudine in virologically suppressed female participants: week 48 data from the pooled TANGO and SALSA studies. HIV Med 2024; 25:873-884. [PMID: 38760011 DOI: 10.1111/hiv.13643] [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: 12/12/2023] [Accepted: 03/24/2024] [Indexed: 05/19/2024]
Abstract
OBJECTIVES Women represent >50% of people with HIV globally but have historically been underrepresented in clinical trials. We evaluated the efficacy and safety of switching to dolutegravir/lamivudine (DTG/3TC) vs continuing their current antiretroviral regimen (CAR) by sex assigned at birth (female and male) in virologically suppressed adults with HIV-1 without prior virological failure in a pooled analysis of two randomized controlled trials. METHODS This analysis included 48-week data from the phase 3 TANGO and SALSA studies. Primary and key secondary endpoints included proportions of participants with HIV-1 RNA ≥50 and <50 copies/mL at week 48, respectively. Safety was also assessed. RESULTS Of 1234 participants, 250 (DTG/3TC, n = 133; CAR, n = 117) were female at birth. Week 48 proportions of participants with Snapshot HIV-1 RNA ≥50 copies/mL were similar regardless of sex at birth (DTG/3TC vs CAR: female, <1% [1/133] vs 2% [2/117]; male, <1% [1/482] vs <1% [3/502]). Proportions with HIV-1 RNA <50 copies/mL were high across sexes and treatment groups (DTG/3TC vs CAR: female, 91% [121/133] vs 89% [104/117]; male, 94% [455/482] vs 94% [471/502]). Immunological response with DTG/3TC was slightly higher in female participants. Incidences of adverse events leading to withdrawal and serious adverse events were low and comparable between treatment groups and across sexes. Weight gain was higher with DTG/3TC than with CAR among female participants aged ≥50 years (treatment difference 2.08 kg [95% confidence interval 0.40-3.75]). CONCLUSIONS Results confirm the robustness of DTG/3TC as a switch option in virologically suppressed females with HIV-1, with outcomes similar to those in males.
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Affiliation(s)
- C Katlama
- AP-HP, Hôpital Pitié-Salpêtrière, Service de Maladies Infectieuses et Tropicales, INSERM-Sorbonne Universités, Paris, France
| | - F Bisshop
- Holdsworth House Medical Brisbane, Fortitude Valley, Queensland, Australia
| | - J Bogner
- Department of Medicine IV, LMU University Hospital, LMU Munich, Munich, Germany
| | | | - S Di Giambenedetto
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Università Cattolica del Sacro Cuore, Rome, Italy
| | - E Clarke
- Axess Sexual Health, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - S Hodder
- West Virginia Clinical and Translational Science Institute, Morgantown, West Virginia, USA
| | | | | | | | | | - B Wynne
- ViiV Healthcare, Durham, North Carolina, USA
| | - C Okoli
- ViiV Healthcare, Brentford, UK
| | - B Jones
- ViiV Healthcare, Brentford, UK
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Fernández A, Imaz A. Clinical considerations when switching antiretroviral therapy. Expert Rev Clin Pharmacol 2024; 17:565-577. [PMID: 38850057 DOI: 10.1080/17512433.2024.2365826] [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: 03/12/2024] [Accepted: 06/05/2024] [Indexed: 06/09/2024]
Abstract
INTRODUCTION Antiretroviral therapy (ART) can be personalized through simple formulations with high resistance barriers, favorable safety profiles, and novel administration routes. Switching treatments has become a key clinical strategy for addressing drug toxicity and interactions and enhancing adherence and convenience. This strategy aims to improve the quality of life and long-term efficacy, even in challenging cases like people living with HIV (PLWH) with multiple comorbidities, prior virological failure, and drug resistance. AREAS COVERED The authors reviewed clinical trials and cohort studies providing evidence of benefits and risks of current antiretroviral (ARV) drugs as switching options for PLWH in various scenarios. The literature search included clinical trials, meta-analyses, observational studies, and review articles in English published after 2000, and current HIV treatment guidelines in English and Spanish as of February 2024. EXPERT OPINION New ARV drugs offer advantages in efficacy and safety over previous options but may also have adverse effects. Second-generation integrase inhibitors and tenofovir alafenamide show benefits as switching options in various scenarios, though more research is needed on potential weight gain and metabolic issues. Injectable long-acting ART is promising for switching strategies, but finding the optimal combination of new drugs remains challenging.
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Affiliation(s)
- Analuz Fernández
- Human Immunodeficiency Virus (HIV) and Sexually Transmitted Infections (STI) Unit, Department of Infectious Diseases, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Arkaitz Imaz
- Human Immunodeficiency Virus (HIV) and Sexually Transmitted Infections (STI) Unit, Department of Infectious Diseases, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
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Scholten S, Cahn P, Portilla J, Bisshop F, Hodder S, Ruane P, Kaplan R, Wynne BR, Man CY, Grove R, Wang R, Jones B, Ait-Khaled M, Kisare M, Okoli C. Dolutegravir/Lamivudine Efficacy and Safety Outcomes in People With HIV-1 With or Without Historical Resistance Results at Screening: 48-Week Pooled Analysis. Open Forum Infect Dis 2024; 11:ofae365. [PMID: 39015350 PMCID: PMC11250229 DOI: 10.1093/ofid/ofae365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 06/27/2024] [Indexed: 07/18/2024] Open
Abstract
Background Drug resistance testing aids in appropriate antiretroviral therapy selection to improve treatment success but may not be readily available. We evaluated the impact of switching to dolutegravir/lamivudine (DTG/3TC) using pooled data from the TANGO and SALSA trials in adults who were virologically suppressed with or without historical resistance results at screening. Methods Adults who were virologically suppressed (HIV-1 RNA <50 copies/mL for >6 months) with no prior virologic failure were randomized to switch to DTG/3TC (TANGO, n = 369; SALSA, n = 246) or continue their current antiretroviral regimen (CAR; TANGO, n = 372; SALSA, n = 247). Week 48 HIV-1 RNA ≥50 and <50 copies/mL (Snapshot algorithm, Food and Drug Administration; intention-to-treat exposed), CD4+ cell count, and safety were analyzed by availability of historical resistance results. Results Overall, 294 of 615 (48%) participants in the DTG/3TC group and 277 of 619 (45%) participants in the CAR group had no historical resistance results at screening. At week 48, proportions with Snapshot HIV-1 RNA ≥50 copies/mL were low (≤1.1%) and similar across treatment groups and by historical resistance results availability. High proportions (91%-95%) maintained virologic suppression through week 48, regardless of results availability. Across both subgroups of results availability, greater increases in CD4+ cell count from baseline to week 48 occurred with DTG/3TC vs CAR. No participants taking DTG/3TC had confirmed virologic withdrawal, regardless of historical resistance results availability. One participant undergoing CAR without historical resistance results had confirmed virologic withdrawal; no resistance was detected. Overall, DTG/3TC was well tolerated; few adverse events led to withdrawal. Conclusions Findings support DTG/3TC as a robust switch option for adults who are virologically suppressed with HIV-1 and no prior virologic failure, regardless of historical resistance results availability. Clinical trial registration TANGO: NCT03446573, https://clinicaltrials.gov/study/NCT03446573. SALSA: NCT04021290, https://clinicaltrials.gov/study/NCT04021290.
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Affiliation(s)
| | - Pedro Cahn
- Fundación Huésped, Buenos Aires, Argentina
| | | | - Fiona Bisshop
- Holdsworth House Medical Brisbane, Queensland, Australia
| | - Sally Hodder
- West Virginia Clinical and Translational Science Institute, Morgantown, West Virginia, USA
| | - Peter Ruane
- Ruane Clinical Research, Los Angeles, California, USA
| | | | | | - Choy Y Man
- ViiV Healthcare, Durham, North Carolina, USA
| | | | - Ruolan Wang
- ViiV Healthcare, Durham, North Carolina, USA
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Turkova A, Chan MK, Kityo C, Kekitiinwa AR, Musoke P, Violari A, Variava E, Archary M, Cressey TR, Chalermpantmetagul S, Sawasdichai K, Ounchanum P, Kanjanavanit S, Srirojana S, Srirompotong U, Welch S, Bamford A, Epalza C, Fortuny C, Colbers A, Nastouli E, Walker S, Carr D, Conway M, Spyer MJ, Parkar N, White I, Nardone A, Thomason MJ, Ferrand RA, Giaquinto C, Ford D. D3/Penta 21 clinical trial design: A randomised non-inferiority trial with nested drug licensing substudy to assess dolutegravir and lamivudine fixed dose formulations for the maintenance of virological suppression in children with HIV-1 infection, aged 2 to 15 years. Contemp Clin Trials 2024; 142:107540. [PMID: 38636725 DOI: 10.1016/j.cct.2024.107540] [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: 01/04/2024] [Revised: 03/29/2024] [Accepted: 04/15/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND There is increasing interest in utilising two-drug regimens for HIV treatment with the goal of reducing toxicity and improve acceptability. The D3 trial evaluates the efficacy and safety of DTG/3TC in children and adolescents and includes a nested pharmacokinetics(PK) substudy for paediatric drug licensing. METHODS D3 is an ongoing open-label, phase III, 96-week non-inferiority randomised controlled trial(RCT) conducted in South Africa, Spain, Thailand, Uganda and the United Kingdom. D3 has enrolled 386 children aged 2- < 15 years, virologically suppressed for ≥6 months, with no prior treatment failure. Participants were randomised 1:1 to receive DTG/3TC or DTG plus two nucleoside reverse transcriptase inhibitors(NRTIs), stratified by region, age (2- < 6, 6- < 12, 12- < 15 years) and DTG use at enrolment (participants permitted to start DTG at enrolment). The primary outcome is confirmed HIV-1 RNA viral rebound ≥50 copies/mL by 96-weeks. The trial employs the Smooth Away From Expected(SAFE) non-inferiority frontier, which specifies the non-inferiority margin and significance level based on the observed event risk in the control arm. The nested PK substudy evaluates WHO weight-band-aligned dosing in the DTG/3TC arm. DISCUSSION D3 is the first comparative trial evaluating DTG/3TC in children and adolescents. Implications of integrating a PK substudy and supplying data for prompt regulatory submission, were carefully considered to ensure the integrity of the ongoing trial. The trial uses an innovative non-inferiority frontier for the primary analysis to allow for a lower-than-expected confirmed viral rebound risk in the control arm, while ensuring interpretability of results and maintaining the planned sample size in an already funded trial. TRIAL REGISTRATION International Standard Randomised Clinical Trial Number Register: ISRCTN17157458. European Clinical Trials Database: 2020-001426-57. CLINICALTRIALS gov: NCT04337450.
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Affiliation(s)
- Anna Turkova
- Medical Research Council Clinical Trials Unit at University College London, UK.
| | - Man K Chan
- Medical Research Council Clinical Trials Unit at University College London, UK
| | - Cissy Kityo
- Joint Clinical Research Centre, Kampala, Uganda
| | | | - Philippa Musoke
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Avy Violari
- Perinatal HIV Research Unit, University of the Witwarsrand, Johannesburg, South Africa
| | - Ebrahim Variava
- Perinatal HIV Research Unit, University of the Witwarsrand, Johannesburg, South Africa
| | - Moherndran Archary
- Department of Paediatrics and Children Health, King Edward VIII Hospital, Enhancing Care Foundation, University of KwaZulu-Natal, Durban, South Africa
| | - Tim R Cressey
- AMS-IRD PHPT Research Collaboration, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Suwalai Chalermpantmetagul
- AMS-IRD PHPT Research Collaboration, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | | | | | | | | | | | - Steven Welch
- Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Alasdair Bamford
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; University College London Great Ormond Street Institute of Child Health, London, UK
| | - Cristina Epalza
- Instituto de Investigación Sanitaria Hospital, 12 de Octubre (imas12), Madrid, Spain
| | - Clàudia Fortuny
- Infectious Diseases Department, Institut de Recerca Sant Joan de Déu, Sant Joan de Déu Children's Hospital, Barcelona, Spain; Department of Surgery and Medico-Surgical Specialties, Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
| | - Angela Colbers
- Department of Pharmacy, Radboud Institute for Medical InnovationHealth Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Eleni Nastouli
- University College London Great Ormond Street Institute of Child Health, London, UK; University College London Hospitals NHS Trust, Advanced Pathogen Diagnostics Unit, London, UK
| | - Simon Walker
- Centre for Health Economics, University of York, Heslington, York, UK
| | - Dan Carr
- Department of Molecular and Clinical Pharmacology, University of Liverpool, UK
| | | | - Moira J Spyer
- Medical Research Council Clinical Trials Unit at University College London, UK; University College London Great Ormond Street Institute of Child Health, London, UK
| | - Nazia Parkar
- Medical Research Council Clinical Trials Unit at University College London, UK
| | - Iona White
- Medical Research Council Clinical Trials Unit at University College London, UK
| | | | - Margaret J Thomason
- Medical Research Council Clinical Trials Unit at University College London, UK
| | | | - Carlo Giaquinto
- Fondazione Penta ETS, Padova, Italy; University of Padova, Department of Women and Child Health, Padova, Italy
| | - Deborah Ford
- Medical Research Council Clinical Trials Unit at University College London, UK
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Rossotti R, D'Amico F, Bana NB, Nava A, Rezzonico LF, Raimondi A, Fanti D, Chianura LG, Moioli MC, Vismara C, Puoti M. Durability of doravirine with dolutegravir dual regimen compared with other dolutegravir-based dual combinations. HIV Med 2024; 25:675-683. [PMID: 38263787 DOI: 10.1111/hiv.13615] [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: 10/08/2023] [Accepted: 01/11/2024] [Indexed: 01/25/2024]
Abstract
OBJECTIVES The availability of doravirine (DOR) allowed clinicians to prescribe a dolutegravir (DTG)-based two-drug regimen (2DR) in individuals not eligible to receive lamivudine (3TC) or rilpivirine (RPV). The aims of this study were to describe the durability of DTG + DOR compared with DTG/3TC and DTG/RPV and the rate of virological failure and target not-detected maintenance over time. METHODS This retrospective, monocentric analysis included all subjects who started a DTG-based 2DR from 2018 to 2022 as a simplification. Descriptive statistics and non-parametric tests to describe and compare the groups were applied. Kaplan-Meier probability curves and Cox regression models for regimens durability were used. RESULTS The study enrolled 710 individuals: 499 treated with DTG/3TC, 140 with DTG/RPV, and 71 with DTG + DOR. A 2DR with DOR was prescribed to older subjects who had a longer infection, greater exposure to different antiretroviral regimens, a higher proportion of resistance-associated mutations, and a worse immune-virologic status. Over a cumulative follow-up of 68 152 weeks, 42 discontinuations were registered (5.9%). DTG + DOR had a risk of treatment interruption of 7.8% at 48 weeks and 9.8% at 96 weeks, significantly higher than the other 2DRs. In the multivariate Cox model, DTG + DOR and DTG/RPV were significantly associated with discontinuation. The maintenance of target not detected during follow-up was similar among groups. The rate of virological failure was higher for DTG + DOR through different event definitions. CONCLUSIONS DTG + DOR durability was high over a long follow-up albeit lower than for other 2DRs. This combination might be an effective option in people with HIV that has proven difficult to treat.
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Affiliation(s)
- Roberto Rossotti
- Department of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Federico D'Amico
- Department of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Nicholas Brian Bana
- Department of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- School of Medicine, University of Milan-Bicocca, Milan, Italy
| | - Alice Nava
- Clinical Microbiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Leonardo Francesco Rezzonico
- Department of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- School of Medicine, University of Pavia, Pavia, Italy
| | - Alessandro Raimondi
- Department of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Diana Fanti
- Clinical Microbiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Maria Cristina Moioli
- Department of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Chiara Vismara
- Clinical Microbiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Massimo Puoti
- Department of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- School of Medicine, University of Milan-Bicocca, Milan, Italy
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de Lazzari E, Negredo EB, Domingo P, Tiraboschi JM, Ribera E, Abdulghani N, Alba V, Fernández-Arroyo S, Viladés C, Peraire J, Gatell JM, Blanco JL, Vidal F, Rull A, Martinez E. Multiomics plasma effects of switching from triple antiretroviral regimens to dolutegravir plus lamivudine. J Antimicrob Chemother 2024; 79:1133-1141. [PMID: 38546974 PMCID: PMC11062938 DOI: 10.1093/jac/dkae083] [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: 11/22/2023] [Accepted: 03/06/2024] [Indexed: 05/03/2024] Open
Abstract
INTRODUCTION The DOLAM trial revealed that switching from triple antiretroviral therapy (three-drug regimen; 3DR) to dolutegravir plus lamivudine (two-drug regimen; 2DR) was virologically non-inferior to continuing 3DR after 48 weeks of follow-up. Weight increased with 2DR relative to 3DR but it did not impact on metabolic parameters. METHODS Multiomics plasma profile was performed to gain further insight into whether this therapy switch might affect specific biological pathways. DOLAM (EudraCT 201500027435) is a Phase 4, randomized, open-label, non-inferiority trial in which virologically suppressed persons with HIV treated with 3DR were assigned (1:1) to switch to 2DR or to continue 3DR for 48 weeks. Untargeted proteomics, metabolomics and lipidomics analyses were performed at baseline and at 48 weeks. Univariate and multivariate analyses were performed to identify changes in key molecules between both therapy arms. RESULTS Switching from 3DR to 2DR showed a multiomic impact on circulating plasma concentration of N-acetylmuramoyl-L-alanine amidase (Q96PD5), insulin-like growth factor-binding protein 3 (A6XND0), alanine and triglyceride (TG) (48:0). Correlation analyses identified an association among the up-regulation of these four molecules in persons treated with 2DR. CONCLUSIONS Untargeted multiomics profiling studies identified molecular changes potentially associated with inflammation immune pathways, and with lipid and glucose metabolism. Although these changes could be associated with potential metabolic or cardiovascular consequences, their clinical significance remains uncertain. Further work is needed to confirm these findings and to assess their long-term clinical consequences.
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Affiliation(s)
- Elisa de Lazzari
- Hospital Clinic - IDIBAPS, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Universitat de Barcelona, Barcelona, Spain
| | - Eugenia B Negredo
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Lluita contra les Infeccions, Hospital Universitari Germans Trias i Pujol, Badalona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pere Domingo
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Esteve Ribera
- Hospital Universitario de la Vall d’Hebron, Barcelona, Spain
| | | | - Verònica Alba
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Infection and Immunity Research Group (INIM), Institut Investigació Sanitària Pere Virgili (IISPV), Tarragona, Spain
- Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
- Universitat Rovira i Virgili (URV), Tarragona, Spain
| | - Salvador Fernández-Arroyo
- Eurecat, Centre Tecnològic de Catalunya, Centre for Omic Sciences, Joint Unit Eurecat-Universitat Rovira i Virgili, Unique Scientific and Technical Infrastructure (ICTS), 43204 Reus, Spain
| | - Consuelo Viladés
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Infection and Immunity Research Group (INIM), Institut Investigació Sanitària Pere Virgili (IISPV), Tarragona, Spain
- Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
- Universitat Rovira i Virgili (URV), Tarragona, Spain
| | - Joaquim Peraire
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Infection and Immunity Research Group (INIM), Institut Investigació Sanitària Pere Virgili (IISPV), Tarragona, Spain
- Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
- Universitat Rovira i Virgili (URV), Tarragona, Spain
| | - Jose M Gatell
- Universitat de Barcelona, Barcelona, Spain
- ViiV Healthcare, Barcelona, Spain
| | - Jose L Blanco
- Hospital Clinic - IDIBAPS, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Francesc Vidal
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Infection and Immunity Research Group (INIM), Institut Investigació Sanitària Pere Virgili (IISPV), Tarragona, Spain
- Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
- Universitat Rovira i Virgili (URV), Tarragona, Spain
| | - Anna Rull
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Infection and Immunity Research Group (INIM), Institut Investigació Sanitària Pere Virgili (IISPV), Tarragona, Spain
- Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
- Universitat Rovira i Virgili (URV), Tarragona, Spain
| | - Esteban Martinez
- Hospital Clinic - IDIBAPS, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Universitat de Barcelona, Barcelona, Spain
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10
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Borghetti A, Ciccullo A, Lombardi F, Giannarelli D, Passerotto RA, Lamanna F, Carcagnì A, Farinacci D, Dusina A, Baldin G, Zazzi M, Di Giambenedetto S. Efficacy of Lamivudine Plus Dolutegravir vs Dolutegravir-Based 3-Drug Regimens in People With HIV Who Are Virologically Suppressed. Open Forum Infect Dis 2024; 11:ofae198. [PMID: 38680613 PMCID: PMC11055392 DOI: 10.1093/ofid/ofae198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 04/09/2024] [Indexed: 05/01/2024] Open
Abstract
Background Lamivudine + dolutegravir maintenance dual therapy (DT) could be less effective than 3-drug therapy (TT) in the context of resistance-associated mutations to nucleoside reverse transcriptase inhibitors (NRTIs). The ARCA database was queried to test this hypothesis with a trial emulation strategy. Methods People with HIV taking 2 NRTIs plus a protease inhibitor or a non-NRTI who switched to DT or dolutegravir-based TT were followed up from the first HIV RNA <50 copies/mL (baseline) to virologic failure (VF; ie, 2 consecutive HIV RNA ≥50 copies/mL or 1 HIV RNA ≥200 copies/mL). Those switching to DT within 6 months were assigned to the treatment arm and all other patients to the control arm. Each participant was also cloned, assigned to the opposite strategy, and censored at the time of deviation from that strategy. Using inverse probability of censoring weight Cox regression models, we calculated hazard ratios of VF for DT vs TT stratified for the presence of resistance-associated mutations. Results Overall 626 people were analyzed: 204 with DT and 422 with TT (73% men; mean age, 44 years). Ten and 31 VFs occurred with DT and TT, respectively, over a median 5.8 years. When compared with a fully active TT, the DT had similar efficacy (adjusted hazard ratio, 0.88; 95% CI, .29-2.61; P = .812) when full susceptibility was confirmed at historical genotype. When previous M184V/I was present in both groups, the risk of VF was higher for DT vs TT but was not statistically significant (adjusted hazard ratio, 3.06; 95% CI, .45-20.84; P = .252). Conclusions DT was not associated with a significantly higher risk of VF than dolutegravir-based TT.
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Affiliation(s)
- Alberto Borghetti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Malattie Infettive, Roma, Italia
| | - Arturo Ciccullo
- Unit of Infectious Diseases, San Salvatore Hospital, L’Aquila, Italy
| | - Francesca Lombardi
- Dipartimento di Sicurezza e Bioetica Sezione Malattie Infettive, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Diana Giannarelli
- Facility of Epidemiology and Biostatistics–Gemelli Generator, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Rosa Anna Passerotto
- Dipartimento di Sicurezza e Bioetica Sezione Malattie Infettive, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Francesco Lamanna
- Dipartimento di Sicurezza e Bioetica Sezione Malattie Infettive, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Antonella Carcagnì
- Facility of Epidemiology and Biostatistics–Gemelli Generator, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Damiano Farinacci
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Malattie Infettive, Roma, Italia
| | - Alex Dusina
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Malattie Infettive, Roma, Italia
| | - Gianmaria Baldin
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Malattie Infettive, Roma, Italia
| | - Maurizio Zazzi
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Simona Di Giambenedetto
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Malattie Infettive, Roma, Italia
- Dipartimento di Sicurezza e Bioetica Sezione Malattie Infettive, Università Cattolica del Sacro Cuore, Roma, Italia
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11
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Ait-Khaled M, Oyee J, Ooi AYR, Wynne B, Maldonado A, Jones B, Wang T. Efficacy and Safety of Switching to Dolutegravir/Lamivudine Versus Continuing a Tenofovir Alafenamide-Based Regimen in Virologically Suppressed Adults With Human Immunodeficiency Virus Type 1: Subgroup Analysis of Participants With Elvitegravir as Baseline Third Agent From the TANGO Study. Open Forum Infect Dis 2024; 11:ofae227. [PMID: 38737429 PMCID: PMC11088357 DOI: 10.1093/ofid/ofae227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Indexed: 05/14/2024] Open
Abstract
TANGO results have established the durable efficacy of dolutegravir/lamivudine in virologically suppressed individuals who switched from 3- or 4-drug tenofovir alafenamide (TAF)-based regimens. In this post hoc subgroup analysis, 144-week efficacy and tolerability of dolutegravir/lamivudine in participants who switched from elvitegravir/cobicistat/emtricitabine/TAF were consistent with the overall switch population. Clinical Trials Registration NCT03446573.
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Affiliation(s)
| | | | | | - Brian Wynne
- ViiV Healthcare, Durham, North Carolina, USA
| | | | - Bryn Jones
- ViiV Healthcare, Brentford, United Kingdom
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12
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Deng M, Chen N, Lao X, Wang X, Fu J, Xing L, Zhao H. Reasons, Efficacy and Safety of Switching to Dolutegravir-Based Regimens Among Virologically Suppressed PLWH: A Retrospective Cohort Study of 96 Weeks. Infect Drug Resist 2024; 17:1571-1582. [PMID: 38681898 PMCID: PMC11055531 DOI: 10.2147/idr.s451346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 04/12/2024] [Indexed: 05/01/2024] Open
Abstract
Purpose The study aimed to explore the reasons, efficacy, and safety of switching to dolutegravir (DTG) based regimens in virologically suppressed people living with HIV (PLWH) in tertiary hospitals in China. Therefore, the study could provide a valuable reference for the rational clinical use of DTG. Methods PLWH's basic information, treatment details, and reasons for switching were collected, through the electrical clinical medical record system and telephone follow-up. Data included the proportion of PLWH with HIV RNA <50 copies/mL, changes in immunological indicators, and metabolic metrics at week 48 and week 96. Results 319 PLWH were included in the analysis. The three major reasons for switching were neurological toxicity (16.30%), simplification (13.79%), and renal toxicity (11.29%). Our study showed high rates of virologic suppression in the per-protocol analysis (week 48: 99.69%; week 96: 99.29%) after switching to DTG-based regimens. The median CD4+ T cell count increased from 579 cells/μL (IQR 420.5-758) to 642 cells/μL (IQR 466.5-854) at week 96 (p<0.0001). An improvement was observed in liver function (ALT: p<0.0001; AST: p<0.0001) and fasting glucose (p<0.0001). However, there was an elevation in creatinine (Cr) (p<0.0001) and a slight decrease in the estimated glomerular filtration rate (eGFR) (p<0.0001). Regarding lipid profile, triglyceride (TG) levels declined, while total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) levels increased. Further analysis revealed that the increase in TC and LDL-C was associated with the withdrawal of tenofovir disoproxil fumarate (TDF). This observed increase in lipid parameters only concerned the PLWH who switched from a TDF-containing regimen to a non-TDF regimen. Conclusion This study confirmed the virologic efficacy of switching to DTG-based regimens in virologically suppressed PLWH over a 96-week period. The findings also expanded the evidence of immune reconstitution and metabolic safety associated with this switch.
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Affiliation(s)
- Meiju Deng
- Clinical Center for HIV/AIDS, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, People’s Republic of China
| | - Na Chen
- Clinical Center for HIV/AIDS, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, People’s Republic of China
| | - Xiaojie Lao
- Clinical Center for HIV/AIDS, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, People’s Republic of China
| | - Xiaolei Wang
- Clinical Center for HIV/AIDS, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, People’s Republic of China
| | - Jiantao Fu
- Clinical Center for HIV/AIDS, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, People’s Republic of China
| | - Lulu Xing
- Clinical Center for HIV/AIDS, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, People’s Republic of China
| | - Hongxin Zhao
- Clinical Center for HIV/AIDS, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, People’s Republic of China
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13
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Pierone Jr G, Brunet L, Fusco JS, Henegar CE, Sarkar S, Van Wyk J, Vannappagari V, Wohlfeiler MB, Fusco GP. Switching to Dolutegravir/Lamivudine Two-Drug Regimen: Durability and Virologic Outcomes by Age, Sex, and Race in Routine US Clinical Care. HIV AIDS (Auckl) 2024; 16:133-140. [PMID: 38645753 PMCID: PMC11032131 DOI: 10.2147/hiv.s452130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/13/2024] [Indexed: 04/23/2024] Open
Abstract
Purpose Two-drug regimens (2DR) may address drug-drug interactions and toxicity concerns. Dolutegravir/lamivudine (DTG/3TC) 2DR was approved in the US for both treatment-naïve and treatment-experienced individuals with a viral load <50 copies/mL. This study describes real-world DTG/3TC 2DR treatment outcomes among treatment-experienced individuals, stratified by age, sex, and race. Methods From the OPERA® cohort, people with HIV with a viral load <50 copies/mL who switched from a commonly used three-drug regimen to DTG/3TC 2DR as per the label between April 8, 2019 and April 30, 2021 were included. Incidence rates (Poisson regression) for loss of virologic control (first viral load ≥50 copies/mL), confirmed virologic failure (2 viral loads ≥200 copies/mL or discontinuation after 1 viral load ≥200 copies/mL), and DTG/3TC 2DR discontinuation were estimated overall and stratified by age, sex, and race. Results The 787 individuals included were followed for a median of 13.6 months (IQR: 8.2, 22.3). Confirmed virologic failure occurred in ≤5 individuals. Loss of virologic control occurred at a rate of 14.0 per 100 person-years (95% CI: 11.7, 16.8). DTG/3TC 2DR discontinuation occurred at a rate of 17.5 per 100 person-years (95% CI: 15.0, 20.3); 4% discontinued for treatment-related reasons (viremia, adverse diagnosis, side effect, lab abnormality). For all outcomes, incidence rates were comparable across strata of age, sex, and race. Conclusion This descriptive study demonstrates that DTG/3TC 2DR is an effective and well-tolerated treatment option for people with HIV with a viral load <50 copies/mL at switch, regardless of their age, sex, or race.
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Affiliation(s)
- Gerald Pierone Jr
- Department of Adult Primary Care, Whole Family Health Center, Vero Beach, FL, USA
| | | | | | - Cassidy E Henegar
- Epidemiology and Real World Evidence, ViiV Healthcare, Research Triangle Park, NC, USA
| | - Supriya Sarkar
- Epidemiology and Real World Evidence, ViiV Healthcare, Research Triangle Park, NC, USA
| | | | - Vani Vannappagari
- Epidemiology and Real World Evidence, ViiV Healthcare, Research Triangle Park, NC, USA
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14
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Mehraj V, Chen J, Routy JP. Effects of statins beyond lipid-lowering agents in ART-treated HIV infection. Front Immunol 2024; 15:1339338. [PMID: 38655259 PMCID: PMC11035727 DOI: 10.3389/fimmu.2024.1339338] [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: 11/16/2023] [Accepted: 03/22/2024] [Indexed: 04/26/2024] Open
Abstract
Antiretroviral therapies (ART) have reduced human immunodeficiency virus (HIV) infection-associated morbidity and mortality improving the life of people with HIV (PWH). However, ART lead to residual HIV production, which in conjunction with microbial translocation and immune dysfunction contributes to chronic inflammation and immune activation. PWH on ART remain at an increased risk for cardiovascular diseases (CVDs) including myocardial infarction and stroke; which in part is explained by chronic inflammation and immune activation. Lifestyle factors and certain ART are associated with dyslipidemia characterized by an increase of low-density lipoprotein (LDL), which further contributes in the increased risk for CVDs. Lipid-lowering agents like statins are emerging as immune modulators in decreasing inflammation in a variety of conditions including HIV. The international randomized clinical trial REPRIEVE has shed light on the reduction of CVDs with statin therapy among PWH. Such reports indicate a more than expected benefit of statins beyond their lipid-lowering effects. Bempedoic acid, a first-in-class non-statin LDL-lowering drug with immune modulatory effects, may further aid PWH in combination with statins. Herein, we critically reviewed studies aimed at lipid-lowering and immune-modulating roles of statins that may benefit aging PWH.
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Affiliation(s)
- Vikram Mehraj
- Research Centre McGill University Health Centre, Montreal, QC, Canada
| | - Jun Chen
- Department of Infectious Diseases and Immunology, Shanghai Public Health Clinical Center, Shanghai, China
| | - Jean-Pierre Routy
- Research Centre McGill University Health Centre, Montreal, QC, Canada
- Chronic Viral Illness Service and Division of Hematology, McGill University Health Centre, Montreal, QC, Canada
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15
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Pujari S, Gaikwad S, Panchawagh S, Chitalikar A, Joshi K, Rohekar C, Dabhade D, Bele V. Effectiveness, Weight Changes, and Metabolic Outcomes on Switch to Generic Dolutegravir/Lamivudine Among People with HIV in Western India: An Observational Study. AIDS Res Hum Retroviruses 2024; 40:204-215. [PMID: 38063004 DOI: 10.1089/aid.2022.0167] [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: 01/07/2024] Open
Abstract
We assessed the effectiveness and safety of switching to generic dolutegravir/lamivudine (DTG/3TC) among People living with Human Immunodeficiency Virus (PWH) in Western India. In this single-center, retrospective observational study, PWH, who switched to DTG/3TC, were followed for virologic, immunologic, and clinical effectiveness, and safety, including weight changes, hyperglycemia, and dyslipidemia. Multivariate linear mixed-effects models were used to predict average change in weight adjusted for age, sex, duration of previous antiretroviral (ARV) regimens, and baseline weight. From May 2017 to July 2022, out of 434 PWH switched to DTG/3TC, 304 with at least 1 follow-up visit were included. Median [interquartile range (IQR)] age was 54 (IQR 49-61) years and 70.1% were male. Prevalence of baseline comorbidities was 57.9% (hypertension-41.5%, chronic kidney disease-40.9%, and diabetes mellitus-18.8%). Reasons for switch were affordability (47.4%), desire for simplification (41.8%), ARV toxicities (19.1%), and concern about potential toxicities (10.2%). Median (IQR) duration of follow-up on DTG/3TC was 40 (IQR 31-49) weeks. No virologic failure was observed. Rates of virologic suppression [viral load (VL) ≤20 copies/mL or target not detected (TND)] at 12, 24, 48, 72, 96 and 120 weeks were 95.2%, 95.9%, 90%, 100%, 81.3%, and 88.4%, respectively. Only 9 (3%) PWH permanently discontinued DTG/3TC. Predicted adjusted mean weight gain of +3.3 kg was observed at 96 weeks. Switching from tenofovir disoproxil fumarate (TDF)/emtricitabine or lamivudine (XTC)/non-nucleoside reverse transcriptase inhibitor (NNRTI) and duration on DTG/3TC were significantly associated with weight gain. Apart from trend in worsening hyperglycemia (nine PWH with new onset diabetes), no clinically significant change in lipids and estimated glomerular filtration rate (eGFR) was documented. Switching to DTG/3TC is an effective and safe option among virologically suppressed PWH with high comorbidity burden in India. In view of the several advantages of DTG/3TC, it may be considered for potential scale-up in the right population, both in private and public health care settings in India.
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Affiliation(s)
| | | | | | | | - Kedar Joshi
- Institute of Infectious Diseases, Pune, India
| | | | | | - Vivek Bele
- Institute of Infectious Diseases, Pune, India
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16
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Vasylyev M, Wit FWNM, Jordans CCE, Soetekouw R, van Lelyveld SFL, Kootstra GJ, Delsing CE, Ammerlaan HSM, van Kasteren MEE, Brouwer AE, Leyten EMS, Claassen MAA, Hassing RJ, den Hollander JG, van den Berge M, Roukens AHE, Bierman WFW, Groeneveld PHP, Lowe SH, van Welzen BJ, Richel O, Nellen JF, van den Berk GEL, van der Valk M, Rijnders BJA, Rokx C. Dolutegravir/Lamivudine Is Noninferior to Continuing Dolutegravir- and Non-Dolutegravir-Based Triple-Drug Antiretroviral Therapy in Virologically Suppressed People With Human Immunodeficiency Virus: DUALING Prospective Nationwide Matched Cohort Study. Open Forum Infect Dis 2024; 11:ofae160. [PMID: 38567196 PMCID: PMC10986854 DOI: 10.1093/ofid/ofae160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 03/15/2024] [Indexed: 04/04/2024] Open
Abstract
Background Confirming the efficacy of dolutegravir/lamivudine in clinical practice solidifies recommendations on its use. Methods Prospective cohort study (DUALING) in 24 human immunodeficiency virus (HIV) treatment centers in the Netherlands. HIV RNA-suppressed cases were on triple-drug antiretroviral regimens without prior virological failure or resistance and started dolutegravir/lamivudine. Cases were 1:2 matched to controls on triple-drug antiretroviral regimens by the use of dolutegravir-based regimens, age, sex, transmission route, CD4+ T-cell nadir, and HIV RNA zenith. The primary endpoint was the treatment failure rate in cases versus controls at 1 year by intention-to-treat and on-treatment analyses with 5% noninferiority margin. Results The 2040 participants were 680 cases and 1380 controls. Treatment failure in the 390 dolutegravir-based cases versus controls occurred in 8.72% and 12.50% (difference: -3.78% [95% confidence interval {CI}, -7.49% to .08%]) by intention-to-treat and 1.39% and 0.80% (difference: 0.59% [95% CI, -.80% to 1.98%]) by on-treatment analyses. The treatment failure risk in 290 non-dolutegravir-based cases was also noninferior to controls. Antiretroviral regimen modifications unrelated to virological failure explained the higher treatment failure rate by intention-to-treat. A shorter time on triple-drug antiretroviral therapy and being of non-Western origin was associated with treatment failure. Treatment failure, defined as 2 consecutive HIV RNA >50 copies/mL, occurred in 4 cases and 5 controls but without genotypic resistance detected. Viral blips occured comparable in cases and controls but cases gained more weight, especially when tenofovir-based regimens were discontinued. Conclusions In routine care, dolutegravir/lamivudine was noninferior to continuing triple-drug antiretroviral regimens after 1 year, supporting the use of dolutegravir/lamivudine in clinical practice. Clinical Trials Registration NCT04707326.
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Affiliation(s)
- Marta Vasylyev
- Section of Infectious Diseases, Department of Internal Medicine, and Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Carlijn C E Jordans
- Section of Infectious Diseases, Department of Internal Medicine, and Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Robin Soetekouw
- Department of Internal Medicine, Spaarne Gasthuis, Haarlem/Hoofddorp, The Netherlands
| | | | - Gert-Jan Kootstra
- Department of Internal Medicine, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Corine E Delsing
- Department of Internal Medicine, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Heidi S M Ammerlaan
- Department of Internal Medicine, Catharina Ziekenhuis Eindhoven, Eindhoven, The Netherlands
| | - Marjo E E van Kasteren
- Department of Internal Medicine, Elisabeth Tweesteden Ziekenhuis, Tilburg, The Netherlands
| | - Annemarie E Brouwer
- Department of Internal Medicine, Elisabeth Tweesteden Ziekenhuis, Tilburg, The Netherlands
| | - Eliane M S Leyten
- Department of Internal Medicine, Haaglanden Medisch Centrum, The Hague, The Netherlands
| | - Mark A A Claassen
- Department of Internal Medicine, Rijnstate Ziekenhuis, Arnhem, The Netherlands
| | - Robert-Jan Hassing
- Department of Internal Medicine, Rijnstate Ziekenhuis, Arnhem, The Netherlands
| | - Jan G den Hollander
- Department of Internal Medicine, Maasstadziekenhuis, Rotterdam, The Netherlands
| | - Marcel van den Berge
- Department of Internal Medicine, Admiraal de Ruyter Ziekenhuis, Vlissingen, The Netherlands
| | - Anna H E Roukens
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - Wouter F W Bierman
- Section of Infectious Diseases, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Selwyn H Lowe
- Infectious Diseases and Infection Prevention, Department of Internal Medicine and Department of Medical Microbiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Berend J van Welzen
- Department of Internal Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Olivier Richel
- Section of Infectious Diseases, Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jeannine F Nellen
- Amsterdam Infection and Immunity Institute, Department of Infectious Diseases, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Marc van der Valk
- Stichting HIV Monitoring, Amsterdam, The Netherlands
- Amsterdam Infection and Immunity Institute, Department of Infectious Diseases, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Bart J A Rijnders
- Section of Infectious Diseases, Department of Internal Medicine, and Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Casper Rokx
- Section of Infectious Diseases, Department of Internal Medicine, and Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
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17
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Schneider S, Blick G, Burke C, Ward D, Benson P, Felizarta F, Green D, Donovan C, Harper G, Merrill D, Metzner AA, Mycock K, Wallis H, Patarroyo J, Brogan AP, Oglesby A. Two-Drug Regimens Dolutegravir/Lamivudine and Dolutegravir/Rilpivirine Are Effective with Few Discontinuations in US Real-World Settings: Results from the TANDEM Study. Infect Dis Ther 2024; 13:891-906. [PMID: 38570443 PMCID: PMC11058742 DOI: 10.1007/s40121-024-00961-y] [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: 12/18/2023] [Accepted: 03/12/2024] [Indexed: 04/05/2024] Open
Abstract
INTRODUCTION Dolutegravir/lamivudine (DTG/3TC) and dolutegravir/rilpivirine (DTG/RPV) are fixed-dose, complete, single-tablet, two-drug regimens (2DRs) indicated for HIV-1. DTG/3TC is approved for antiretroviral therapy (ART)-naive people with HIV-1 and virologically suppressed individuals to replace current ART; DTG/RPV is indicated for virologically suppressed individuals as a switch option. Virologic efficacy and effectiveness of these DTG-based 2DRs have been demonstrated in phase 3 clinical trials and real-world cohorts, primarily from Europe. This study characterized real-world use of DTG-based 2DRs for HIV-1 treatment in the USA. METHODS TANDEM was a retrospective medical chart review across 24 US sites. Individuals aged ≥ 18 years who initiated DTG/3TC or DTG/RPV before September 30, 2020, with ≥ 6 months of follow-up were included. One cohort included ART-naive people who initiated DTG/3TC (n = 126), and two other cohorts included virologically suppressed (HIV-1 RNA < 50 copies/mL) people on stable ART regimens for ≥ 3 months before switch to either DTG/3TC (n = 192) or DTG/RPV (n = 151). Clinical characteristics, treatment history, and outcomes are described. RESULTS Virologically suppressed individuals were older than those who were ART-naive, and the ART-naive cohort had higher proportions of individuals assigned male at birth and of Hispanic ethnicity. The most common healthcare provider-reported reason for choosing a DTG-based 2DR was avoidance of long-term toxicities (25-33% across cohorts), followed by simplification/streamlining of treatment. Among ART-naive people on DTG/3TC, 94% achieved virologic suppression after initiation, and 83% maintained suppression at last follow-up; discontinuation rate was < 1%. Among cohorts who switched to DTG-based 2DRs, 96% maintained virologic suppression on DTG/3TC and 93% on DTG/RPV; 2% on DTG/3TC and 3% on DTG/RPV discontinued. CONCLUSION Motivation for selecting DTG-based 2DRs was primarily driven by a desire to avoid or manage toxicities and simplify treatment. Results demonstrate that DTG/3TC and DTG/RPV are effective in real-world settings, with few discontinuations, reflecting data from clinical trials.
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Affiliation(s)
- Stefan Schneider
- Long Beach Education and Research Consultants, 1040 Elm Avenue, #303, Long Beach, CA, 90813, USA
| | - Gary Blick
- Health Care Advocates International, 2595 Main Street, 2nd Floor, Stratford, CT, 06615, USA
| | - Christina Burke
- CAN Community Health, 3251 3rd Avenue N, St Petersburg, FL, 33713, USA
| | - Douglas Ward
- Dupont Circle Physicians Group, 1145 19th Street NW, Suite 200, Washington, DC, 20009, USA
| | - Paul Benson
- Be Well Medical Center, 1964 W Eleven Mile Road, Berkley, MI, 48072, USA
| | - Franco Felizarta
- Bakersfield Family Medical Center, 4580 California Avenue, Bakersfield, CA, 93309, USA
| | - Dallas Green
- AHF Healthcare Center-Kinder, 3661 S Miami Avenue, Suite 806, Miami, FL, 33133, USA
| | - Cynthia Donovan
- ViiV Healthcare, 406 Blackwell Street, Suite 300, Durham, NC, 27701, USA
| | - Gavin Harper
- Adelphi Real World, Adelphi Mill, Grimshaw Lane, Bollington, Macclesfield, SK10 5JB, UK
| | - Deanna Merrill
- ViiV Healthcare, 406 Blackwell Street, Suite 300, Durham, NC, 27701, USA
| | - Aimee A Metzner
- ViiV Healthcare, 406 Blackwell Street, Suite 300, Durham, NC, 27701, USA
| | - Katie Mycock
- Adelphi Real World, Adelphi Mill, Grimshaw Lane, Bollington, Macclesfield, SK10 5JB, UK
| | - Hannah Wallis
- Adelphi Real World, Adelphi Mill, Grimshaw Lane, Bollington, Macclesfield, SK10 5JB, UK
| | - Jimena Patarroyo
- ViiV Healthcare, 406 Blackwell Street, Suite 300, Durham, NC, 27701, USA
| | - Andrew P Brogan
- ViiV Healthcare, 406 Blackwell Street, Suite 300, Durham, NC, 27701, USA
| | - Alan Oglesby
- ViiV Healthcare, 406 Blackwell Street, Suite 300, Durham, NC, 27701, USA.
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18
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Walmsley S, Smith DE, Górgolas M, Cahn PE, Lutz T, Lacombe K, Kumar PN, Wynne B, Grove R, Bontempo G, Moodley R, Okoli C, Kisare M, Jones B, Clark A, Ait-Khaled M. Efficacy and safety of switching to dolutegravir/lamivudine in virologically suppressed people with HIV-1 aged ≥ 50 years: week 48 pooled results from the TANGO and SALSA studies. AIDS Res Ther 2024; 21:17. [PMID: 38515183 PMCID: PMC10958962 DOI: 10.1186/s12981-024-00604-9] [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: 12/13/2023] [Accepted: 03/13/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND As the population of people with HIV ages, concerns over managing age-related comorbidities, polypharmacy, immune recovery, and drug-drug interactions while maintaining viral suppression have arisen. We present pooled TANGO and SALSA efficacy and safety results dichotomized by age (< 50 and ≥ 50 years). METHODS Week 48 data from the open-label phase 3 TANGO and SALSA trials evaluating switch to once-daily dolutegravir/lamivudine (DTG/3TC) fixed-dose combination vs continuing current antiretroviral regimen (CAR) were pooled. Proportions of participants with HIV-1 RNA ≥ 50 and < 50 copies/mL (Snapshot, intention-to-treat exposed) and safety were analyzed by age category. Adjusted mean change from baseline in CD4 + cell count was assessed using mixed-models repeated-measures analysis. RESULTS Of 1234 participants, 80% of whom were male, 29% were aged ≥ 50 years. Among those aged ≥ 50 years, 1/177 (< 1%) DTG/3TC participant and 3/187 (2%) CAR participants had HIV-1 RNA ≥ 50 copies/mL at 48 weeks; proportions with HIV-1 RNA < 50 copies/mL were high in both treatment groups (≥ 92%), consistent with overall efficacy and similar to observations in participants aged < 50 years (≥ 93%). Regardless of age category, CD4 + cell count increased or was maintained from baseline with DTG/3TC. Change from baseline in CD4 + /CD8 + ratio was similar across age groups and between treatment groups. One CAR participant aged < 50 years had confirmed virologic withdrawal, but no resistance was detected. In the DTG/3TC group, incidence of adverse events (AEs) was similar across age groups. Proportions of AEs leading to withdrawal were low and comparable between age groups. Although drug-related AEs were generally low, across age groups, drug-related AEs were more frequent in participants who switched to DTG/3TC compared with those who continued CAR. While few serious AEs were observed in both treatment groups, more were reported in participants aged ≥ 50 years vs < 50 years. CONCLUSIONS Among individuals with HIV-1, switching to DTG/3TC maintained high rates of virologic suppression and demonstrated a favorable safety profile, including in those aged ≥ 50 years despite higher prevalence of concomitant medication use and comorbidities. TRIAL REGISTRATION NUMBER TANGO, NCT03446573 (February 27, 2018); SALSA, NCT04021290 (July 16, 2019).
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Affiliation(s)
- Sharon Walmsley
- University Health Network, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada
| | - Don E Smith
- Albion Centre, 150 Albion Street, Surry Hills NSW 2010, Sydney, Australia
| | - Miguel Górgolas
- Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Av. de los Reyes Católicos, 2, 28040, Madrid, Spain
| | - Pedro E Cahn
- Fundación Huésped, Dr. Carlos A. Gianantonio 3932, C1204 CABA, Buenos Aires, Argentina
| | - Thomas Lutz
- Infektiologikum, Stresemannallee 3, 60596, Frankfurt am Main, Frankfurt, Germany
| | - Karine Lacombe
- Hôpital Saint-Antoine, 184 Rue du Faubourg Saint-Antoine, 75012, Paris, France
| | - Princy N Kumar
- Georgetown University Medical Center, 4000 Reservoir Road, NW, Washington, DC, 20057, USA
| | - Brian Wynne
- ViiV Healthcare, 406 Blackwell Street, Suite 300, Durham, NC, 27701, USA
| | - Richard Grove
- GSK, 980 Great West Road, Brentford, Middlesex, TW8 9GS, UK
| | - Gilda Bontempo
- ViiV Healthcare, 36 E Industrial Road, Branford, CT, 06405, USA
| | - Riya Moodley
- ViiV Healthcare, 980 Great West Road, Brentford, Middlesex, TW8 9GS, UK
| | - Chinyere Okoli
- ViiV Healthcare, 980 Great West Road, Brentford, Middlesex, TW8 9GS, UK
| | - Michelle Kisare
- ViiV Healthcare, 980 Great West Road, Brentford, Middlesex, TW8 9GS, UK.
| | - Bryn Jones
- ViiV Healthcare, 980 Great West Road, Brentford, Middlesex, TW8 9GS, UK
| | - Andrew Clark
- ViiV Healthcare, 980 Great West Road, Brentford, Middlesex, TW8 9GS, UK
| | - Mounir Ait-Khaled
- ViiV Healthcare, 980 Great West Road, Brentford, Middlesex, TW8 9GS, UK
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19
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Chu C, Tao K, Kouamou V, Avalos A, Scott J, Grant PM, Rhee SY, McCluskey SM, Jordan MR, Morgan RL, Shafer RW. Prevalence of Emergent Dolutegravir Resistance Mutations in People Living with HIV: A Rapid Scoping Review. Viruses 2024; 16:399. [PMID: 38543764 PMCID: PMC10975848 DOI: 10.3390/v16030399] [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: 01/23/2024] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Dolutegravir (DTG) is a cornerstone of global antiretroviral (ARV) therapy (ART) due to its high efficacy and favorable tolerability. However, limited data exist regarding the risk of emergent integrase strand transfer inhibitor (INSTI) drug-resistance mutations (DRMs) in individuals receiving DTG-containing ART. METHODS We performed a PubMed search using the term "Dolutegravir", last updated 18 December 2023, to estimate the prevalence of VF with emergent INSTI DRMs in people living with HIV (PLWH) without previous VF on an INSTI who received DTG-containing ART. RESULTS Of 2131 retrieved records, 43 clinical trials, 39 cohorts, and 6 cross-sectional studies provided data across 6 clinical scenarios based on ART history, virological status, and co-administered ARVs: (1) ART-naïve PLWH receiving DTG plus two NRTIs; (2) ART-naïve PLWH receiving DTG plus lamivudine; (3) ART-experienced PLWH with VF on a previous regimen receiving DTG plus two NRTIs; (4) ART-experienced PLWH with virological suppression receiving DTG plus two NRTIs; (5) ART-experienced PLWH with virological suppression receiving DTG and a second ARV; and (6) ART-experienced PLWH with virological suppression receiving DTG monotherapy. The median proportion of PLWH in clinical trials with emergent INSTI DRMs was 1.5% for scenario 3 and 3.4% for scenario 6. In the remaining four trial scenarios, VF prevalence with emergent INSTI DRMs was ≤0.1%. Data from cohort studies minimally influenced prevalence estimates from clinical trials, whereas cross-sectional studies yielded prevalence data lacking denominator details. CONCLUSIONS In clinical trials, the prevalence of VF with emergent INSTI DRMs in PLWH receiving DTG-containing regimens has been low. Novel approaches are required to assess VF prevalence with emergent INSTI DRMs in PLWH receiving DTG in real-world settings.
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Affiliation(s)
- Carolyn Chu
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA 94110, USA;
| | - Kaiming Tao
- Division of Infectious Diseases, Department of Medicine, Stanford University, Stanford, CA 94305, USA (J.S.); (S.-Y.R.)
| | - Vinie Kouamou
- Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare 00263, Zimbabwe;
| | - Ava Avalos
- Careena Center for Health, Gaborone, Botswana
| | - Jake Scott
- Division of Infectious Diseases, Department of Medicine, Stanford University, Stanford, CA 94305, USA (J.S.); (S.-Y.R.)
| | - Philip M. Grant
- Division of Infectious Diseases, Department of Medicine, Stanford University, Stanford, CA 94305, USA (J.S.); (S.-Y.R.)
| | - Soo-Yon Rhee
- Division of Infectious Diseases, Department of Medicine, Stanford University, Stanford, CA 94305, USA (J.S.); (S.-Y.R.)
| | | | - Michael R. Jordan
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, MA 02111, USA
- Collaboratory for Emerging Infectious Diseases and Response (CEIDR), Tufts University, Medford, MA 02155, USA
| | - Rebecca L. Morgan
- School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Robert W. Shafer
- Division of Infectious Diseases, Department of Medicine, Stanford University, Stanford, CA 94305, USA (J.S.); (S.-Y.R.)
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20
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Shimura M, Higashi-Kuwata N, Fujiwara A, Taniguchi M, Ichinose T, Hamano F, Uematsu M, Inoue T, Matsuyama S, Suzuki T, Ghosh AK, Shindou H, Shimuzu T, Mitsuya H. A lipid index for risk of hyperlipidemia caused by anti-retroviral drugs. Antiviral Res 2024; 223:105819. [PMID: 38272319 DOI: 10.1016/j.antiviral.2024.105819] [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: 11/29/2023] [Revised: 01/14/2024] [Accepted: 01/20/2024] [Indexed: 01/27/2024]
Abstract
HIV-associated lipodystrophy has been reported in people taking anti-retroviral therapy (ART). Lipodystrophy can cause cardiovascular diseases, affecting the quality of life of HIV-infected individuals. In this study, we propose a pharmacological lipid index to estimate the risk of hyperlipidemia caused by anti-retroviral drugs. Lipid droplets were stained in cells treated with anti-retroviral drugs and cyclosporin A. Signal intensities of lipid droplets were plotted against the drug concentrations to obtain an isodose of 10 μM of cyclosporin A, which we call the Pharmacological Lipid Index (PLI). The PLI was then normalized by EC50. PLI/EC50 values were low in early proteinase inhibitors and the nucleoside reverse transcriptase inhibitor, d4T, indicating high risk of hyperlipidemia, which is consistent with previous findings of hyperlipidemia. In contrast, there are few reports of hyperlipidemia for drugs with high PLI/EC50 scores. Data suggests that PLI/EC50 is a useful index for estimating the risk of hyperlipidemia.
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Affiliation(s)
- Mari Shimura
- Research Institute, National Center for Global Health and Medicine, Shinjuku, Tokyo, Japan; RIKEN SPring-8 Center, Sayo, Hyogo, Japan.
| | - Nobuyo Higashi-Kuwata
- Department of Refractory Viral Diseases, National Center for Global Health and Medicine, Shinjuku, Tokyo, Japan
| | - Asuka Fujiwara
- Department of Refractory Viral Diseases, National Center for Global Health and Medicine, Shinjuku, Tokyo, Japan
| | - Mai Taniguchi
- Inorganic Analysis Laboratories, Toray Research Center, Inc., Otsu, Shiga, Japan
| | - Takayuki Ichinose
- Inorganic Analysis Laboratories, Toray Research Center, Inc., Otsu, Shiga, Japan
| | - Fumie Hamano
- Life Sciences Core Facility, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan; Department of Lipid Signaling, Research Institute, National Center for Global Health and Medicine, Shinjuku, Tokyo, Japan
| | - Masaaki Uematsu
- Department of Lipid Signaling, Research Institute, National Center for Global Health and Medicine, Shinjuku, Tokyo, Japan
| | - Takato Inoue
- Department of Materials Physics, Graduate School of Engineering, Nagoya University, Furo-cho, Chikusa-ku, Nagoya, 464-8603, Japan
| | - Satoshi Matsuyama
- RIKEN SPring-8 Center, Sayo, Hyogo, Japan; Department of Materials Physics, Graduate School of Engineering, Nagoya University, Furo-cho, Chikusa-ku, Nagoya, 464-8603, Japan
| | - Takahiro Suzuki
- Department of Chemistry, Faculty of Science, Hokkaido University, Sapporo, Japan
| | - Arun K Ghosh
- Department of Chemistry & Department of Medicinal Chemistry, Purdue University, West Lafayette, IN, 47907, USA
| | - Hideo Shindou
- Department of Lipid Life Science, Research Institute, National Center for Global Health and Medicine, Shinjuku, Tokyo, Japan; Department of Medical Lipid Science, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Takao Shimuzu
- Department of Lipid Signaling, Research Institute, National Center for Global Health and Medicine, Shinjuku, Tokyo, Japan; Institute of Microbial Chemistry, Shinagawa-ku, Tokyo, Japan
| | - Hiroaki Mitsuya
- Department of Refractory Viral Diseases, National Center for Global Health and Medicine, Shinjuku, Tokyo, Japan; Experimental Retrovirology Section, HIV and AIDS Malignancy Branch, National Center Institute, National Institutes of Health, Bethesda, MD, 20893, USA.
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21
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Malagnino V, Mulas T, Teti E, Basso M, Giobbia M, Geremia N, Battagin G, Abi Aad Y, Vincensini JP, Iannetta M, Parisi SG, Sarmati L, Lacombe K. HBcAb Positivity as a Risk Factor for Missing HIV RNA Undetectability after the 3TC+DTG Switch. Viruses 2024; 16:348. [PMID: 38543714 PMCID: PMC10974397 DOI: 10.3390/v16030348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 02/19/2024] [Accepted: 02/21/2024] [Indexed: 05/23/2024] Open
Abstract
Hepatitis B Core antibody (HBcAb) positivity is the surrogate marker of hepatitis B occult infection. This condition is not a contraindication for switching to two-drug (2DR) antiretroviral therapy; however, the removal of tenofovir may contribute to poor control of HBV replication. A multicentre retrospective cohort study investigated the impact of HBcAb positivity on HIV control in patients switching to a 2DR with Lamivudine and Dolutegravir (3TC-DTG). In this study, a comparison analysis was conducted between HBcAb-positive and -negative PLWH regarding HIV-RNA suppression, considering: (1): Target Not Detected (TND) < 20 cp/mL; (2) Target Detected (TD) < 20 cp/mL; and (3) Detectable > 20 cp/mL and <50 cp/mL and >50 copies/mL. A total of 267 patients on 2DR with 3TC-DTG were included. In comparison to HBcAb-negative, HBcAb-positive patients were older (45 years [35-54]) and had a lower CD4+ nadir (248 vs. 349 cells/mmc, p = 0.007). No difference in the maintenance of virological suppression was present in the two groups of patients before the switch. Although no patient had an HIV-RNA > 20 cp/mL after the switch, significantly fewer HBcAb-positive compared with -negative subjects resulted in TND at 12, 24, and 36 months after the switch: 52 (69.3%) versus 164 (85.4%), p = 0.004, 50 [72.5%] versus 143 [89.9%], p = 0.001, and 30 [66.7%] versus 90 [92.8%], p = 0.001, respectively. HBcAb positivity is associated with an increased risk of suboptimal HIV suppression during the 36 months after 3TC/DTG simplification. This finding reinforces the relevance of the OBI condition in PLWH and raises the issue of careful virological monitoring of such cases.
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Affiliation(s)
- Vincenzo Malagnino
- Infectious Disease Unit, Policlinico Tor Vergata of Rome, 00133 Rome, Italy; (T.M.); (E.T.); (M.I.); (L.S.)
- Department of System Medicine, Tor Vergata University of Rome, 00133 Rome, Italy
| | - Tiziana Mulas
- Infectious Disease Unit, Policlinico Tor Vergata of Rome, 00133 Rome, Italy; (T.M.); (E.T.); (M.I.); (L.S.)
| | - Elisabetta Teti
- Infectious Disease Unit, Policlinico Tor Vergata of Rome, 00133 Rome, Italy; (T.M.); (E.T.); (M.I.); (L.S.)
| | - Monica Basso
- Department of Molecular Medicine, University of Padova, 35128 Padova, Italy; (M.B.); (S.G.P.)
| | - Mario Giobbia
- Infectious Disease Unit, Ospedale di Treviso, 31100 Treviso, Italy;
| | - Nicholas Geremia
- Infectious Disease Unit, Ospedale di Venezia, 30122 Venezia, Italy;
| | | | - Yasmine Abi Aad
- Hôpital Saint-Antoine, Assistance Publique Des Hôpitaux de Paris, Service Des Maladies Infectieuses Et Tropicales, Cedex 12, 75571 Paris, France; (Y.A.A.); (J.-P.V.); (K.L.)
| | - Jean-Paul Vincensini
- Hôpital Saint-Antoine, Assistance Publique Des Hôpitaux de Paris, Service Des Maladies Infectieuses Et Tropicales, Cedex 12, 75571 Paris, France; (Y.A.A.); (J.-P.V.); (K.L.)
| | - Marco Iannetta
- Infectious Disease Unit, Policlinico Tor Vergata of Rome, 00133 Rome, Italy; (T.M.); (E.T.); (M.I.); (L.S.)
- Department of System Medicine, Tor Vergata University of Rome, 00133 Rome, Italy
| | - Saverio Giuseppe Parisi
- Department of Molecular Medicine, University of Padova, 35128 Padova, Italy; (M.B.); (S.G.P.)
| | - Loredana Sarmati
- Infectious Disease Unit, Policlinico Tor Vergata of Rome, 00133 Rome, Italy; (T.M.); (E.T.); (M.I.); (L.S.)
- Department of System Medicine, Tor Vergata University of Rome, 00133 Rome, Italy
| | - Karine Lacombe
- Hôpital Saint-Antoine, Assistance Publique Des Hôpitaux de Paris, Service Des Maladies Infectieuses Et Tropicales, Cedex 12, 75571 Paris, France; (Y.A.A.); (J.-P.V.); (K.L.)
- INSERM, Pierre Louis Institute of Epidemiology and Public Health (IPLESP), Sorbonne University, 75646 Paris, France
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Sequera-Arquelladas S, Hidalgo-Tenorio C, López-Cortés L, Gutiérrez A, Santos J, Téllez F, Omar M, Ferra-Murcia S, Fernández E, Javier R, García-Vallecillos C, Pasquau J. DOLAMA 200: Effectiveness and Safety of a Dual Therapy with Dolutegravir Plus Lamivudine in Treatment-Experienced HIV-1 Infected Real World Participants in Spain. Viruses 2024; 16:259. [PMID: 38400035 PMCID: PMC10893067 DOI: 10.3390/v16020259] [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: 12/20/2023] [Revised: 01/14/2024] [Accepted: 02/01/2024] [Indexed: 02/25/2024] Open
Abstract
The continuous pharmacological advances in antiretroviral treatment (ART) and the increasing understanding of HIV drug resistance has led to a change in the paradigm of ART optimization in the setting of the viral suppression of treatment-experienced patients with the emerging evidence of the effectiveness and safety of dual therapies. The aim of this study is to determine the antiviral efficacy and safety of switching to Dolutegravir + Lamivudine in people living with HIV, and to analyze the rate of patients with virologic failure (VF). A total of 200 patients were included with a median age of 51 years, 189 cells/µL of nadir CD4+, 13 years on ART and four previous ART regimens. Among the 168 patients who completed a follow-up at 48 weeks, a total of five VFs occurred, resulting in a 2.98% (5/168) VF rate. The results of the intention-to-treat analysis were a VF rate of 2.54% (5/197), and the rate of patients/year with viral suppression was 98.3% (298/303) in the observed data analysis. We observed a significant improvement in mean CD4 lymphocytes, the CD4/CD8 ratio and lipid profiles. The optimization of ART to DTG plus 3TC is a cost-effective switch option for treatment-experienced HIV patients, and also improves their lipid profiles.
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Affiliation(s)
- Sergio Sequera-Arquelladas
- Unit of Infectious Diseases, Instituto de Investigación Biosanitario de Granada (IBS-Granada), Virgen de las Nieves University Hospital, 18014 Granada, Spain; (C.H.-T.); (R.J.); (C.G.-V.); (J.P.)
| | - Carmen Hidalgo-Tenorio
- Unit of Infectious Diseases, Instituto de Investigación Biosanitario de Granada (IBS-Granada), Virgen de las Nieves University Hospital, 18014 Granada, Spain; (C.H.-T.); (R.J.); (C.G.-V.); (J.P.)
| | - Luis López-Cortés
- Department of Infectious Diseases, Virgen del Rocio University Hospitals, 41013 Seville, Spain; (L.L.-C.); (A.G.)
| | - Alicia Gutiérrez
- Department of Infectious Diseases, Virgen del Rocio University Hospitals, 41013 Seville, Spain; (L.L.-C.); (A.G.)
| | - Jesús Santos
- IBIMA Plataforma BIONAND, Unit of Infectious Diseases, Virgen de la Victoria University Hospital, 29010 Málaga, Spain;
| | - Francisco Téllez
- Unit of Infectious Diseases, Puerto Real Universitary Hospital, 11510 Cádiz, Spain;
| | - Mohamed Omar
- Unit of Infectious Diseases, Hospital Complex of Jaen, 23007 Jaén, Spain;
| | - Sergio Ferra-Murcia
- Unit of Infectious Diseases, Hospital Torrecárdenas Hospital, 04009 Almería, Spain;
| | - Elisa Fernández
- Internal medicine Service, Hospital Poniente, 04700 Almería, Spain;
| | - Rosario Javier
- Unit of Infectious Diseases, Instituto de Investigación Biosanitario de Granada (IBS-Granada), Virgen de las Nieves University Hospital, 18014 Granada, Spain; (C.H.-T.); (R.J.); (C.G.-V.); (J.P.)
| | - Coral García-Vallecillos
- Unit of Infectious Diseases, Instituto de Investigación Biosanitario de Granada (IBS-Granada), Virgen de las Nieves University Hospital, 18014 Granada, Spain; (C.H.-T.); (R.J.); (C.G.-V.); (J.P.)
| | - Juan Pasquau
- Unit of Infectious Diseases, Instituto de Investigación Biosanitario de Granada (IBS-Granada), Virgen de las Nieves University Hospital, 18014 Granada, Spain; (C.H.-T.); (R.J.); (C.G.-V.); (J.P.)
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23
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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.
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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
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Calza L, Colangeli V, Legnani G, Cretella S, Bon I, Viale P. Efficacy and Safety of Switching to Dolutegravir/Lamivudine in Virologically Suppressed People Living with HIV-1 Aged Over 65 Years. AIDS Res Hum Retroviruses 2024; 40:73-79. [PMID: 37335031 DOI: 10.1089/aid.2023.0046] [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: 06/21/2023] Open
Abstract
Clinical trials of dual regimen dolutegravir/lamivudine (DOL/3TC) demonstrated potent efficacy and favorable safety in both antiretroviral therapy-naïve and -experienced patients, but data on older people are lacking. We aimed to evaluate virological efficacy and safety of DOL/3TC in suppressed older patients over a 12-month period. We performed a retrospective cohort study evaluating people living with HIV (PLWHIV) aged ≥65 years at our HIV Clinic who were switched to DOL/3TC. Eligible patients had baseline HIV-1 RNA <20 copies/mL, and no previous virological failures or known resistance mutations for lamivudine or dolutegravir. Inclusion criteria were met by 72 patients: 59 were men, median age was 69.2 years, and one or more comorbidities were present in 89% of patients. The most common reason for switch was simplification, followed by drug-drug interactions (DDIs) and toxicities. After 12 months, 64 (88.9%, by the intention-to-treat analysis) patients maintained HIV-1 RNA <20 copies/mL, and reasons for treatment failure were virological failure in three cases, adverse events in three, and missing data in two. Genotype resistance testing showed no resistance mutations for lamivudine or dolutegravir in subjects with virological failure. The number of potential DDIs decreased from 92 to 12 after switching to DOL/3TC, and a significant reduction in median total and low-density lipoprotein cholesterol was reported, while median change in body weight was not significant. In this real-life cohort, switching to DOL/3TC was associated with maintenance of virological control and good tolerability among persons aged >65 years, supporting use of this dual regimen in older PLWHIV.
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Affiliation(s)
- Leonardo Calza
- Unit of Infectious Diseases, Department of Medical and Surgical Sciences, S.Orsola Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Vincenzo Colangeli
- Unit of Infectious Diseases, Department of Medical and Surgical Sciences, S.Orsola Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Giorgio Legnani
- Unit of Infectious Diseases, Department of Medical and Surgical Sciences, S.Orsola Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Silvia Cretella
- Unit of Infectious Diseases, Department of Medical and Surgical Sciences, S.Orsola Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Isabella Bon
- Unit of Microbiology, Department of Medical and Surgical Sciences, S.Orsola Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Pierluigi Viale
- Unit of Infectious Diseases, Department of Medical and Surgical Sciences, S.Orsola Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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25
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Ripamonti D, Rusconi S, Zazzi M. A cautionary note on entry and exit strategies with long-acting cabotegravir and rilpivirine. AIDS 2024; 38:263-265. [PMID: 38116723 DOI: 10.1097/qad.0000000000003760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Affiliation(s)
| | - Stefano Rusconi
- Infectious Diseases Unit, ASST Ovest Milanese, Legnano General Hospital and DIBIC 'Luigi, Sacco', University of Milan, Milan
| | - Maurizio Zazzi
- Department of Medical Biotechnology, University of Siena, Siena, Italy
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26
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Lao X, Zhang H, Deng M, Li Q, Xiao Q, He L, Ma L, Song A, Liang X, Yu F, Zhao H, Zhang F. Incidence of low-level viremia and its impact on virologic failure among people living with HIV who started an integrase strand transfer inhibitors: a longitudinal cohort study. BMC Infect Dis 2024; 24:8. [PMID: 38166689 PMCID: PMC10759638 DOI: 10.1186/s12879-023-08906-5] [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: 10/12/2023] [Accepted: 12/13/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Low-level viremia (LLV) has been identified as a potential precursor to virologic failure (VF), yet its clinical implications, particularly within the context of Integrase Strand Transfer Inhibitors (INSTIs)-based regimens, remain insufficiently explored. The study aimed to investigate the relationship between LLV and VF within ART-naïve patients on INSTIs-based regimens in China. METHODS A longitudinal cohort study was conducted with ART-naïve patients aged ≥ 18 years at Beijing Ditan Hospital, under the Chinese National Free Antiretroviral Treatment Program (NFATP). The LLV was defined as a viral load (VL) ranging from 50 to 199 copies/mL after six months of ART initiation, and VF as a VL ≥ 200 copies/mL. Sensitive analyses were also performed, defining LLV as 50-999 copies/mL and VF as exceeding 1000 copies/mL. Multivariate logistic regression, Kaplan-Meier (KM) curve, and Generalized Estimating Equation (GEE) models were used to evaluate the risk factors associated with LLV and VF events. RESULTS The study involved 830 ART-naïve patients, comprising 600 in the INSTIs group and 230 in the protease inhibitors (PIs) group. LLV events were observed in 10.4% of patients on PIs-based regimens and and 3.2% on INSTIs-based regimens (P < 0.001). INSTIs-based regimens demonstrated a protective effect against LLV events (aHR = 0.27, 95% CI 0.137-0.532). VF events occurred in 10.9% of patients on PIs-based regimens and 2.0% on INSTIs-based regimens, respectively (P < 0.001). The occurrence of LLV events significantly increased the risk of VF by 123.5% (95% CI 7.5%-364.4%), while the integrase inhibitors were associated with a 76.9% (95% CI 59.1%-86.9%) reduction in VF risk. CONCLUSION Our findings indicate that INSTIs-based regimens are critical protective factors against LLV and subsequent VF. These results underscore the importance of HIV viral load monitoring to ensuring effective treatment outcomes, highlighting the necessity for prompt and precise monitoring to refine HIV treatment methodologies.
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Affiliation(s)
- Xiaojie Lao
- Department of Infectious Disease, Beijing Ditan Hospital Capital Medical University, Beijing, 100015, China
| | - Hanxi Zhang
- WHO Collaborating Centre for Comprehensive Management of HIV Treatment and Care, Beijing Ditan Hospital Capital Medical University, Beijing, 100015, China
| | - Meiju Deng
- Clinical Center for HIV/AIDS, Beijing Ditan Hospital Capital Medical University, Beijing, 100015, China
| | - Qun Li
- Department of Infectious Disease, Beijing Ditan Hospital Capital Medical University, Beijing, 100015, China
| | - Qing Xiao
- Department of Infectious Disease, Beijing Ditan Hospital Capital Medical University, Beijing, 100015, China
| | - Lin He
- State Key Laboratory of Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 102206, China
| | - Liying Ma
- State Key Laboratory of Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 102206, China
| | - Aqian Song
- Department of Gastroenterology, Beijing Ditan Hospital Capital Medical University, Beijing, 100015, China
| | - Xuelei Liang
- Department of Infectious Disease, Beijing Ditan Hospital Capital Medical University, Beijing, 100015, China
| | - Fengting Yu
- Department of Infectious Disease, Beijing Ditan Hospital Capital Medical University, Beijing, 100015, China
| | - Hongxin Zhao
- Clinical Center for HIV/AIDS, Beijing Ditan Hospital Capital Medical University, Beijing, 100015, China
| | - Fujie Zhang
- Department of Infectious Disease, Beijing Ditan Hospital Capital Medical University, Beijing, 100015, China.
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27
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Wang R, Underwood M, Llibre JM, Bernal Morell E, Brinson C, Sanz Moreno J, Scholten S, Moore R, Saggu P, Oyee J, Moodley R, Wynne B, Kisare M, Jones B, Ait-Khaled M. Very-Low-Level Viremia, Inflammatory Biomarkers, and Associated Baseline Variables: Three-Year Results of the Randomized TANGO Study. Open Forum Infect Dis 2024; 11:ofad626. [PMID: 38213637 PMCID: PMC10783236 DOI: 10.1093/ofid/ofad626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Indexed: 01/13/2024] Open
Abstract
Background We compared proportions of participants with target detected, target not detected (TND), and elevated viral load (VL) and assessed baseline variables associated with week 144 inflammatory biomarker levels between dolutegravir-lamivudine (DTG/3TC) and tenofovir alafenamide-based regimens (TBRs) in the TANGO study (post hoc). Methods TANGO is an open-label, multicenter, phase 3 study that randomized adults with VL <50 copies/mL to switch to once-daily fixed-dose DTG/3TC or continue TBR. At baseline and each study visit, the VL was measured. Elevated VL event frequencies were assessed, including "blips." Interleukin 6, D-dimer, high-sensitivity C-reactive protein, soluble CD14, and soluble CD163 were measured at baseline and at week 144. Loge-transformed week 144 biomarker levels were compared between treatment groups using an analysis of covariance model adjusting for baseline variables. Results High, comparable proportions of participants had VL <40 copies/mL and TND at week 144 (DTG/3TC, 279 of 369 [76%]; TBR, 267 of 372 [72%], intention-to-treat exposed Snapshot analysis; adjusted difference, 3.9% [95% confidence interval, -2.5% to 10.2%]), with similar TND proportions at all postbaseline visits (123 of 369 [33%] vs 101 of 372 [27%], respectively). Similar proportions of DTG/3TC participants had ≥1 postbaseline VL ≥50 copies/mL (28 of 369 [8%] vs 42 of 372 [11%] for TBR), primarily blips (18 of 369 [5%] and 26 of 372 [7%], respectively). Week 144 inflammatory biomarker levels were low and comparable between groups and associated with multiple demographic and baseline characteristics, including baseline biomarker levels, indicating a multifactorial inflammatory response. Conclusions Week 144 biomarker levels were low and generally comparable between treatment groups, reflecting similar, robust, and durable viral suppression observed using the stringent TND end point. Trial registration: ClinicalTrials.gov, NCT03446573.
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Affiliation(s)
- Ruolan Wang
- ViiV Healthcare, Durham, North Carolina, USA
| | | | - Josep M Llibre
- Infectious Diseases Division and Fight Infections Foundation, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Enrique Bernal Morell
- Department of Infectious Diseases, Hospital General Universitario Reina Sofía, Murcia, Spain
| | | | - José Sanz Moreno
- Departamento de Medicina Interna, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Spain
| | | | | | | | | | | | - Brian Wynne
- ViiV Healthcare, Durham, North Carolina, USA
| | | | - Bryn Jones
- ViiV Healthcare, Brentford, United Kingdom
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28
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Abadie RB, Brown EM, Campbell JR, Alvarez IA, Allampalli V, Ahmadzadeh S, Varrassi G, Shekoohi S, Kaye AD. Incidence and Risks of HIV Infection, Medication Options, and Adverse Effects in Accidental Needle Stick Injuries: A Narrative Review. Cureus 2024; 16:e51521. [PMID: 38304675 PMCID: PMC10831193 DOI: 10.7759/cureus.51521] [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: 11/29/2023] [Accepted: 01/02/2024] [Indexed: 02/03/2024] Open
Abstract
Accidental needle sticks can lead to infections, including HIV. As scientists have learned more about HIV and its replicative physiology, identification of target sites and novel medications have been developed. HIV is spread throughout the population through contact with blood, semen, and rectal or vaginal secretions of infected individuals. Therefore, it is important in general for healthcare workers to be aware of its transmission modes and ways to minimize exposure. In this regard, even with hospitals providing education, training, and safety protocols, there is a continued infection spread with HIV, especially by accidental needle sticks. There is also a wide variety of testing that can be used for HIV utilizing different methodologies, allowing for improved measurement of infection status. Any person with HIV should be tested to clarify infection status and be educated to minimize future virus spread. The current CDC recommendations for HIV infection treatment are antiretroviral therapies, such as an HIV postexposure prophylaxis regimen, which consists of a cocktail of antiretrovirals and postexposure prophylaxis immediately for occupational exposures, such as accidental needlestick exposure from an HIV infected patient. To decrease accidental HIV stick injuries, there are safety precautions in place, that if followed, would help reduce this incidence. HIV accidental needle stick injuries still happen in the hospital workplace, but with proper education and treatment, if exposed, there is hope to minimize the effects.
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Affiliation(s)
- Raegan B Abadie
- School of Medicine, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Elise M Brown
- School of Medicine, Louisiana State University Health Sciences Center, Shreveport, USA
| | - John R Campbell
- School of Medicine, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Ivan A Alvarez
- School of Medicine, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Varsha Allampalli
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Shahab Ahmadzadeh
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | | | - Sahar Shekoohi
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
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29
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De Socio GV, Tordi S, Altobelli D, Gidari A, Zoffoli A, Francisci D. Dolutegravir/Lamivudine versus Tenofovir Alafenamide/Emtricitabine/Bictegravir as a Switch Strategy in a Real-Life Cohort of Virogically Suppressed People Living with HIV. J Clin Med 2023; 12:7759. [PMID: 38137828 PMCID: PMC10743626 DOI: 10.3390/jcm12247759] [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: 11/18/2023] [Revised: 12/01/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND The aim of the study is to evaluate the effectiveness, safety, and tolerability of a two-drug regimen (2-DR) dolutegravir/lamivudine (DTG/3TC) versus a three-drug regimen (3-DR) tenofovir alafenamide/emtricitabine/bictegravir (TAF/FTC/BIC) in a real-life cohort of HIV-1 virologically suppressed treatment-experienced (TE) people living with HIV (PLWH). METHODS This was a single-center, retrospective, observational study analyzing adult TE PLWH who started the 2-DR or 3-DR between January 2018 and January 2023. All PLWH with a viral load (VL) <50 copies/mL at the time of switching, and a follow-up of more than 6 months or interruption of treatment at any time, were included. RESULTS A total of 324 PLWH were included; of these, 110 (34%) were on the 2-DR and 214 (66%) were on the 3-DR. Most patients remained on therapy in both groups (93.6% 2-DR versus 90.2% 3-DR) and, at the last control, 99.1% achieved VL < 50 copies/mL with the 2-DR versus 97.2% with the 3-DR (p = 0.260). No virological failures occurred in either group. Adverse events occurred in a few cases: four (3.6%) in the 2-DR group and five (2.3%) in the 3-DR group (p = 0.500). The median follow-up-time was 19.6 months for the 2-DR and 27.5 months for the 3-DR. CONCLUSION Our study shows a similar effectiveness and safety profile in virologically suppressed PLWH switching to DTG/3TC or TAF/FTC/BIC.
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Affiliation(s)
| | - Sara Tordi
- Correspondence: (G.V.D.S.); (S.T.); Tel.: +39-0755783262 (S.T.)
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30
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Henegar C, Letang E, Wang R, Hicks C, Fox D, Jones B, de Ruiter A, Vannappagari V. A Comprehensive Literature Review of Treatment-Emergent Integrase Resistance with Dolutegravir-Based Regimens in Real-World Settings. Viruses 2023; 15:2426. [PMID: 38140667 PMCID: PMC10747437 DOI: 10.3390/v15122426] [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: 11/15/2023] [Revised: 12/08/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
After a decade of dolutegravir (DTG) use in various antiretroviral therapy combinations and in diverse populations globally, it is critical to identify HIV strains with reduced drug susceptibility and monitor emergent resistance in people living with HIV who experience virologic failure while on DTG-based regimens. We searched the PubMed, Embase, and Cochrane databases to identify studies that reported DTG resistance-associated mutations (RAMs) emerging under selection pressure. Our review showed that RAMs conferring resistance to DTG were rare in 2-drug and 3-drug regimens used in real-world cohorts, corroborating data from clinical trials. The potency of DTG in maintaining virologic suppression was demonstrated, even in cases of pre-existing resistance to companion drugs in the regimen. Estimates of DTG RAMs depended on the population and certain risk factors, including monotherapy, baseline resistance or lack of genotypic testing, treatment history and prior virologic failure, and suboptimal treatment adherence. The RAMs detected after virologic failure, often in heavily treatment-experienced individuals with prior exposure to integrase strand transfer inhibitors, were G118R, E138K, G140A/C/R/S, Q148H/K/R, N155H, and R263K. Overall, these data highlight the durable effectiveness and high barrier to resistance of DTG as part of combination antiretroviral therapy in a wide variety of settings.
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Affiliation(s)
- Cassidy Henegar
- ViiV Healthcare, 406 Blackwell Street, Suite 300, Durham, NC 27701, USA; (R.W.); (C.H.); (D.F.); (V.V.)
| | - Emilio Letang
- ViiV Healthcare, P.T.M., Severo Ochoa 2, 28760 Tres Cantos, Madrid, Spain
| | - Ruolan Wang
- ViiV Healthcare, 406 Blackwell Street, Suite 300, Durham, NC 27701, USA; (R.W.); (C.H.); (D.F.); (V.V.)
| | - Charles Hicks
- ViiV Healthcare, 406 Blackwell Street, Suite 300, Durham, NC 27701, USA; (R.W.); (C.H.); (D.F.); (V.V.)
| | - Dainielle Fox
- ViiV Healthcare, 406 Blackwell Street, Suite 300, Durham, NC 27701, USA; (R.W.); (C.H.); (D.F.); (V.V.)
| | - Bryn Jones
- ViiV Healthcare, 980 Great West Road, Brentford TW8 9GS, Middlesex, UK
| | | | - Vani Vannappagari
- ViiV Healthcare, 406 Blackwell Street, Suite 300, Durham, NC 27701, USA; (R.W.); (C.H.); (D.F.); (V.V.)
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31
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Loaiza JD, Chvatal-Medina M, Hernandez JC, Rugeles MT. Integrase inhibitors: current protagonists in antiretroviral therapy. Immunotherapy 2023; 15:1477-1495. [PMID: 37822251 DOI: 10.2217/imt-2023-0011] [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: 10/13/2023] Open
Abstract
Since HIV was identified as the etiological agent of AIDS, there have been significant advances in antiretroviral therapy (ART) that has reduced morbidity/mortality. Still, the viral genome's high mutation rate, suboptimal ART regimens, incomplete adherence to therapy and poor control of the viral load generate variants resistant to multiple drugs. Licensing over 30 anti-HIV drugs worldwide, including integrase inhibitors, has marked a milestone since they are potent and well-tolerated drugs. In addition, they favor a faster recovery of CD4+ T cells. They also increase the diversity profile of the gut microbiota and reduce inflammatory markers. All of these highlight the importance of including them in different ART regimens.
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Affiliation(s)
- John D Loaiza
- Grupo Inmunovirología, Facultad de medicina, Universidad de Antioquia, Medellín, 050010, Colombia
| | - Mateo Chvatal-Medina
- Grupo Inmunovirología, Facultad de medicina, Universidad de Antioquia, Medellín, 050010, Colombia
| | - Juan C Hernandez
- Infettare, Facultad de medicina, Universidad Cooperativa de Colombia, Medellín, 050012, Colombia
| | - Maria T Rugeles
- Grupo Inmunovirología, Facultad de medicina, Universidad de Antioquia, Medellín, 050010, Colombia
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32
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Gan L, Xie X, Fu Y, Yang X, Ma S, Kong L, Song C, Song Y, Ren T, Long H. Comparison of dolutegravir+Lamivudine and bictegravir/emtricitabine/tenofovir alafenamide in antiretroviral therapy-naïve patients infected with HIV: preliminary results from clinical practice. Expert Rev Anti Infect Ther 2023:1-8. [PMID: 37927079 DOI: 10.1080/14787210.2023.2279719] [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: 07/09/2023] [Accepted: 09/29/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND The efficacy and safety of dolutegravir+lamivudine (DTG +3TC) and bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) have been demonstrated in clinical trials of treatment-naïve therapy. However, real-life data are lacking. We investigated and compared the virological outcomes and safety of DTG + 3TC with BIC/FTC/TAF in an adult cohort of people living with HIV (PLWH). RESEARCH DESIGN AND METHODS We performed a retrospective cohort analysis of PLWH who were naïve to antiretroviral therapy and initiated the antiretroviral regimen of DTG + 3TC or BIC/FTC/TAF from January 2020 to March 2022. Treatment effectiveness, defined as the capability of treatment to achieve viral suppression (viral load < 50 copies/mL), was analyzed. Changes in immunology, metabolism, liver and renal function after 48 weeks of treatment were evaluated. RESULTS At 48 weeks, both groups showed high viral suppression, with 82.4% (108/131) and 89% (129/145) of the patients in the BIC/FTC/TAF and DTG + 3TC groups, respectively, having viral suppression (OR = 0.58, 95% CI: 0.29-1.15, P = 0.3). No differences existed in immunology, metabolism, liver and renal function; however, BIC/FTC/TAF led to greater weight gain. CONCLUSIONS Both optimization strategies showed high tolerability in antiretroviral therapy-naïve patients, with no differences in virological efficacy; however, BIC/FTC/TAF may be related to the risk of weight gain risk. Further research is required to evaluate this problem.
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Affiliation(s)
- Lin Gan
- Infection disease department of Guiyang Public Health Clinical Center, Guiyang Public Health Clinical Center, Guiyang, China
| | - Xiaoxin Xie
- Infection disease department of Guiyang Public Health Clinical Center, Guiyang Public Health Clinical Center, Guiyang, China
| | - Yanhua Fu
- Infection disease department of Guiyang Public Health Clinical Center, Guiyang Public Health Clinical Center, Guiyang, China
| | - Xiaoyan Yang
- School of Public Health, the key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, China
| | - Shujing Ma
- School of Public Health, the key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, China
| | - Linghong Kong
- School of Public Health, the key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, China
| | - Chunli Song
- Infection disease department of Guiyang Public Health Clinical Center, Guiyang Public Health Clinical Center, Guiyang, China
| | - Yebing Song
- Infection disease department of Guiyang Public Health Clinical Center, Guiyang Public Health Clinical Center, Guiyang, China
| | - Tingting Ren
- Infection disease department of Guiyang Public Health Clinical Center, Guiyang Public Health Clinical Center, Guiyang, China
| | - Hai Long
- Infection disease department of Guiyang Public Health Clinical Center, Guiyang Public Health Clinical Center, Guiyang, China
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33
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Gan L, Xie X, Fu Y, Yang X, Ma S, Kong L, Song C, Song Y, Ren T, Long H. Bictegravir/Emtricitabine/Tenofovir Alafenamide Versus Dolutegravir Plus Lamivudine for Switch Therapy in Patients with HIV-1 Infection: A Real-World Cohort Study. Infect Dis Ther 2023; 12:2581-2593. [PMID: 37845566 PMCID: PMC10651567 DOI: 10.1007/s40121-023-00879-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 09/22/2023] [Indexed: 10/18/2023] Open
Abstract
INTRODUCTION Bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) and dolutegravir plus lamivudine (DTG + 3TC) are well tolerated and effective in clinical trials. This study aimed to evaluate the safety and efficacy of these two schemes in a real-world setting and to obtain the first dataset for switching to BIC/FTC/TAF and DTG + 3TC in a Chinese population. METHODS This retrospective single-center cohort study in China included participants who switched to DTG + 3TC or BIC/FTC/TAF between January 2020 and February 2023. The main endpoint was the proportion of participants with HIV-1 RNA levels of ≥ 50 copies/mL. Safety, tolerance, and the incidence of low-level viremia (LLV) were evaluated. RESULTS A total of 525 participants were included, 454 of whom were included in the PP analysis. At week 48, the proportions of participants with HIV-1 RNA ≥ 50 copies/mL were 4.4% (10/225) for DTG + 3TC and 6.1% (14/229) for BIC/FTC/TAF; virological efficacy did not differ significantly between the two groups. Consistent results were obtained in an intent-to-treat (ITT) analysis. The incidences of LLV were 3.6% (7/193) and 4.9% (10/206), respectively. During the study, none of the participants stopped taking drugs because of a lack of efficacy or adverse reactions. CONCLUSIONS Both regimens are well tolerated and effective for switching HIV-1 infection therapy. However, the detection of genotypic drug resistance should be considered when baseline virological non-suppression is observed.
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Affiliation(s)
- Lin Gan
- Guiyang Public Health Clinical Center, 6 Daying Road, Yunyan District, Guiyang, 550001, China
| | - Xiaoxin Xie
- Guiyang Public Health Clinical Center, 6 Daying Road, Yunyan District, Guiyang, 550001, China
| | - Yanhua Fu
- Guiyang Public Health Clinical Center, 6 Daying Road, Yunyan District, Guiyang, 550001, China
| | - Xiaoyan Yang
- School of Public Health, Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, 550025, China
| | - Shujing Ma
- School of Public Health, Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, 550025, China
| | - Linghong Kong
- School of Public Health, Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, 550025, China
| | - Chunli Song
- Guiyang Public Health Clinical Center, 6 Daying Road, Yunyan District, Guiyang, 550001, China
| | - Yebing Song
- Guiyang Public Health Clinical Center, 6 Daying Road, Yunyan District, Guiyang, 550001, China
| | - Tingting Ren
- Guiyang Public Health Clinical Center, 6 Daying Road, Yunyan District, Guiyang, 550001, China
| | - Hai Long
- Guiyang Public Health Clinical Center, 6 Daying Road, Yunyan District, Guiyang, 550001, China.
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Kabra M, Barber TJ, Allavena C, Marcelin AG, Di Giambenedetto S, Pasquau J, Gianotti N, Llibre JM, Rial-Crestelo D, De Miguel-Buckley R, Blick G, Turner M, Harrison C, Wynne T, Verdier G, Parry CM, Jones B, Okoli C, Donovan C, Priest J, Letang E. Virologic Response to Dolutegravir Plus Lamivudine in People With Suppressed Human Immunodeficiency Virus Type 1 and Historical M184V/I: A Systematic Literature Review and Meta-analysis. Open Forum Infect Dis 2023; 10:ofad526. [PMID: 38033982 PMCID: PMC10686367 DOI: 10.1093/ofid/ofad526] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Indexed: 12/02/2023] Open
Abstract
Background To investigate the impact of the M184V/I mutation on virologic response to dolutegravir plus lamivudine (DTG + 3TC) in suppressed-switch populations, a meta-analysis was performed using virologic outcomes from people with human immunodeficiency virus type 1 (PWH) with and without M184V/I before DTG + 3TC switch in real-world studies identified via systematic literature review. Sensitivity analyses were performed using data from PWH with M184V/I in interventional studies identified via targeted literature review. Methods Single-arm meta-analyses using common- and random-effects models were used to estimate proportions of PWH with virologic failure (VF) among real-world populations with and without M184V/I and interventional study participants with M184V/I at 24, 48, and 96 weeks. Results Literature reviews identified 5 real-world studies from 3907 publications and 51 abstracts meeting inclusion criteria and 5 interventional studies from 1789 publications and 3 abstracts. All time points had low VF incidence in PWH with M184V/I (real-world: 1.43%-3.81%; interventional: 0.00%) and without (real-world: 0.73%-2.37%). Meta-analysis-estimated proportions (95% confidence interval) with VF were low at weeks 24, 48, and 96, respectively, for PWH with M184V/I (real-world: 0.01 [.00-.04], 0.03 [.01-.06], and 0.04 [.01-.07]; interventional: 0.00 [.00-.02], 0.00 [.00-.01], and 0.00 [.00-.03]) and without (real-world: 0.00 [.00-.02], 0.02 [.01-.04], and 0.02 [.00-.05]). One real-world study (n = 712) reported treatment-emergent M184V at VF in 1 of 652 (0.15%) PWH without prior M184V/I. Conclusions Results suggest that prior M184V/I has minimal impact on virologic suppression after switching to DTG + 3TC and provide reassurance when considering switching regimens in virologically suppressed PWH with incomplete treatment history or limited treatment options.
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Affiliation(s)
| | - Tristan J Barber
- Ian Charleson Day Centre, Royal Free London National Health Service Foundation Trust, London, United Kingdom
- Institute for Global Health, University College London, London, United Kingdom
| | - Clotilde Allavena
- Department of Infectious and Tropical Diseases, Centre Hospitalier Universitaire Hôtel-Dieu, Nantes, France
| | - Anne-Geneviève Marcelin
- Sorbonne Université, Inserm, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Assistance Publique–Hôpitaux de Paris, Laboratoire de Virologie, Hôpital Pitié-Salpêtrière, Paris, France
| | - Simona Di Giambenedetto
- Laboratory and Infectious Diseases Sciences, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico and Department of Safety and Bioethics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Juan Pasquau
- Unit of Infectious Diseases, Virgen de las Nieves University Hospital, Granada, Spain
| | - Nicola Gianotti
- Infectious Diseases Unit, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale San Raffaele, Milan, Italy
| | - Josep M Llibre
- Infectious Diseases Division and Fight Infections Foundation, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - David Rial-Crestelo
- HIV Unit, Hospital Universitario 12 de Octubre, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
| | - Rosa De Miguel-Buckley
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
- Infectious Diseases Unit, Hospital Universitario La Paz, Madrid, Spain
| | - Gary Blick
- Health Care Advocates International, Stratford, Connecticut, USA
| | | | | | | | | | | | - Bryn Jones
- ViiV Healthcare, Brentford, United Kingdom
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Peng Y, Zong Y, Wang D, Chen J, Chen ZS, Peng F, Liu Z. Current drugs for HIV-1: from challenges to potential in HIV/AIDS. Front Pharmacol 2023; 14:1294966. [PMID: 37954841 PMCID: PMC10637376 DOI: 10.3389/fphar.2023.1294966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 10/11/2023] [Indexed: 11/14/2023] Open
Abstract
The human immunodeficiency virus (HIV) persists in latently infected CD4+T cells and integrates with the host genome until cell death. Acquired immunodeficiency syndrome (AIDS) is associated with HIV-1. Possibly, treating HIV/AIDS is an essential but challenging clinical goal. This review provides a detailed account of the types and mechanisms of monotherapy and combination therapy against HIV-1 and describes nanoparticle and hydrogel delivery systems. In particular, the recently developed capsid inhibitor (Lenacapavir) and the Ainuovirine/tenofovir disoproxil fumarate/lamivudine combination (ACC008) are described. It is interestingly to note that the lack of the multipass transmembrane proteins serine incorporator 3 (SERINC3) and the multipass transmembrane proteins serine incorporator 5 (SERINC5) may be one of the reasons for the enhanced infectivity of HIV-1. This discovery of SERINC3 and SERINC5 provides new ideas for HIV-1 medication development. Therefore, we believe that in treating AIDS, antiviral medications should be rationally selected for pre-exposure and post-exposure prophylaxis to avoid the emergence of drug resistance. Attention should be paid to the research and development of new drugs to predict HIV mutations as accurately as possible and to develop immune antibodies to provide multiple guarantees for the cure of AIDS.
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Affiliation(s)
- Yuan Peng
- School of Clinical Medicine, Weifang Medical University, Weifang, China
| | - Yanjun Zong
- Department of Medical Microbiology, School of Basic Medical Sciences, Weifang Medical University, Weifang, China
| | - Dongfeng Wang
- School of Basic Medical Sciences, Weifang Medical University, Weifang, China
| | - Junbing Chen
- Department of Liver Surgery and Transplantation, Zhongshan Hospital, Liver Cancer Institute, Fudan University, Shanghai, China
- Key Laboratory of Carcinogenesis and Cancer Invasion, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhe-Sheng Chen
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, St. John’s University, New York, NY, United States
| | - Fujun Peng
- School of Basic Medical Sciences, Weifang Medical University, Weifang, China
| | - Zhijun Liu
- Department of Medical Microbiology, School of Basic Medical Sciences, Weifang Medical University, Weifang, China
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Cossarizza A, Cozzi-Lepri A, Mattioli M, Paolini A, Neroni A, De Biasi S, Tartaro DL, Borella R, Fidanza L, Gibellini L, Beghetto B, Roncaglia E, Nardini G, Milic J, Menozzi M, Cuomo G, Digaetano M, Orlando G, Borghi V, Guaraldi G, Mussini C. Evaluating immunological and inflammatory changes of treatment-experienced people living with HIV switching from first-line triple cART regimens to DTG/3TC vs. B/F/TAF: the DEBATE trial. Front Immunol 2023; 14:1279390. [PMID: 37908359 PMCID: PMC10613634 DOI: 10.3389/fimmu.2023.1279390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 09/21/2023] [Indexed: 11/02/2023] Open
Abstract
Background The aim of this randomized clinical trial (RCT) was to compare immunological changes in virally suppressed people living with HIV (PLWH) switching from a three-drug regimen (3DR) to a two-drug regimen (2DR). Methods An open-label, prospective RCT enrolling PLWH receiving a 3DR who switched to bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) or dolutegravir/lamivudine (DTG/3TC) was performed. Blood was taken at baseline and months 6 and 12. The primary outcome was the change in CD4+ or CD8+ T-cell counts and CD4/CD8 ratio over time points. The secondary outcomes were the changes in immunological and inflammatory parameters. Parametric mixed-linear models with random intercepts and slopes were fitted separately for each marker after controlling for potential confounders. Results Between the two arms (33 PLWH each), there was no difference in CD4+ or CD8+ T cells, CD4/CD8 ratio, and IL-6 trajectories. PLWH switching to DTG/3TC had increased levels of both transitional memory and terminally differentiated CD4+ T cells (arm-time interaction p-value = 0.02) and to a lesser extent for the corresponding CD8+ T-cell subsets (p = 0.09). Significantly lower levels of non-classical monocytes were detected in the B/F/TAF arm at T6 (diff = -6.7 cells/mm3; 95% CI; -16, +2.6; p-value for interaction between arm and time = 0.03). All differences were attenuated at T12. Conclusion No evidence for a difference in absolute CD4+ and CD8+ T-cell counts, CD4/CD8 ratio, and IL-6 trajectories by study arm over 12 months was found. PLWH on DTG/3TC showed higher levels of terminally differentiated and exhausted CD4+ and CD8+ T lymphocytes and non-classical monocytes at T6. Further studies are warranted to better understand the clinical impact of our results. Clinical Trial Registration https://clinicaltrials.gov, identifier NCT04054089.
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Affiliation(s)
- Andrea Cossarizza
- Chair of Pathology and Immunology, University of Modena and Reggio Emilia School of Medicine, Modena, Italy
| | - Alessandro Cozzi-Lepri
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London (UCL), London, United Kingdom
| | - Marco Mattioli
- Chair of Pathology and Immunology, University of Modena and Reggio Emilia School of Medicine, Modena, Italy
| | - Annamaria Paolini
- Chair of Pathology and Immunology, University of Modena and Reggio Emilia School of Medicine, Modena, Italy
| | - Anita Neroni
- Chair of Pathology and Immunology, University of Modena and Reggio Emilia School of Medicine, Modena, Italy
| | - Sara De Biasi
- Chair of Pathology and Immunology, University of Modena and Reggio Emilia School of Medicine, Modena, Italy
| | - Domenico Lo Tartaro
- Chair of Pathology and Immunology, University of Modena and Reggio Emilia School of Medicine, Modena, Italy
| | - Rebecca Borella
- Chair of Pathology and Immunology, University of Modena and Reggio Emilia School of Medicine, Modena, Italy
| | - Lucia Fidanza
- Chair of Pathology and Immunology, University of Modena and Reggio Emilia School of Medicine, Modena, Italy
| | - Lara Gibellini
- Chair of Pathology and Immunology, University of Modena and Reggio Emilia School of Medicine, Modena, Italy
| | - Barbara Beghetto
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Enrica Roncaglia
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Giulia Nardini
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Jovana Milic
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Marianna Menozzi
- Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Gianluca Cuomo
- Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Margherita Digaetano
- Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Gabriella Orlando
- Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Vanni Borghi
- Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Giovanni Guaraldi
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Cristina Mussini
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
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Lagi F, Giacomelli A, Borghi V, Ciccullo A, Taramasso L, Madeddu G, D'Ettorre G, Giacometti A, Ducci F, De Vito A, Pincino R, Di Giambenedetto S, Mussini C, Antinori S, Sterrantino G. Efficacy and tolerability of dolutegravir/lamivudine versus dolutegravir/rilpivirine in switching from a three-drug regimen based on nonnucleoside reverse transcriptase inhibitors: A retrospective cohort study. J Med Virol 2023; 95:e29149. [PMID: 37805832 DOI: 10.1002/jmv.29149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 09/17/2023] [Accepted: 09/26/2023] [Indexed: 10/09/2023]
Abstract
Real-life comparisons of dolutegravir/rilpivirine (DTG/RPV) and DTG/lamivudine (3TC) regimens in people living with human immunodeficiency virus (PLWHIV) who switched from a standard three-drug regimen based on nonnucleoside reverse transcriptase inhibitors (NNRTIs) are missing. This study aimed to compare DTG/3TC and DTG/RPV in virologically suppressed patients (HIV-RNA < 50 copies/mL) coming from any NNRTI-based regimen in terms of discontinuation due to virologic failure (VF) discontinuation rates due to all causes, and adverse events. As a secondary outcome, we evaluated the difference in creatinine, total cholesterol, CD4, and triglycerides from baseline to weeks 48 after the switch. Of the 415 PLWHs included in the study, 278 (66.9%) switched to DTG/3TC, and 137 (33.1%) switched to DTG/RPV. Overall, 48 PLWHs (11.6%) discontinued the treatment:38 with DTG/3TC and 10 with DTG/RPV with similar discontinuation rates: 5.01 × 100 py (95% confidence interval [CI] 3.64-6.94) and 4.66 × 100 py (95% CI 2.51-8.67), respectively. The most common reason for discontinuation was toxicity (26 patients, 22/278 [7.9%] in the DTG/3TC group and 4/137 [2.9%] in the DTG/RPV group), mainly neurologic toxicity (never above grade 2). We found no differences in discontinuation rates due to treatment adverse events. Two study participants experienced virological failure in the DTG/3TC arm. We observed no significant difference in CD4 cell counts, lipid parameters, or renal function between the two groups at 48 weeks. This study demonstrated that, in clinical practice, a two-drug regimen with DTG/3TC or DTG/RPV is characterized by a low discontinuation rate and VF in virologically suppressed PLWHs switched from an NNRTI-based three antiretroviral drugs regimen.
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Affiliation(s)
- Filippo Lagi
- Infectious and Tropical Diseases Unit, Emergency Department, Careggi University Hospital, Florence, Italy
| | - Andrea Giacomelli
- Department of Infectious Diseases, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Vanni Borghi
- Department of Infectious Diseases, Azienda Ospedaliero, Universitaria Policlinico of Modena, Modena, Italy
| | - Arturo Ciccullo
- Section of Infectious Diseases, Department of Safety and Bioethics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Lucia Taramasso
- Infectious Diseases Unit, Department of Internal Medicine, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
| | - Giordano Madeddu
- Department of Medicine, Surgery and Pharmacy, Unit of Infectious Disease, University of Sassari, Sassari, Italy
| | - Gabriella D'Ettorre
- Department of Public Health and Infectious Diseases, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Andrea Giacometti
- Institute of Infectious Diseases and Public Health, Department of Biological Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Filippo Ducci
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Andrea De Vito
- Department of Medicine, Surgery and Pharmacy, Unit of Infectious Disease, University of Sassari, Sassari, Italy
| | - Rachele Pincino
- Department of Health Sciences (DISSAL), Infectious Diseases Unit, University of Genoa, Genoa, Italy
| | - Simona Di Giambenedetto
- Section of Infectious Diseases, Department of Safety and Bioethics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Cristina Mussini
- Department of Infectious Diseases, Azienda Ospedaliero, Universitaria Policlinico of Modena, Modena, Italy
| | - Spinello Antinori
- Department of Infectious Diseases, ASST Fatebenefratelli-Sacco, Milan, Italy
- Luigi Sacco Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Gaetana Sterrantino
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Dufour I, Fougère Y, Goetghebuer T, Hainaut M, Mbiya B, Kakkar F, Yombi JC, Van der Linden D. Gen Z and HIV-Strategies for Optimizing the Care of the Next Generation of Adolescents Living with HIV. Viruses 2023; 15:2023. [PMID: 37896800 PMCID: PMC10611287 DOI: 10.3390/v15102023] [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: 09/04/2023] [Revised: 09/25/2023] [Accepted: 09/26/2023] [Indexed: 10/29/2023] Open
Abstract
The management of adolescents living with HIV represents a particular challenge in the global response to HIV. The challenges specific to this age group include difficulties engaging and maintaining them in care, challenges with transition to adult care, and limited therapeutic options for treatment-experienced patients, all of which have been jeopardized by the COVID-19 pandemic. This paper summarizes some of the challenges in managing adolescents living with HIV, as well as some of the most recent and innovative therapeutic approaches in this population.
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Affiliation(s)
- Inès Dufour
- Department of Internal Medicine and Infectious Diseases, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, 1200 Brussels, Belgium;
| | - Yves Fougère
- Division of Infectious Diseases, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, QC H3T 1J4, Canada; (Y.F.); (F.K.)
- Centre d’Infectiologie Mère-Enfant (CIME), Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, QC H3T 1J4, Canada
| | - Tessa Goetghebuer
- Department of Pediatrics, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles, 1000 Brussels, Belgium; (T.G.); (M.H.)
| | - Marc Hainaut
- Department of Pediatrics, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles, 1000 Brussels, Belgium; (T.G.); (M.H.)
| | - Benoît Mbiya
- Pediatrics Department, Faculty of Medicine, University of Mbujimayi, Mbujimayi 06201, Democratic Republic of the Congo;
- Sickle Cell Reference Center, Clinique Pédiatrique de Mbujimayi, Pediatrics Clinic of Mbujimayi, Mbujimayi 06201, Democratic Republic of the Congo
| | - Fatima Kakkar
- Division of Infectious Diseases, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, QC H3T 1J4, Canada; (Y.F.); (F.K.)
- Centre d’Infectiologie Mère-Enfant (CIME), Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, QC H3T 1J4, Canada
| | - Jean Cyr Yombi
- Department of Internal Medicine and Infectious Diseases, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, 1200 Brussels, Belgium;
- Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, 1348 Brussels, Belgium;
| | - Dimitri Van der Linden
- Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, 1348 Brussels, Belgium;
- Pediatric Infectious Diseases, Service of Specialized Pediatrics, Department of Pediatrics, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, 1200 Brussels, Belgium
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Pedersen KBH, Knudsen A, Møller S, Siebner HR, Hove JD, Gerstoft J, Benfield T. Changes in weight, body composition and metabolic parameters after switch to dolutegravir/lamivudine compared with continued treatment with dolutegravir/abacavir/lamivudine for virologically suppressed HIV infection (The AVERTAS trial): a randomised, open-label, superiority trial in Copenhagen, Denmark. BMJ Open 2023; 13:e075673. [PMID: 37604629 PMCID: PMC10445393 DOI: 10.1136/bmjopen-2023-075673] [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: 05/15/2023] [Accepted: 07/13/2023] [Indexed: 08/23/2023] Open
Abstract
INTRODUCTION With longer life expectancy in people living with HIV (PLWH) on antiretroviral therapy, cardiovascular disease (CVD) has become a common cause of mortality among them. Abacavir has been associated with an increased risk of myocardial infarction, but the mechanism is unknown. Additionally, abacavir may be obesogenic which could mediate an additional risk factor of CVD. We aim to investigate if discontinuation of abacavir will have a favourable impact on body weight and cardiac parameters in PLWH. METHODS AND ANALYSIS Randomised, controlled, superiority trial of virologically suppressed PLWH on dolutegravir, abacavir and lamivudine (DTG/ABC/3TC) for ≥6 months. In total, 70 PLWH will be randomised 1:2 to either continue DTG/ABC/3TC or to switch to dolutegravir and lamivudine (DTG/3TC) providing the power of 80% at alpha 5% to detect a mean difference in weight change of 2 kg (Δ) given an SD of 2.7 kg. Follow-up will be 48 weeks. Data will be collected at baseline and week 48. Primary outcome will be change in mean body weight from baseline to week 24 and 48 evaluated in a linear mixed model. Secondary outcomes will be changes in cardiac, inflammatory and metabolic parameters, fat distribution, coagulation, endothelial, platelet function, quality of life and virological control from baseline to week 48. Measurements include CT of thorax and abdomen, external carotid artery ultrasound, liver elastography and dual energy X-ray absorptiometry and blood analysis. Plasma HIV RNA will be measured at baseline, week 4, 24 and 48. Forty participants (20 from each arm) will be included in a substudy involving cardiac MRI at baseline and week 48. Twenty non-HIV-infected controls will be included with a single scan to compare with baseline scan data. ETHICS AND DISSEMINATION Result from this study will lead to a better understanding of the association between antiretroviral therapy and the impact on weight and risk of CVD. Findings will be useful for both clinicians and PLWH in the guidance of a more individualised HIV treatment. Results from the main study and the substudies will be submitted for publication in a peer-reviewed journal(s). The AVERTAS study is approved by the Ethics Committee of the Capital Region, Denmark (H-20011433), Danish Medicines Agency (EudraCT no. 2019-004999-19) and Regional Data Protection Centre (P-2020-207). TRIAL REGISTRATION NUMBER Pre-results registration at ClinicalTrials.gov Identifier: NCT04904406, registered 27 May 2021. PROTOCOL VERSION Protocol version 9.0, 4 April 2023, approved 10-05-2023 by Ethics Committee of the Capital Region, Denmark (H-20011433). Danish Medicines Agency (EudraCT no. 2019-004999-19). Regional Data Protection Centre (P-2020-207) ClinicalTrials.gov.
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Affiliation(s)
- Karen Brorup Heje Pedersen
- Department of Infectious Diseases, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - Andreas Knudsen
- Department of Respiratory Medicine and Infectious Diseases, Copenhagen University Hospital - Bispebjerg, Copenhagen, Denmark
| | - Søren Møller
- Department of Clinical Physiology and Nuclear Medicine, Center for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Hartwig Roman Siebner
- Department of Clinical Physiology and Nuclear Medicine, Center for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Danish Research Centre for Magnetic Resonance (DRCMR), Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Jens Dahlgaard Hove
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Hvidovre Hospital, Hvidovre, Denmark
| | - Jan Gerstoft
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital- Rigshospitalet, Copenhagen, Denmark
| | - Thomas Benfield
- Department of Infectious Diseases, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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40
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Perfezou P, Hall N, Duthe JC, Abdi B, Seang S, Arvieux C, Lamaury I, Menard A, Marcelin AG, Katlama C, Palich R. Doravirine plus lamivudine two-drug regimen as maintenance antiretroviral therapy in people living with HIV: a French observational study. J Antimicrob Chemother 2023; 78:1929-1933. [PMID: 37303236 DOI: 10.1093/jac/dkad185] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/30/2023] [Indexed: 06/13/2023] Open
Abstract
BACKGROUND Two-drug regimens based on integrase strand transfer inhibitors (INSTIs) and boosted PIs have entered recommended ART. However, INSTIs and boosted PIs may not be suitable for all patients. We aimed to report our experience with doravirine/lamivudine as maintenance therapy in people living with HIV (PLWH) followed in French HIV settings. METHODS This observational study enrolled all adults who initiated doravirine/lamivudine between 1 September 2019 and 31 October 2021, in French HIV centres participating in the Dat'AIDS cohort. The primary outcome was the rate of virological success (plasma HIV-RNA < 50 copies/mL) at Week (W)48. Secondary outcomes included: rate of treatment discontinuation for non-virological reasons, evolution of CD4 count and CD4/CD8 ratio over follow-up. RESULTS Fifty patients were included, with 34 (68%) men; median age: 58 years (IQR 51-62), ART duration: 20 years (13-23), duration of virological suppression: 14 years (8-19), CD4 count: 784 cells/mm3 (636-889). Prior to switching, all had plasma HIV-RNA < 50 copies/mL. All but three were naive to doravirine, and 36 (72%) came from a three-drug regimen. Median follow-up was 79 weeks (IQR 60-96). Virological success rate at W48 was 98.0% (95% CI 89.4-99.9). One virological failure occurred at W18 (HIV-RNA = 101 copies/mL) in a patient who briefly discontinued doravirine/lamivudine due to intense nightmares; there was no resistance at baseline and no resistance emergence. There were three strategy discontinuations for adverse events (digestive disorders: n = 2; insomnia: n = 1). There was no significant change in CD4/CD8 ratio, while CD4 T cell count significantly increased. CONCLUSIONS These preliminary findings suggest that doravirine/lamivudine regimens can maintain high levels of viral suppression in highly ART-experienced PLWH with long-term viral suppression, and good CD4+ T cell count.
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Affiliation(s)
| | - Nolwenn Hall
- Public Health Center, Quimper Hospital, Quimper, France
| | | | - Basma Abdi
- Virology Department, Sorbonne University, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM 1136, Paris, France
| | - Sophie Seang
- Infectious Diseases Department, Sorbonne University, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM 1136, Paris, France
| | - Cédric Arvieux
- Infectious Diseases and Intensive Care Unit, University Hospital, Rennes, France
| | - Isabelle Lamaury
- Infectious and Tropical Diseases Department, University Hospital of Guadeloupe, Pointe-à-Pitre, France
| | - Amélie Menard
- IHU-Méditerranée Infection, Aix Marseille University, AP-HM, Marseille, France
| | - Anne-Geneviève Marcelin
- Virology Department, Sorbonne University, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM 1136, Paris, France
| | - Christine Katlama
- Infectious Diseases Department, Sorbonne University, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM 1136, Paris, France
| | - Romain Palich
- Infectious Diseases Department, Sorbonne University, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM 1136, Paris, France
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de Wet JJ, Ban JK, Verdier G, Ling J, Eberg M, Bunko A, McKimm M. A real-world observational retrospective cohort study of Canadian people living with HIV switching from nevirapine plus two nucleoside reverse transcriptase inhibitors to dolutegravir/lamivudine. Int J Antimicrob Agents 2023; 62:106839. [PMID: 37160239 DOI: 10.1016/j.ijantimicag.2023.106839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 04/21/2023] [Accepted: 05/03/2023] [Indexed: 05/11/2023]
Affiliation(s)
- Joseph J de Wet
- Spectrum Health, Vancouver, British Columbia, Canada; Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
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Batterham RL, Espinosa N, Katlama C, McKellar M, Scholten S, Smith DE, Ait-Khaled M, George N, Wright J, Gordon LA, Moodley R, Wynne B, van Wyk J. Cardiometabolic Parameters 3 Years After Switch to Dolutegravir/Lamivudine vs Maintenance of Tenofovir Alafenamide-Based Regimens. Open Forum Infect Dis 2023; 10:ofad359. [PMID: 37520420 PMCID: PMC10375426 DOI: 10.1093/ofid/ofad359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/11/2023] [Indexed: 08/01/2023] Open
Abstract
Background Cardiometabolic outcomes were investigated 3 years after switching to the 2-drug regimen dolutegravir/lamivudine (DTG/3TC) vs continuing 3-/4-drug tenofovir alafenamide (TAF)-based regimens in a multicenter phase 3 noninferiority study based on an open-label randomized design. Method Adults with virologically suppressed HIV-1 switched to once-daily DTG/3TC (n = 369) or continued TAF-based regimens (n = 372). Cardiometabolic health parameters were assessed through week 144 via mixed-model repeated measures or logistic regression analyses, adjusting for baseline variables. Results At week 144, 13% (42/316) of the DTG/3TC group and 12% (37/303) of the TAF-based regimen group had ≥10% weight gain from baseline (adjusted odds ratio, 1.11; 95% CI, .68-1.80). Adjusted change from baseline in serum leptin, a surrogate marker of adiposity, was similar between groups (treatment ratio, 1.00; 95% CI, .89-1.13). The lipid profile generally favored DTG/3TC in the baseline boosted subgroup. Adjusted odds revealed no clinically meaningful differences between groups: homeostatic model assessment of insulin resistance ≥2 (adjusted odds ratio, 0.79; 95% CI, .50-1.26), metabolic syndrome (International Diabetes Federation criteria, 0.99; .59-1.68), hepatic fibrosis (fibrosis-4 index score ≥1.45, 1.39; .63-3.06), and coronary artery disease risk (Framingham risk score ≥10%, 0.92; .56-1.49). Baseline variables and characteristics associated with odds of each cardiometabolic parameter outcome were consistent with known risk factors, including age, sex, race, and some disease characteristics. Conclusions Cardiometabolic health 3 years after switching to DTG/3TC was comparable to that for individuals continuing TAF-based regimens, further supporting DTG/3TC as a robust switch option with a stable metabolic profile. Trial registration ClinicalTrials.gov NCT03446573.
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Affiliation(s)
- Rachel L Batterham
- Department of Medicine, Centre for Obesity Research, University College London, London, UK
- National Institute of Health Research, University College London Hospitals Biomedical Research Centre, London, UK
| | - Nuria Espinosa
- Hospital Universitario Virgen del Rocío, Sevilla, Andalucía, Spain
| | - Christine Katlama
- Service de Maladies Infectieuses et Tropicales, AP-HP, Hôpital Pitié-Salpêtrière, INSERM–Sorbonne Universités, Paris, France
| | - Mehri McKellar
- Department of Medicine, School of Medicine, Duke University, Durham, North Carolina, USA
| | | | | | | | | | | | | | | | - Brian Wynne
- ViiV Healthcare, Durham, North Carolina, USA
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Martínez-Serra A, De Lazzari E, Berrocal L, Foncillas A, De La Mora L, Inciarte A, Chivite I, González-Cordón A, Martínez-Rebollar M, Torres B, Laguno M, Blanco JL, Martínez E, Mallolas J, Ambrosioni J. Clinical use and effectiveness of dolutegravir and lamivudine: a long-term, real-world, retrospective study. J Antimicrob Chemother 2023:dkad189. [PMID: 37311224 DOI: 10.1093/jac/dkad189] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 05/30/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND The use of dolutegravir/lamivudine is based on solid clinical trials; however, real-world data remain limited. OBJECTIVES To provide data on the clinical use and effectiveness of dolutegravir/lamivudine in persons with HIV in a real-world scenario. PATIENTS AND METHODS Retrospective, single-centre and observational study. We included all adults starting dolutegravir/lamivudine since November 2014. We reported all demographic, virological and immunological variables at baseline and assessed effectiveness [on treatment (OT), modified ITT (mITT) and ITT in those persons who reached 6 and 12 month follow-ups (M6 and M12). RESULTS Of the 1058 persons, 9 were treatment-naive; the final analysis included 1049 treatment-experienced people with HIV. Median (IQR) follow-up was 1 (0.3-1.6) years, with 81% and 63% persons reaching M6 and M12, respectively. The longest use of dolutegravir/lamivudine was 7.4 years. Per OT, mITT and ITT, HIV-RNA < 50 copies/mL was 97%, 92% and 81% (M6) and 98%, 90% and 80% (M12), respectively. Females [adjusted risk ratio, aRR (95% CI): 1.69 (1.19-2.40)]; immediate, previous PI-based regimen [aRR (95% CI): 1.67 (1.09-2.56)]; and viral load (VL) ≥ 50 copies/mL at dolutegravir/lamivudine initiation [aRR (95% CI): 3.36 (2.32-4.88)] were independently associated with lack of effectiveness at M12; other demographic, immunological and virological variables like previous M184V/I substitutions or virological failure, were unrelated. Of the total, 944 (90%) continued dolutegravir/lamivudine. The most frequent known reason for discontinuation was toxicity [48 (46%) cases]. CONCLUSIONS In our real-world experience, virological suppression rates were high for treatment-experienced persons on dolutegravir/lamivudine; however, we identified subgroups with a higher risk of lack of effectiveness at M12, who may benefit from closer follow-ups.
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Affiliation(s)
- Adrián Martínez-Serra
- Infectious Disease Department, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Elisa De Lazzari
- Infectious Disease Department, School of Medicine, University of Barcelona, Barcelona, Spain
- HIV Unit, Infectious Diseases Service, Hospital Clinic, Villarroel 170, 08036, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - Leire Berrocal
- HIV Unit, Infectious Diseases Service, Hospital Clinic, Villarroel 170, 08036, Barcelona, Spain
| | - Alberto Foncillas
- Infectious Disease Department, School of Medicine, University of Barcelona, Barcelona, Spain
- HIV Unit, Infectious Diseases Service, Hospital Clinic, Villarroel 170, 08036, Barcelona, Spain
| | - Lorena De La Mora
- Infectious Disease Department, School of Medicine, University of Barcelona, Barcelona, Spain
- HIV Unit, Infectious Diseases Service, Hospital Clinic, Villarroel 170, 08036, Barcelona, Spain
| | - Alexy Inciarte
- Infectious Disease Department, School of Medicine, University of Barcelona, Barcelona, Spain
- HIV Unit, Infectious Diseases Service, Hospital Clinic, Villarroel 170, 08036, Barcelona, Spain
| | - Iván Chivite
- Infectious Disease Department, School of Medicine, University of Barcelona, Barcelona, Spain
- HIV Unit, Infectious Diseases Service, Hospital Clinic, Villarroel 170, 08036, Barcelona, Spain
| | - Ana González-Cordón
- Infectious Disease Department, School of Medicine, University of Barcelona, Barcelona, Spain
- HIV Unit, Infectious Diseases Service, Hospital Clinic, Villarroel 170, 08036, Barcelona, Spain
| | - María Martínez-Rebollar
- Infectious Disease Department, School of Medicine, University of Barcelona, Barcelona, Spain
- HIV Unit, Infectious Diseases Service, Hospital Clinic, Villarroel 170, 08036, Barcelona, Spain
| | - Berta Torres
- Infectious Disease Department, School of Medicine, University of Barcelona, Barcelona, Spain
- HIV Unit, Infectious Diseases Service, Hospital Clinic, Villarroel 170, 08036, Barcelona, Spain
| | - Montserrat Laguno
- Infectious Disease Department, School of Medicine, University of Barcelona, Barcelona, Spain
- HIV Unit, Infectious Diseases Service, Hospital Clinic, Villarroel 170, 08036, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - José Luis Blanco
- Infectious Disease Department, School of Medicine, University of Barcelona, Barcelona, Spain
- HIV Unit, Infectious Diseases Service, Hospital Clinic, Villarroel 170, 08036, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - Esteban Martínez
- Infectious Disease Department, School of Medicine, University of Barcelona, Barcelona, Spain
- HIV Unit, Infectious Diseases Service, Hospital Clinic, Villarroel 170, 08036, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - Josep Mallolas
- Infectious Disease Department, School of Medicine, University of Barcelona, Barcelona, Spain
- HIV Unit, Infectious Diseases Service, Hospital Clinic, Villarroel 170, 08036, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - Juan Ambrosioni
- Infectious Disease Department, School of Medicine, University of Barcelona, Barcelona, Spain
- HIV Unit, Infectious Diseases Service, Hospital Clinic, Villarroel 170, 08036, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
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Wang R, Wright J, Saggu P, Ait-Khaled M, Moodley R, Parry CM, Lutz T, Podzamczer D, Moore R, Górgolas Hernández-Mora M, Kinder C, Wynne B, van Wyk J, Underwood M. Assessing the Virologic Impact of Archived Resistance in the Dolutegravir/Lamivudine 2-Drug Regimen HIV-1 Switch Study TANGO through Week 144. Viruses 2023; 15:1350. [PMID: 37376649 DOI: 10.3390/v15061350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
The TANGO study (ClinicalTrials.gov, NCT03446573) demonstrated that switching to dolutegravir/lamivudine (DTG/3TC) was non-inferior to continuing tenofovir alafenamide-based regimens (TBR) through week 144. Retrospective baseline proviral DNA genotypes were performed for 734 participants (post-hoc analysis) to assess the impact of archived, pre-existing drug resistance on 144-week virologic outcomes by last on-treatment viral load (VL) and Snapshot. A total of 320 (86%) participants on DTG/3TC and 318 (85%) on TBR had both proviral genotype data and ≥1 on-treatment post-baseline VL results and were defined as the proviral DNA resistance analysis population. Archived International AIDS Society-USA major nucleoside reverse transcriptase inhibitor, non-nucleoside reverse transcriptase inhibitor, protease inhibitor, and integrase strand transfer inhibitor resistance-associated mutations (RAMs) were observed in 42 (7%), 90 (14%), 42 (7%), and 11 (2%) participants, respectively, across both groups; 469 (74%) had no major RAMs at baseline. M184V/I (1%), K65N/R (<1%), and thymidine analogue mutations (2%) were infrequent. Through week 144, >99% of participants on DTG/3TC and 99% on TBR were virologically suppressed (last on-treatment VL <50 copies/mL) regardless of the presence of major RAMs. Results from the sensitivity analysis by Snapshot were consistent with the last available on-treatment VL. In TANGO, archived, pre-existing major RAMs did not impact virologic outcomes through week 144.
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Affiliation(s)
- Ruolan Wang
- ViiV Healthcare, 406 Blackwell Street, Suite 300, Durham, NC 27701, USA
| | | | | | - Mounir Ait-Khaled
- ViiV Healthcare, 980 Great West Road, Brentford TW8 9GS, Middlesex, UK
| | - Riya Moodley
- ViiV Healthcare, 980 Great West Road, Brentford TW8 9GS, Middlesex, UK
| | - Chris M Parry
- ViiV Healthcare, 980 Great West Road, Brentford TW8 9GS, Middlesex, UK
| | - Thomas Lutz
- Infektiologikum, Stresemannallee 3, 60596 Frankfurt am Main, Germany
| | - Daniel Podzamczer
- Hospital Universitari de Bellvitge, Carrer de la Feixa Llarga, s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Richard Moore
- Northside Clinic, 370 St Georges Rd, Fitzroy North, VIC 3068, Australia
| | | | - Clifford Kinder
- AIDS Healthcare Foundation-The Kinder Medical Group, 3661 S Miami Ave Suite 806, Miami, FL 33133, USA
| | - Brian Wynne
- ViiV Healthcare, 406 Blackwell Street, Suite 300, Durham, NC 27701, USA
| | - Jean van Wyk
- ViiV Healthcare, 980 Great West Road, Brentford TW8 9GS, Middlesex, UK
| | - Mark Underwood
- ViiV Healthcare, 406 Blackwell Street, Suite 300, Durham, NC 27701, USA
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Dueñas-Gutiérrez C, Buzón L, Pedrero-Tomé R, Iribarren JA, De Los Santos I, De la Fuente S, Pousada G, Moran MA, Moreno E, Ferreira E, Gómez J, Troya J. Efficacy and Safety of Two-Drug Regimens with Dolutegravir plus Rilpivirine or Lamivudine in HIV-1 Virologically Suppressed People Living with HIV. Viruses 2023; 15:v15040936. [PMID: 37112915 PMCID: PMC10145987 DOI: 10.3390/v15040936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 04/05/2023] [Accepted: 04/08/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND The high effectiveness and safety of the two-drug (2DRs) strategy using dolutegravir (DTG) plus lamivudine (3TC) have led to international guidelines recommending their use for treatment-naive HIV patients. In virologically suppressed patients, de-escalating from 3DRs to DTG plus either rilpivirine (RPV) or 3TC has shown high rates of virological suppression. OBJECTIVES This study aimed to compare the real-life data of two multicenter Spanish cohorts of PLWHIV treated with DTG plus 3TC (SPADE-3) or RPV (DORIPEX) as a switch strategy, not only in terms of virological suppression, safety, and durability but also in terms of immune restoration. The primary endpoint was the percentage of patients with virological suppression on DTG plus 3TC and DTG plus RPV at weeks 24 and 48. The secondary outcomes included the proportion of patients who experienced the protocol-defined loss of virological control by week 48; changes in immune status in terms of CD4+ and CD8+ T lymphocyte counts and the CD4+/CD8+ ratio; the rate, incidence, and reasons for discontinuation of treatment over the 48-week study period; and safety profiles at weeks 24 and 48. METHODS We conducted a retrospective, observational, multicenter study of 638 and 943 virologically suppressed HIV-1-infected patients in two cohorts who switched to 2DRs with DTG plus RPV or DTG plus 3TC. RESULTS The most frequent reasons for starting DTG-based 2DRs were treatment simplification/pill burden or drug decrease. The virological suppression rates were 96.9%, 97.4%, and 99.1% at weeks 24, 48, and 96, respectively. The proportion of patients with virological failure over the 48-week study period was 0.01%. Adverse drug reactions were uncommon. Patients treated with DTG+3TC increased CD4, CD8, and CD4/CD8 parameters at 24 and 48 weeks. CONCLUSIONS We conclude that DTG-based 2DRs (combined with 3TC or RPV) in clinical practice were effective and safe as a switching strategy, with a low VF and high viral suppression rates. Both regimens were well tolerated, and ADR rates were low, including neurotoxicity and induced treatment discontinuations.
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Affiliation(s)
- Carlos Dueñas-Gutiérrez
- Infectious Diseases Division, Hospital Universitario Clínico de Valladolid, 47003 Valladolid, Spain
| | - Luis Buzón
- Infectious Diseases Division, Hospital Universitario de Burgos, 09006 Burgos, Spain
| | - Roberto Pedrero-Tomé
- Infanta Leonor University Hospital Research and Innovation Foundation, 28031 Madrid, Spain
| | - José A Iribarren
- Infectious Diseases Department, Hospital Universitario de Donostia, 20014 San Sebastián, Spain
| | - Ignacio De Los Santos
- Infectious Diseases Division, Hospital Universitario de La Princesa, 28006 Madrid, Spain
| | - Sara De la Fuente
- Infectious Diseases Division, Hospital Universitario Puerta de Hierro, 28222 Madrid, Spain
| | - Guillermo Pousada
- Infectious Diseases Division, Hospital Universitario de Txagorritxu, 01009 Vitoria, Spain
| | - Miguel Angel Moran
- Infectious Diseases Division, HospitalÁlvaro Cunqueiro, 36312 Vigo, Spain
| | - Estela Moreno
- Infectious Diseases Division, Complejo Hospitalario de Navarra, 31008 Pamplona, Spain
| | - Eva Ferreira
- Infectious Diseases Division, Hospital de Segovia, 47002 Segovia, Spain
| | - Julia Gómez
- Infectious Diseases Division, Hospital Universitario de Salamanca, 37007 Salamanca, Spain
| | - Jesús Troya
- Internal Medicine Department, Hospital Universitario Infanta Leonor, 28031 Madrid, Spain
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Troya J, Pedrero-Tomé R, Buzón L, Dueñas C. Predict the Effects of Dolutegravir (DTG) Plus Lamivudine (3TC) on Immunological Responses in People Living with HIV (PLWHIV). J Clin Med 2023; 12:jcm12031176. [PMID: 36769822 PMCID: PMC9917651 DOI: 10.3390/jcm12031176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/24/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Immune recovery in people living with HIV (PLWHIV) is a residual aspect of antiretroviral treatment (ART) in most patients, but in a non-negligible proportion of them, the CD4+ lymphocytes count, or CD4/CD8 ratio remains suboptimal. METHODS We performed a model of the immune response after 24 weeks of switching to a 2DR with DTG plus 3TC in a retrospective multicenter cohort of undetectable and experienced patients using significant predictor variables associated with the parameters or situations defined as success and failure. Clinical variables studied were CD4+ and CD8+ lymphocyte count, percentage of CD4, and CD4/CD8 ratio. These parameters were assessed at baseline and 24 weeks after the switch. Based on the evolution of each variable, four categories of immune response and four categories of non-immune response were defined. Immune response was defined as CD4+ count > 500 cells/mm3, %CD4 > 30%, CD8+ count < 1000 cells/mm3 and CD4/CD8 ratio ≥ 0.9. Non-response is just the opposite. RESULTS In our different models of immunological response, the presence of stage of AIDS (p = 0.035, p = 0.065) and current age over 50 years (p = 0.045) are postulated as statistically significative limiting factors in achieving an improvement in CD4, %CD4, CD8, and CD4/CD8 ratio. Late HIV diagnosis (p = 0.156), without statistical significance, enhanced late the previous variables. In contrast, conditions where patients start with CD4 > 500 cells/mm3 (p = 0.054); CD4 > 30% (p = 0.054, p = 0.084); CD8 < 1000 cells/mm3 (p = 0.018), and CD4/CD8 ≥ 0.9 (p = 0.013, p = 0.09) are detected as stimulating or conducive to DTG plus 3TC treatment success. CONCLUSION These models represent a proof of concept that could become a valuable tool for clinicians to predict the effects of DTG plus 3TC on immunological responses prior to the switch in undetectable pre-treated PLWHIV with immune dysfunction. The main predictors for immunological failure were late HIV diagnosis, stage of AIDS, and current age over 50 years. In contrast, starting with a normalized immune status was detected as stimulating or conducive to DTG plus 3TC treatment success.
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Affiliation(s)
- Jesús Troya
- Department of Internal Medicine, Infanta Leonor University Hospital, 28031 Madrid, Spain
- Correspondence:
| | - Roberto Pedrero-Tomé
- Infanta Leonor University Hospital Research and Innovation Foundation, 28031 Madrid, Spain
- EPINUT Research Group, Faculty of Medicine, Complutense University of Madrid, 28040 Madrid, Spain
| | - Luis Buzón
- Department of Internal Medicine, Infectious Diseases Division, Burgos Hospital, 09006 Burgos, Spain
| | - Carlos Dueñas
- Valladolid University Hospital, Faculty of Medicine, University of Valladolid, 47003 Valladolid, Spain
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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.
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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
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Ciccullo A, Baldin G, Borghi V, Cossu MV, Giacomelli A, Lagi F, Farinacci D, Iannone V, Passerotto RA, Capetti A, Sterrantino G, Mussini C, Antinori S, Di Giambenedetto S. Analysing the efficacy and tolerability of dolutegravir plus either rilpivirine or lamivudine in a multicentre cohort of virologically suppressed PLWHIV. J Antimicrob Chemother 2022; 78:117-121. [PMID: 36272137 DOI: 10.1093/jac/dkac362] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 10/05/2022] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES We aimed to investigate and compare the efficacy and safety of two dolutegravir-based two-drug regimens: dolutegravir + lamivudine versus dolutegravir + rilpivirine. METHODS We analysed a cohort of people living with HIV (PLWHIV) switching to dolutegravir + lamivudine or dolutegravir + rilpivirine. We excluded from the analysis PLWHIV with no available pre-switch genotypic test or with a known resistance mutation to one of the study drugs. We evaluated incidence of virological failure (VF) and treatment discontinuation (TD), as well as changes in immunological and metabolic parameters. RESULTS We enrolled 592 PLWHIV: 306 in the lamivudine group and 286 in the rilpivirine group. We observed nine VFs in the lamivudine group [1.4 VF per 100 patient-years of follow-up (PYFU)] and four VFs in the rilpivirine group (0.6 VF per 100 PYFU). Subsequent genotypic analysis showed no acquired resistance-associated mutations in those experiencing VF. Estimated probability of maintaining virological suppression at 144 and 240 weeks were 96.6% and 92.7%, respectively, in the lamivudine group and 98.7% and 98.7%, respectively, in the rilpivirine group (log-rank P = 0.172). The estimated probability of maintaining study regimen at Week 240 was 82.3% in the lamivudine group and 85.9% in the rilpivirine group (log-rank P = 0.018). We observed a significant improvement in CD4+ cell count at Week 240 in the lamivudine group (P = 0.012); in the rilpivirine group we registered a significant increase in CD4/CD8 ratio (P = 0.014). CONCLUSIONS Both analysed strategies are effective and safe as switch strategies in clinical practice, with a low incidence of VF and a favourable immunological recovery, even in the long term.
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Affiliation(s)
- A Ciccullo
- Unit of Infectious Diseases, San Salvatore Hospital, L'Aquila, Italy
| | - G Baldin
- Unit of Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Mater Olbia Hospital, Olbia, Italy
| | - V Borghi
- Azienda Ospedaliero Universitaria di Modena, Clinica Malattie Infettive e Tropicali, Modena, Italy
| | - M V Cossu
- Division of Infectious Diseases, Department of Infectious Diseases, Luigi Sacco University Hospital, Milan, Italy
| | - A Giacomelli
- UOC Malattie Infettive III, DIBIC Luigi Sacco, University of Milan, Milan, Italy
| | - F Lagi
- Division of Tropical and Infectious Diseases, 'Careggi' Hospital, Florence, Italy
| | - D Farinacci
- Catholic University of the Sacred Heart, Rome, Italy
| | - V Iannone
- Catholic University of the Sacred Heart, Rome, Italy
| | | | - A Capetti
- Division of Infectious Diseases, Department of Infectious Diseases, Luigi Sacco University Hospital, Milan, Italy
| | - G Sterrantino
- Division of Tropical and Infectious Diseases, 'Careggi' Hospital, Florence, Italy
| | - C Mussini
- Azienda Ospedaliero Universitaria di Modena, Clinica Malattie Infettive e Tropicali, Modena, Italy
| | - S Antinori
- UOC Malattie Infettive III, DIBIC Luigi Sacco, University of Milan, Milan, Italy
| | - S Di Giambenedetto
- Unit of Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Catholic University of the Sacred Heart, Rome, Italy
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49
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Adachi E, Ikeuchi K, Koga M, Yotsuyanagi H. Changes in Inflammatory Biomarkers When Switching from Three-Drug Regimens to Dolutegravir Plus Lamivudine in People Living with HIV. AIDS Res Hum Retroviruses 2022; 38:881-883. [PMID: 36301933 DOI: 10.1089/aid.2022.0115] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
It is not clear if there is a difference between three-drug regimens (3DR) and two-drug regimens (2DR) in terms of suppression of chronic inflammation. We compared C-reactive protein (CRP), CD4+/CD8+ ratio, lipid profiles measured in daily clinical practice before and after the switch to dolutegravir plus lamivudine (DTG/3TC) to examine the difference in the anti-inflammatory effect of 3DR and 2DR. In this single-center retrospective observational study, individuals who were on abacavir/lamivudine/dolutegravir (ABC/3TC/DTG), tenofovir alafenamide/emtricitabine (TAF/FTC) plus DTG, or bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) before switching to DTG/3TC were eligible. A total of 119 individuals were enrolled in the study. The median (interquartile range) time since diagnosis of HIV infection was 12 (7-16) years. Overall, inflammation markers such as CD4+/CD8+ ratio, CD4+, CRP, and lipid profiles did not change. Analysis of only individuals who switched from ABC/3TC/DTG, TAF-based regimens also showed no significant changes in inflammatory markers. Since viremia raises inflammatory markers, differences in antiviral efficacy may make a difference in the suppression of chronic inflammation, but in conclusion we did not find any change in inflammatory markers by changing from 3DR to 2DR in daily clinical practice.
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Affiliation(s)
- Eisuke Adachi
- Department of Infectious Diseases and Applied Immunology, IMSUT Hospital of The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Kazuhiko Ikeuchi
- Department of Infectious Diseases and Applied Immunology, IMSUT Hospital of The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Michiko Koga
- Department of Infectious Diseases and Applied Immunology, IMSUT Hospital of The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Yotsuyanagi
- Department of Infectious Diseases and Applied Immunology, IMSUT Hospital of The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
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50
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Troya J, Pedrero-Tomé R, Dueñas C, Buzón L. A predictive model of immune recovery for DTG + 3TC and DTG + RPV used as switching strategies in HIV+ patients. J Antimicrob Chemother 2022; 77:3519-3523. [PMID: 36245072 DOI: 10.1093/jac/dkac354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Jesús Troya
- Department of Internal Medicine, Infanta Leonor University Hospital, Madrid, Spain
| | - Roberto Pedrero-Tomé
- Infanta Leonor University Hospital Research and Innovation Foundation, Madrid, Spain.,EPINUT Research Group, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Carlos Dueñas
- Clínico Universitario Valladolid Hospital, Faculty of Medicine, University of Valladolid, Valladolid, Spain
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