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Henning N, Kellermann TA, Smith C. Effect of Chronic Dolutegravir Administration on the Trace Amine Profile in Wistar Rats. Drugs R D 2024:10.1007/s40268-024-00484-4. [PMID: 39177936 DOI: 10.1007/s40268-024-00484-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2024] [Indexed: 08/24/2024] Open
Abstract
BACKGROUND Dolutegravir (DTG), an integrase strand inhibitor, is currently used as the first-line treatment for HIV. Despite relatively poor tissue penetration, the risk of adverse effects in metabolic and excretory systems should be considered. The trace aminergic system and trace amines are emerging as relevant role players in many chronic diseases that are commonly diagnosed but poorly understood. Trace amines are biogenic amines that are endogenously produced and can also be ingested by the intake of trace amine-rich food. Trace amines are known to differentially regulate inflammatory and neurological outcome. OBJECTIVE This study investigated the effects of DTG on the trace amine profile in a wistar rat model. METHODS A total of 24 healthy wistar rats were randomly divided into four experimental groups: male and female controls and male and female DTG-treated. Blood and tissue samples were collected following a 12-week DTG administration study. Liquid chromatography-tandem mass spectroscopy (LC-MS/MS) was used to determine trace amine concentrations in urine, plasma, brain, and gastrointestinal tissue. RESULTS Current data illustrate that polyamines differ significantly (p < 0.05) between males and females in various matrices. DTG significantly (p < 0.05) reduced jejunal tyramine and urinary synephrine levels. CONCLUSION Data do not raise major concerns about DTG in the context of the trace amine profile. However, given the importance of the dysregulated trace amine profile in various diseased states, including HIV, current data warrant clinical investigation to further evaluate the significance of DTG-associated effects on the trace amine profile.
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Affiliation(s)
- Natasha Henning
- Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Experimental Medicine Research Group, Division of Internal Medicine, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Parow, Cape Town, 7505, South Africa
| | - Tracy A Kellermann
- Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Carine Smith
- Experimental Medicine Research Group, Division of Internal Medicine, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Parow, Cape Town, 7505, South Africa.
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2
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De Greef J, Akue M, Panin N, Delongie KA, André M, Mahieu G, Hoste E, Elens L, Belkhir L, Haufroid V. Effect of ABCB1 most frequent polymorphisms on the accumulation of bictegravir in recombinant HEK293 cell lines. Sci Rep 2024; 14:16290. [PMID: 39009738 PMCID: PMC11251168 DOI: 10.1038/s41598-024-66809-0] [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: 02/12/2024] [Accepted: 07/04/2024] [Indexed: 07/17/2024] Open
Abstract
Bictegravir, a key second-generation integrase strand transfer inhibitor in the treatment of HIV, is subject to active efflux transport mediated by ABCB1 (P-glycoprotein). Several coding variants of ABCB1 have been described and associated with variable effects on substrate drugs pharmacokinetics. Here, we investigated the effect of the four most common coding ABCB1 single nucleotide polymorphisms (i.e., c.1199G > A, c.1236C > T, c.2677G > T and c.3435C > T) on the intracellular accumulation of bictegravir. Using a previously validated HEK293 recombinant cell line model, we found decreased bictegravir intracellular concentrations in cell lines overexpressing ABCB1 as compared to control cell lines, in line with the known role of ABCB1 in bictegravir transport. However, we were unable to demonstrate any significant difference in bictegravir intracellular accumulation when comparing HEK293 cells overexpressing the wild type (1236C-2677G-3435C, 1199G) or the variant (1236C-2677G-3435T, 1236T-2677T-3435T or 1199A) proteins. These findings suggest that the ABCB1 c.1199G > A and c.1236C > T-c.2677G > T-c.3435C > T variants have no or at least limited impact on the active transport of bictegravir by ABCB1.
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Affiliation(s)
- Julien De Greef
- Louvain Centre for Toxicology and Applied Pharmacology, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain (UCLouvain), Brussels, Belgium.
- Service de Médecine Interne et Maladies infectieuses, Cliniques universitaires Saint-Luc, Brussels, Belgium.
| | - Mathilde Akue
- Louvain Centre for Toxicology and Applied Pharmacology, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Nadtha Panin
- Louvain Centre for Toxicology and Applied Pharmacology, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain (UCLouvain), Brussels, Belgium
| | | | - Marina André
- Louvain Centre for Toxicology and Applied Pharmacology, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain (UCLouvain), Brussels, Belgium
- Department of Clinical Chemistry, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Gwenaëlle Mahieu
- Integrated PharmacoMetrics, PharmacoGenomics and PharmacoKinetics, Louvain Drug Research Institute, Université catholique de Louvain (UCLouvain), Brussels, Belgium
- Pharmacologie Cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Emilia Hoste
- Integrated PharmacoMetrics, PharmacoGenomics and PharmacoKinetics, Louvain Drug Research Institute, Université catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Laure Elens
- Louvain Centre for Toxicology and Applied Pharmacology, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain (UCLouvain), Brussels, Belgium
- Integrated PharmacoMetrics, PharmacoGenomics and PharmacoKinetics, Louvain Drug Research Institute, Université catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Leïla Belkhir
- Louvain Centre for Toxicology and Applied Pharmacology, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain (UCLouvain), Brussels, Belgium
- Service de Médecine Interne et Maladies infectieuses, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Vincent Haufroid
- Louvain Centre for Toxicology and Applied Pharmacology, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain (UCLouvain), Brussels, Belgium
- Department of Clinical Chemistry, Cliniques universitaires Saint-Luc, Brussels, Belgium
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3
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Huang C, Hoque MT, Qu QR, Henderson J, Bendayan R. Antiretroviral drug dolutegravir induces inflammation at the mouse brain barriers. FASEB J 2024; 38:e23790. [PMID: 38982638 DOI: 10.1096/fj.202400558r] [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: 03/12/2024] [Revised: 06/05/2024] [Accepted: 06/24/2024] [Indexed: 07/11/2024]
Abstract
Integrase strand transfer inhibitors (INSTIs) based antiretroviral therapy (ART) is currently used as first-line regimen to treat HIV infection. Despite its high efficacy and barrier to resistance, ART-associated neuropsychiatric adverse effects remain a major concern. Recent studies have identified a potential interaction between the INSTI, dolutegravir (DTG), and folate transport pathways at the placental barrier. We hypothesized that such interactions could also occur at the two major blood-brain interfaces: blood-cerebrospinal fluid barrier (BCSFB) and blood-brain barrier (BBB). To address this question, we evaluated the effect of two INSTIs, DTG and bictegravir (BTG), on folate transporters and receptor expression at the mouse BCSFB and the BBB in vitro, ex vivo and in vivo. We demonstrated that DTG but not BTG significantly downregulated the mRNA and/or protein expression of folate transporters (RFC/SLC19A1, PCFT/SLC46A1) in human and mouse BBB models in vitro, and mouse brain capillaries ex vivo. Our in vivo study further revealed a significant downregulation in Slc19a1 and Slc46a1 mRNA expression at the BCSFB and the BBB following a 14-day DTG oral treatment in C57BL/6 mice. However, despite the observed downregulatory effect of DTG in folate transporters/receptor at both brain barriers, a 14-day oral treatment of DTG-based ART did not significantly alter the brain folate level in animals. Interestingly, DTG treatment robustly elevated the mRNA and/or protein expression of pro-inflammatory cytokines and chemokines (Cxcl1, Cxcl2, Cxcl3, Il6, Il23, Il12) in primary cultures of mouse brain microvascular endothelial cells (BBB). DTG oral treatment also significantly upregulated proinflammatory cytokines and chemokine (Il6, Il1β, Tnfα, Ccl2) at the BCSFB in mice. We additionally observed a downregulated mRNA expression of drug efflux transporters (Abcc1, Abcc4, and Abcb1a) and tight junction protein (Cldn3) at the CP isolated from mice treated with DTG. Despite the structural similarities, BTG only elicited minor effects on the markers of interest at both the BBB and BCSFB. In summary, our current data demonstrates that DTG but not BTG strongly induced inflammatory responses in a rodent BBB and BCSFB model. Together, these data provide valuable insights into the mechanism of DTG-induced brain toxicity, which may contribute to the pathogenesis of DTG-associated neuropsychiatric adverse effect.
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Affiliation(s)
- Chang Huang
- Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Md Tozammel Hoque
- Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Qing Rui Qu
- Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Jeffrey Henderson
- Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Reina Bendayan
- Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
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4
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Mata-Marín JA, Juárez-Contreras CA, Rodríguez-Evaristo MS, Martínez-Carrizales OC, Pompa-Mera E, Chaparro Sánchez A, Triana-González S, Cano-Díaz AL, Gaytán-Martínez JE. Reversibility of Neuropsychiatric Adverse Events after Switching to Darunavir/Cobicistat or Doravirine in Men on INSTI-Based Regimen. Viruses 2024; 16:1083. [PMID: 39066245 PMCID: PMC11281698 DOI: 10.3390/v16071083] [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: 04/05/2024] [Revised: 06/09/2024] [Accepted: 06/28/2024] [Indexed: 07/28/2024] Open
Abstract
Integrase strand transfer inhibitors (INSTI) are associated with neuropsychiatric adverse events (NPAEs). The aim of this study was to evaluate improvements in NPAEs after switching an INSTI-based regimen to darunavir/cobicistat (DRV/c) or doravirine (DOR). Methods: A prospective cohort study was conducted to evaluate the reversibility of NPAEs via the Patient Health Questionnaire (PHQ-9), the Insomnia Severity Index (ISI), and the Hospital Anxiety and Depression Scale (HADS-A and D) in patients who started antiretroviral therapy with dolutegravir (DTG) or bictegravir (BIC). These patients were switched to DRV/c or DOR. Scales were compared at the moment of the switch and 12 weeks later. Results: We included 1153 treatment-naïve men, 676 (58.7%) with BIC and 477 (41.3%) with DTG. A total of 32 (2.7%) experienced NPAEs that led to discontinuation. Insomnia was found in 20 patients; depression via PHQ-9 in 21 patients, via HADS-D in 5 patients, and anxiety via HADS-A in 12 patients. All of them were evaluated by a psychiatrist at the moment of the symptoms; 7 (21.8%) started psychotropic drugs. After 12 weeks of follow-up, PHQ-9, ISI, HADS-A, and HADS-D decreased, with a p-value ≤ 0.05. Conclusions: NPAEs seem to improve after switching to a DRV/c- or DOR-based regimen after the first 4 and 12 weeks.
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Affiliation(s)
- José Antonio Mata-Marín
- Infectious Diseases Department, Hospital de Infectología, “La Raza” National Medical Center, Instituto Mexicano del Seguro Social, Mexico City 02990, Mexico; (J.A.M.-M.)
| | - Carina Aurora Juárez-Contreras
- Infectious Diseases Department, Hospital de Infectología, “La Raza” National Medical Center, Instituto Mexicano del Seguro Social, Mexico City 02990, Mexico; (J.A.M.-M.)
| | - Mara Soraya Rodríguez-Evaristo
- Internal Medicine Department, Hospital de Especialidades, “La Raza” National Medical Center, Instituto Mexicano del Seguro Social, Mexico City 02990, Mexico
- Departamento de Posgrados, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City 07360, Mexico
| | - Olivia Concepción Martínez-Carrizales
- Psychiatric Department, Hospital de Infectología, “La Raza” National Medical Center, Instituto Mexicano del Seguro Social, Mexico City 02990, Mexico
| | - Ericka Pompa-Mera
- Research Unit, Hospital de Infectología, “La Raza” National Medical Center, Instituto Mexicano del Seguro Social, Mexico City 02990, Mexico;
| | - Alberto Chaparro Sánchez
- Infectious Diseases Department, Hospital de Infectología, “La Raza” National Medical Center, Instituto Mexicano del Seguro Social, Mexico City 02990, Mexico; (J.A.M.-M.)
| | - Salma Triana-González
- Infectious Diseases Department, Hospital de Infectología, “La Raza” National Medical Center, Instituto Mexicano del Seguro Social, Mexico City 02990, Mexico; (J.A.M.-M.)
| | - Ana Luz Cano-Díaz
- Infectious Diseases Department, Hospital de Infectología, “La Raza” National Medical Center, Instituto Mexicano del Seguro Social, Mexico City 02990, Mexico; (J.A.M.-M.)
| | - Jesús Enrique Gaytán-Martínez
- Infectious Diseases Department, Hospital de Infectología, “La Raza” National Medical Center, Instituto Mexicano del Seguro Social, Mexico City 02990, Mexico; (J.A.M.-M.)
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5
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van der Wekken-Pas L, Nassiwa S, Malaba T, Lamorde M, Myer L, Waitt C, Reynolds H, Khoo S, He N, van Leeuwen L, Burger D, Wang D, Colbers A. Comparison of dolutegravir and efavirenz on depression, anxiety and sleep disorders in pregnant and postpartum women living with HIV. AIDS 2024; 38:975-981. [PMID: 38277390 PMCID: PMC11064908 DOI: 10.1097/qad.0000000000003852] [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: 11/24/2023] [Revised: 01/18/2024] [Accepted: 01/21/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND Both dolutegravir and efavirenz are known to be effective in pregnancy and postpartum to prevent vertical transmission of HIV and to maintain maternal health. Both drugs have also been associated with neuropsychiatric symptoms. To what extent, these symptoms occur in pregnant and postpartum women, however, is not yet known. METHODS This was a secondary analysis of the DolPHIN2 study, a multicentre randomized trial among women presenting late in pregnancy with untreated HIV - who received either a dolutegravir-containing or efavirenz-containing regimen. Longitudinal measures of depression, anxiety and sleep quality were analysed during pregnancy and up to 48 weeks postpartum. RESULTS Among 268 women, median (IQR) Edinburgh Post Natal Depression Score (EPDS) scores were 8 (3-11) and highest at enrolment. In the dolutegravir and efavirenz arm, respectively, 23.7 and 25.6% had an EPDS score above 9, indicating possible or probable depression. Abnormal Hospital Anxiety Depression scores (HADS) (above 11) were seen at least once during follow-up in 42 of patients (15.7%), although no differences were seen between treatment arms. No association was found between EPDS, suicidality and HADS scores and the assigned regimen ( P = 0.93, 0.97 and 0.18 respectively). Median (IQR) Pittsburgh Sleep Quality index (PSQI) scores for dolutegravir and efavirenz were 6 (5-7) and 5 (5-6.5), respectively, P = 0.70. CONCLUSION No statistically significant differences were observed between efavirenz-containing or dolutegravir-containing regimens. Rates of depression were high, but decreased over the course of time and confirm the need for psychological support after initial HIV diagnosis in pregnancy.
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Affiliation(s)
- Lena van der Wekken-Pas
- Radboud University Medical Center, Department of Pharmacy, Radboud Institute for Medical Innovations (RIMI), Nijmegen, the Netherlands
| | - Sylvia Nassiwa
- Research Department, Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Thokozile Malaba
- School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Mohammed Lamorde
- Research Department, Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Landon Myer
- School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Catriona Waitt
- Research Department, Infectious Diseases Institute, Makerere University, Kampala, Uganda
- Department of Pharmacology & Therapeutics, University of Liverpool
| | - Helen Reynolds
- Department of Pharmacology & Therapeutics, University of Liverpool
| | - Saye Khoo
- Department of Pharmacology & Therapeutics, University of Liverpool
| | - Nengjie He
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Liesbeth van Leeuwen
- Department of Obstetrics and Gynecology, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
| | - David Burger
- Radboud University Medical Center, Department of Pharmacy, Radboud Institute for Medical Innovations (RIMI), Nijmegen, the Netherlands
| | - Duolao Wang
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Angela Colbers
- Radboud University Medical Center, Department of Pharmacy, Radboud Institute for Medical Innovations (RIMI), Nijmegen, the Netherlands
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6
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Hurbans N, Naidoo P. Efficacy, safety, and tolerability of dolutegravir-based ART regimen in Durban, South Africa: a cohort study. BMC Infect Dis 2024; 24:343. [PMID: 38515041 PMCID: PMC10958909 DOI: 10.1186/s12879-024-09202-6] [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: 09/23/2023] [Accepted: 03/06/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Dolutegravir is an integrase strand transfer inhibitor that has been recommended for use in first-line antiretroviral regimens by the World Health Organisation and is currently being rolled out globally. There has been safety concerns with dolutegravir which has caused concern about its use in the general population. Dolutegravir first-line regimens have been used in South Africa since early 2020. Therefore, the aim of the present study was to assess the efficacy, safety, and tolerability of first-line dolutegravir-based antiretrovirals amongst adults living with HIV in Durban, South Africa. METHODS This was a mixed-methods study, which comprised a cross-sectional survey and longitudinal retrospective follow-up of medical records. The study was conducted between October 2020 and January 2022. Data were described using descriptive and summary statistics. Bivariate logistic regression was applied to socio-demographic and clinical variables and crude odds ratios with a 95% confidence interval was calculated. Pearson chi-square tests, paired sample T-tests, and cross-tabulations were performed on selected variables. RESULTS A total of 461 participants were enrolled in the study. There was a significant change in immunological outcomes (p < 0.001) after dolutegravir initiation. Furthermore, an assessment of laboratory parameters showed that there was a significant decrease in cholesterol (p < 0.001) and increase in creatinine (p < 0.001) levels. Increased weight was shown by 60.7% of the participants but was not associated with age, gender, CD4 counts, and previous antiretroviral usage. The study found that 43.6% of the participants experienced at least one side-effect. A total of 21.6% and 23.2% of the participants experienced neuropsychiatric and central nervous system side-effects, respectively. In the bivariate analyses, only gender was shown to be associated with side-effects, and only 1.7% of the participants discontinued the study due to side-effects. CONCLUSION Our results suggest that dolutegravir is effective, safe, and well tolerated in the study population.
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Affiliation(s)
- Nivriti Hurbans
- Discipline of Pharmaceutical Sciences, School of Health Sciences, College of Health Science, University of KwaZulu-Natal, Westville, Durban, 4001, South Africa.
- South African Medical Research Council, HIV and Other Infectious Diseases Research Unit, Durban, South Africa.
| | - Panjasaram Naidoo
- Discipline of Pharmaceutical Sciences, School of Health Sciences, College of Health Science, University of KwaZulu-Natal, Westville, Durban, 4001, South Africa
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7
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Parra-Rodriguez L, O'Halloran J, Wang Y, Jin W, Dastgheyb RM, Spence AB, Sharma A, Gustafson DR, Milam J, Weber KM, Adimora AA, Ofotokun I, Fischl MA, Konkle-Parker D, Maki PM, Xu Y, Rubin LH. Common antiretroviral combinations are associated with somatic depressive symptoms in women with HIV. AIDS 2024; 38:167-176. [PMID: 37773048 DOI: 10.1097/qad.0000000000003730] [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] [Indexed: 09/30/2023]
Abstract
OBJECTIVE While modern antiretroviral therapy (ART) is highly effective and safe, depressive symptoms have been associated with certain ART drugs. We examined the association between common ART regimens and depressive symptoms in women with HIV (WWH) with a focus on somatic vs. nonsomatic symptoms. DESIGN Analysis of longitudinal data from the Women's Interagency HIV Study. METHODS Participants were classified into three groups based on the frequency of positive depression screening (CES-D ≥16): chronic depression (≥50% of visits since study enrollment), infrequent depression (<50% of visits), and never depressed (no visits). Novel Bayesian machine learning methods building upon a subset-tree kernel approach were developed to estimate the combined effects of ART regimens on depressive symptoms in each group after covariate adjustment. RESULTS The analysis included 1538 WWH who participated in 12 924 (mean = 8.4) visits. The mean age was 49.9 years, 72% were Black, and 14% Hispanic. In the chronic depression group, combinations including tenofovir alafenamide and cobicistat-boosted elvitegravir and/or darunavir were associated with greater somatic symptoms of depression, whereas those combinations containing tenofovir disoproxil fumarate and efavirenz or rilpivirine were associated with less somatic depressive symptoms. ART was not associated with somatic symptoms in the infrequent depression or never depressed groups. ART regimens were not associated with nonsomatic symptoms in any group. CONCLUSIONS Specific ART combinations are associated with somatic depressive symptoms in WWH with chronic depression. Future studies should consider specific depressive symptoms domains as well as complete drug combinations when assessing the relationship between ART and depression.
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Affiliation(s)
- Luis Parra-Rodriguez
- Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Jane O'Halloran
- Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Yuezhe Wang
- Department of Applied Mathematics and Statistics, Johns Hopkins University
| | - Wei Jin
- Department of Applied Mathematics and Statistics, Johns Hopkins University
| | - Raha M Dastgheyb
- Departments of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Amanda B Spence
- Department of Medicine, Division of Infectious Disease and Tropical Medicine, Georgetown University, Washington, DC
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx
| | - Deborah R Gustafson
- Department of Neurology, State University of New York Downstate Health Sciences University, Brooklyn, New York
| | - Joel Milam
- Department of Epidemiology and Biostatistics, University of California, Irvine, California
| | - Kathleen M Weber
- Cook County Health and Hektoen Institute of Medicine, Chicago, Illinois
| | - Adaora A Adimora
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Igho Ofotokun
- Department of Medicine, Division of Infectious Diseases, Emory University, Atlanta, Georgia
| | - Margaret A Fischl
- Division of Infectious Disease, University of Miami Miller School of Medicine, Miami, Florida
| | - Deborah Konkle-Parker
- Schools of Nursing, Medicine and Population Health, University of Mississippi Medical Center, Jackson, Mississippi, Mississippi
| | - Pauline M Maki
- Departments of Psychiatry and Psychology, University of Illinois at Chicago, Chicago, Illinois
| | - Yanxun Xu
- Department of Applied Mathematics and Statistics, Johns Hopkins University
- Division of Biostatistics and Bioinformatics at The Sidney Kimmel Comprehensive Cancer Center
| | - Leah H Rubin
- Departments of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Psychiatry and Behavioral Sciences
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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8
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Fimbo A, Mwalwisi YH, Mwamwitwa K, Matiko D, Mfinanga E, Lyimo J, Sabasaba A, Missago S, Bukundi E, Gotora G, Respick D, Nkayamba A, Masunga E, Mnkugwe RH, Kunambi PP, Munishi C, Musanhu CC, Minzi OMS, Mlugu EM. Incidence and determinants of adverse events in individuals with HIV commencing Dolutegravir-based antiretroviral therapy in mainland Tanzania. Sci Rep 2024; 14:615. [PMID: 38182720 PMCID: PMC10770041 DOI: 10.1038/s41598-023-51144-7] [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: 05/25/2023] [Accepted: 12/31/2023] [Indexed: 01/07/2024] Open
Abstract
Tanzania adopted a Dolutegravir (DTG)-based regimen as first-line treatment in 2019 following the World Health Organization recommendation. Data on the DTG safety profile from sub-Saharan Africa including Tanzania are limited. We investigated the incidence of DTG-related adverse events (AEs) and associated factors among people living with HIV (PLHIV) initiated on a DTG regimen. A prospective cohort study was conducted from 25 Care and Treatment Clinics in mainland Tanzania. PLHIV aged 12 years and above who were initiated on a DTG-based regimen were actively followed up for three months. The Cox regression model was used to determine the predictors of occurrence of AEs over time. A p-value of 0.05 was considered statistically significant. From January 2020 to June 2022, a cohort of 935 participants who were both newly diagnosed and ART-experienced who transitioned to a DTG-based regimen was enrolled. Out of 935 participants, 59 (6.3%) reported a total of 62 AEs. The most frequently experienced AE was skin itching and rashes (15/62; 24.2%). DTG-associated neuropsychiatric AEs were less common and included headache (6 [9.6%]) and sleep disturbances (3 [4.8%]). The overall incidence of occurrence of the first AEs was 96.7 per 1000 person-months [95% C.I: 74.4-125.7] with the highest incidence observed among the elderly (≥ 60 years). Individuals on WHO HIV Clinical Stage 2 had a 2.7 significantly higher risk of developing AEs (adjusted hazard ratio = 2.73, 95% CI = 1.46-5.12, p = 0.017). We report a low incidence of grade I (mild) and grade II (moderate) DTG-associated AEs suggesting that the regimen is generally safe in the population. Continued monitoring of DTG safety in the population is recommended.
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Affiliation(s)
- Adam Fimbo
- Tanzania Medicines and Medical Devices Authority (TMDA), Dodoma, Tanzania
| | - Yonah H Mwalwisi
- Tanzania Medicines and Medical Devices Authority (TMDA), Dodoma, Tanzania
| | - Kissa Mwamwitwa
- Tanzania Medicines and Medical Devices Authority (TMDA), Dodoma, Tanzania
| | - Damas Matiko
- Tanzania Medicines and Medical Devices Authority (TMDA), Dodoma, Tanzania
| | - Elirehema Mfinanga
- Tanzania Medicines and Medical Devices Authority (TMDA), Dodoma, Tanzania
| | | | - Amon Sabasaba
- Department of Epidemiology, School of Public Health, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Seth Missago
- National Institute for Medical Research, Headquarters, Dar Es Salaam, Tanzania
| | - Elias Bukundi
- Department of Epidemiology, School of Public Health, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Goodluck Gotora
- Tanzania Medicines and Medical Devices Authority (TMDA), Dodoma, Tanzania
| | - Dorice Respick
- Department of Epidemiology, School of Public Health, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Alex Nkayamba
- Tanzania Medicines and Medical Devices Authority (TMDA), Dodoma, Tanzania
| | - Emmanuel Masunga
- Tanzania Medicines and Medical Devices Authority (TMDA), Dodoma, Tanzania
| | - Rajabu Hussein Mnkugwe
- Department of Clinical Pharmacology, School of Biomedical Sciences, Campus College of Medicine, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Peter P Kunambi
- Department of Clinical Pharmacology, School of Biomedical Sciences, Campus College of Medicine, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Castory Munishi
- Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | | | - Omary M S Minzi
- Department of Clinical Pharmacy and Pharmacology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Eulambius M Mlugu
- Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania.
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9
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O'Halloran JA, Parra-Rodriguez L, Goss CW, Agarwal M, Cooley S, Wu K, Westerhaus E, Presti R, Ances BM, Tassiopoulos K, Erlandson KM. Impact of Integrase Strand Transfer Inhibitors on Cognition in the HAILO Cohort. J Acquir Immune Defic Syndr 2023; 94:437-444. [PMID: 37949447 PMCID: PMC11303936 DOI: 10.1097/qai.0000000000003297] [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: 04/09/2023] [Accepted: 08/21/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Integrase inhibitors (INSTIs) have been associated with poorer cognition in people with HIV (PWH). We examined the impact of switching to INSTIs on neuropsychological (NP) outcomes in PWH 40 years of age and older. METHODS From the AIDS Clinical Trials Group observational cohort study, HAILO, we identified PWH who switched to INSTIs, had ≥2 NP assessments before and at least 1 after switch, and maintained viral suppression while on INSTIs. NP performance was assessed with a composite score (NPZ4) including Hopkins Verbal Learning Test (HVLT-R), Digit Symbol test (DSY), Trail Making A, and Trail Making B, while adjusting for covariates and learning effects. Outcomes changes from preswitch and postswitch periods were estimated using piecewise linear mixed models. RESULTS Among 395 PWH (mean age 54 years, 81% male, 20% Hispanic, and 29% Black) NPZ4 increased preswitch and postswitch. There was no difference in slopes between periods for NPZ4 [preswitch 0.036/year (95% CI: 0.03 to 0.043); postswitch 0.022/year (95% CI: 0.006 to 0.005); P = 0.147]. All tests scores improved preswitch (P < 0.01). Postswitch, Trail Making A and DSY increased (all P < 0.01) without differences in rate of change (all P > 0.05). HVLT-R had a nonsignificant decrease postswitch (P = 0.22), resulting in a significant preswitch vs postswitch difference in slopes (P = 0.03). CONCLUSIONS NP performance improved regardless of INSTI use. There was an attenuation of improvement in verbal memory in the postswitch vs preswitch period. The clinical significance of these changes is unclear but, overall, INSTIs did not have a consistent detrimental effect on NP outcomes.
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Affiliation(s)
| | | | | | - Mansi Agarwal
- Washington University School of Medicine, St Louis, MO
| | - Sarah Cooley
- Washington University School of Medicine, St Louis, MO
| | - Kunling Wu
- Harvard T. H. Chan School of Public Health, Boston, MA; and
| | | | - Rachel Presti
- Washington University School of Medicine, St Louis, MO
| | - Beau M Ances
- Washington University School of Medicine, St Louis, MO
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10
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Jakimiuk A, Piechal A, Wiercińska-Drapało A, Nowaczyk A, Mirowska-Guzel D. Central nervous system disorders after use of dolutegravir: evidence from preclinical and clinical studies. Pharmacol Rep 2023; 75:1138-1151. [PMID: 37605102 PMCID: PMC10539422 DOI: 10.1007/s43440-023-00515-y] [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: 05/23/2023] [Revised: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 08/23/2023]
Abstract
The evaluation of dolutegravir based on available preclinical and clinical studies reveals a risk of central nervous system (CNS) disorders associated with long-term use of the drug. The available literature on the pharmacokinetics of the drug, including its penetration of the blood-brain barrier, was reviewed, as well as clinical trials assessing the incidence of adverse effects in the CNS and the frequency of its discontinuation. This paper also summarizes the impact of factors affecting the occurrence of CNS disorders and indicates the key role of pharmacovigilance in the process of supplementing knowledge on the safety of drugs, especially those that are newly registered.
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Affiliation(s)
- Alicja Jakimiuk
- Department of Clinical and Experimental Pharmacology, Centre for Preclinical Research and Technology, Medical University of Warsaw, Banacha 1b, 02-097, Warsaw, Poland
| | - Agnieszka Piechal
- Department of Clinical and Experimental Pharmacology, Centre for Preclinical Research and Technology, Medical University of Warsaw, Banacha 1b, 02-097, Warsaw, Poland
| | - Alicja Wiercińska-Drapało
- Department of Hepatology and Infectious and Tropical Diseases, Medical University of Warsaw, Provincial Infectious Diseases Hospital in Warsaw, Wolska 37, 01-201, Warsaw, Poland
| | - Alicja Nowaczyk
- Department of Organic Chemistry, Faculty of Pharmacy, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 2 dr. A. Jurasza, 85-094, Bydgoszcz, Poland
| | - Dagmara Mirowska-Guzel
- Department of Clinical and Experimental Pharmacology, Centre for Preclinical Research and Technology, Medical University of Warsaw, Banacha 1b, 02-097, Warsaw, Poland.
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11
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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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12
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Letendre SL, Chen H, McKhann A, Roa J, Vecchio A, Daar ES, Berzins B, Hunt PW, Marra CM, Campbell TB, Coombs RW, Ma Q, Swaminathan S, Macatangay BJC, Morse GD, Miller T, Rusin D, Greninger AL, Ha B, Alston-Smith B, Robertson K, Paul R, Spudich S. Antiretroviral Therapy Intensification for Neurocognitive Impairment in Human Immunodeficiency Virus. Clin Infect Dis 2023; 77:866-874. [PMID: 37183889 PMCID: PMC10506779 DOI: 10.1093/cid/ciad265] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/23/2023] [Accepted: 04/27/2023] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND Neurocognitive impairment (NCI) in people with HIV (PWH) on antiretroviral therapy (ART) is common and may result from persistent HIV replication in the central nervous system. METHODS A5324 was a randomized, double-blind, placebo-controlled, 96-week trial of ART intensification with dolutegravir (DTG) + MVC, DTG + Placebo, or Dual - Placebo in PWH with plasma HIV RNA <50 copies/mL on ART and NCI. The primary outcome was the change on the normalized total z score (ie, the mean of individual NC test z scores) at week 48. RESULTS Of 357 screened, 191 enrolled: 71% male, 51% Black race, 22% Hispanic ethnicity; mean age 52 years; mean CD4+ T-cells 681 cells/µL. Most (65%) had symptomatic HIV-associated NC disorder. Study drug was discontinued due to an adverse event in 15 (8%) and did not differ between arms (P = .17). Total z score, depressive symptoms, and daily functioning improved over time in all arms with no significant differences between them at week 48 or later. Adjusting for age, sex, race, study site, efavirenz use, or baseline z score did not alter the results. Body mass index modestly increased over 96 weeks (mean increase 0.32 kg/m2, P = .006) and did not differ between arms (P > .10). CONCLUSIONS This is the largest, randomized, placebo-controlled trial of ART intensification for NCI in PWH. The findings do not support empiric ART intensification as a treatment for NCI in PWH on suppressive ART. They also do not support that DTG adversely affects cognition, mood, or weight.
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Affiliation(s)
| | - Huichao Chen
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Ashley McKhann
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Jhoanna Roa
- DLH Corporation, Silver Spring, Maryland, USA
| | - Alyssa Vecchio
- University of North Carolina, Chapel Hill, North Carolina, USA
| | - Eric S Daar
- Lundquist Institute at Harbor–University of California–Los Angeles Medical Center, Torrance, California, USA
| | | | - Peter W Hunt
- University of California–San Francisco, San Francisco, California, USA
| | - Christina M Marra
- University of Washington School of Medicine, Seattle, Washington, USA
| | | | - Robert W Coombs
- University of Washington School of Medicine, Seattle, Washington, USA
| | - Qing Ma
- University at Buffalo, Buffalo, New York, USA
| | | | | | | | | | - David Rusin
- DLH Corporation, Silver Spring, Maryland, USA
| | | | - Belinda Ha
- ViiV Healthcare Ltd, Research Triangle Park, North Carolina, USA
| | | | - Kevin Robertson
- University of North Carolina, Chapel Hill, North Carolina, USA
| | - Robert Paul
- University of Missouri, St. Louis, Missouri, USA
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13
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Zeuli JD, Rivera CG, Wright JA, Kasten MJ, Mahmood M, Ragan AK, Rizza SA, Temesgen Z, Vergidis P, Wilson JW, Cummins NW. Pharmacogenomic panel testing provides insight and enhances medication management in people with HIV. AIDS 2023; 37:1525-1533. [PMID: 37199600 DOI: 10.1097/qad.0000000000003598] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
OBJECTIVE Our study aimed to assess the impact of pharmacogenomic panel testing in people with HIV (PWH). DESIGN Prospective, observational intervention assessment. METHODS One hundred PWH were provided a comprehensive pharmacogenomic panel during routine care visits within the HIV specialty clinic of a large academic medical center. The panel determined the presence of specific genetic variants that could predict response or toxicity to commonly prescribed antiretroviral therapy (ART) and non-ART medications. An HIV specialty pharmacist reviewed the results with participants and the care team. The pharmacist (1) recommended clinically actionable interventions based on the participants' current drug therapy, (2) assessed for genetic explanations for prior medication failures, adverse effects, or intolerances, and (3) advised on potential future clinically actionable care interventions based on individual genetic phenotypes. RESULTS Ninety-six participants (median age 53 years, 74% white, 84% men, 89% viral load <50 copies/ml) completed panel testing, yielding 682 clinically relevant pharmacogenomic results (133 major, 549 mild-moderate). Ninety participants (89 on ART) completed follow-up visits with 65 (72%) receiving clinical recommendations based on current medication profiles. Of the 105 clinical recommendations, 70% advised additional monitoring for efficacy or toxicity, and 10% advised alteration of drug therapy. Panel results offered explanation for prior ART inefficacy in one participant and ART intolerance in 29%. Genetic explanation for non-ART toxicity was seen in 21% of participants, with genetic contributors to inefficacy of non-ART therapy identified in 39% of participants. CONCLUSION Preliminary data in a small cohort of PWH demonstrates benefit of routine pharmacogenomic panel testing.
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Affiliation(s)
- John D Zeuli
- Department of Pharmacy
- Section of Infectious Diseases
| | | | - Jessica A Wright
- Department of Pharmacy
- Center for Individualized Medicine, Mayo Clinic, Rochester, Minnesota, USA
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14
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Santos JR, Casadellà M, Noguera-Julian M, Micán-Rivera R, Domingo P, Antela A, Portilla J, Sanz J, Montero-Alonso M, Navarro J, Masiá M, Valcarce-Pardeiro N, Ocampo A, Pérez-Martínez L, García-Vallecillos C, Vivancos MJ, Imaz A, Iribarren JA, Hernández-Quero J, Villar-García J, Barrufet P, Paredes R. Effectiveness and safety of integrase strand transfer inhibitors in Spain: a prospective real-world study. Front Cell Infect Microbiol 2023; 13:1187999. [PMID: 37434782 PMCID: PMC10331300 DOI: 10.3389/fcimb.2023.1187999] [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: 03/18/2023] [Accepted: 05/30/2023] [Indexed: 07/13/2023] Open
Abstract
Introduction Second-generation integrase strand transfer inhibitors (INSTIs) are preferred treatment options worldwide, and dolutegravir (DTG) is the treatment of choice in resource-limited settings. Nevertheless, in some resource-limited settings, these drugs are not always available. An analysis of the experience with the use of INSTIs in unselected adults living with HIV may be of help to make therapeutic decisions when second-generation INSTIs are not available. This study aimed to evaluate the real-life effectiveness and safety of dolutegravir (DTG), elvitegravir/cobicistat (EVG/c), and raltegravir (RAL) in a large Spanish cohort of HIV-1-infected patients. Methods Real-world study of adults living with HIV who initiated integrase INSTIs DTG, EVG/c, and RAL-based regimens in three settings (ART-naïve patients, ART-switching, and ART-salvage patients). The primary endpoint was the median time to treatment discontinuation after INSTI-based regimen initiation. Proportion of patients experiencing virological failure (VF) (defined as two consecutive viral loads (VL) ≥200 copies/mL at 24 weeks or as a single determination of VL ≥1,000 copies/mL while receiving DTG, EVG/c or RAL, and at least 3 months after INSTI initiation) and time to VF were also evaluated. Results Virological effectiveness of EVG/c- and RAL-based regimens was similar to that of DTG when given as first-line and salvage therapy. Treatment switching for reasons other than virological failure was more frequent in subjects receiving EVG/c and, in particular, RAL. Naïve patients with CD4+ nadir <100 cells/μL were more likely to develop VF, particularly if they initiated RAL or EVG/c. In the ART switching population, initiation of RAL and EVG/c was associated with both VF and INSTI discontinuation. There were no differences in the time to VF and INSTI discontinuation between DTG, EVG/c and RAL. Immunological parameters improved in the three groups and for the three drugs assessed. Safety and tolerability were consistent with expected safety profiles. Discussion Whereas second-generation INSTIs are preferred treatment options worldwide, and DTG is one of the treatment of choices in resource-limited settings, first-generation INSTIs may still provide high virological and immunological effectiveness when DTG is not available.
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Affiliation(s)
- José Ramón Santos
- Fight Infections Foundation, Service of Infectious Diseases, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | | | | | - Pere Domingo
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Antonio Antela
- Infectious Diseases Unit, Santiago de Compostela Clinical University Hospital, Santiago de Compostela, Spain
| | - Joaquin Portilla
- Department of Internal Medicine, Hospital General Universitario Dr. Balmis de Alicante, Alicante, Spain
| | - Jesús Sanz
- Department of Infectious Diseases, University Hospital de La Princesa, Madrid, Spain
| | - Marta Montero-Alonso
- Infectious Diseases Unit, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Jordi Navarro
- Infectious Diseases Department, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Mar Masiá
- Infectious Diseases Unit, Elche University General Hospital, Elche, Spain
- Centro de Investigaciones Biomédicas en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | | | | | - Laura Pérez-Martínez
- Department of Infectious Diseases, Biomedical Research Center of La Rioja (CIBIR), Logroño, Spain
| | | | - María Jesús Vivancos
- Centro de Investigaciones Biomédicas en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Department of Infectious Diseases and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Ramón y Cajal Hospital, Madrid, Spain
| | - Arkaitz Imaz
- HIV and STI Unit, Infectious Diseases Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Spain
| | - José Antonio Iribarren
- Department of Infectious Diseases, Donostia University Hospital, Instituto de Investigación Sanitaria BioDonostia, Universidad del País Vasco, San Sebastián, Spain
| | | | - Judit Villar-García
- Infectious Diseases Department, Hospital del Mar - Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Pilar Barrufet
- Infectious Diseases Unit, Mataró Hospital, Mataró, Spain
| | - Roger Paredes
- Fight Infections Foundation, Service of Infectious Diseases, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- IrsiCaixa AIDS Research Institute, Badalona, Spain
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15
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Rubin LH, O'Halloran JA, Williams DW, Li Y, Fitzgerald KC, Dastgheyb R, Damron AL, Maki PM, Spence AB, Sharma A, Gustafson DR, Milam J, Weber KM, Adimora AA, Ofotokun I, Fischl MA, Konkle-Parker D, Xu Y. Integrase Inhibitors are Associated with Neuropsychiatric Symptoms in Women with HIV. J Neuroimmune Pharmacol 2023; 18:1-8. [PMID: 35178611 PMCID: PMC9381649 DOI: 10.1007/s11481-021-10042-3] [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: 10/11/2021] [Accepted: 12/06/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Women with HIV(WWH) are more likely to discontinue/change antiretroviral therapy(ART) due to side effects including neuropsychiatric symptoms. Efavirenz and integrase strand transfer inhibitors(INSTIs) are particularly concerning. We focused on these ART agents and neuropsychiatric symptoms in previously developed subgroups of WWH that differed on key sociodemographic factors as well as longitudinal behavioral and clinical profiles. WWH from the Women's Interagency HIV Study were included if they had ART data available, completed the Perceived Stress Scale-10 and PTSD Checklist-Civilian. Questionnaires were completed biannually beginning in 2008 through 2016. To examine ART-symptom associations, constrained continuation ratio model via penalized maximum likelihood were fit within 5 subgroups of WWH. Data from 1882 WWH contributed a total of 4598 observations. 353 women were previously defined as primarily having well-controlled HIV with vascular comorbidities, 463 with legacy effects(CD4 nadir < 250cells/mL), 274 aged ≤ 45 with hepatitis, 453 between 35-55 years, and 339 with poorly-controlled HIV/substance users. INSTIs, but not efavirenz, were associated with symptoms among key subgroups of WWH. Among those with HIV legacy effects, dolutegravir and elvitegravir were associated with greater stress/anxiety and avoidance symptoms(P's < 0.01); dolutegravir was also associated with greater re-experiencing symptoms(P = 0.005). Elvitegravir related to greater re-experiencing and hyperarousal among women with well-controlled HIV with vascular comorbidities(P's < 0.022). Raltegravir was associated with less hyperarousal, but only among women aged ≤ 45 years(P = 0.001). The adverse neuropsychiatric effects of INSTIs do not appear to be consistent across all WWH. Key characteristics (e.g., age, hepatitis positivity) may need consideration to fully weight the risk-benefit ratio of dolutegravir and elvitegravir in WWH.
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Affiliation(s)
- Leah H Rubin
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MDD, USA.
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MDD, USA.
| | - Jane A O'Halloran
- Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Dionna W Williams
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, MDD, USA
- Division of Clinical Pharmacology, Johns Hopkins University School of Medicine, Baltimore, MDD, USA
| | - Yuliang Li
- Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, MDD, USA
| | - Kathryn C Fitzgerald
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Raha Dastgheyb
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alexandra L Damron
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Pauline M Maki
- Departments of Psychiatry and Psychology, University of Illinois at Chicago, Chicago, ILD, USA
| | - Amanda B Spence
- Department of Medicine, Division of Infectious Disease and Travel Medicine, Georgetown University, Washington, DCD, USA
| | | | - Deborah R Gustafson
- Department of Neurology, State University of New York Downstate Health Sciences University, New York City, , USA
| | - Joel Milam
- Institute for Health Promotion & Disease Prevention Research, University of Southern California, Los Angeles, CA, USA
| | - Kathleen M Weber
- CORE Center, Cook County Health and Hektoen Institute of Medicine, Chicago, IL, USA
| | - Adaora A Adimora
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Igho Ofotokun
- Department of Medicine, Division of Infectious Diseases, Emory University, Atlanta, GA, USA
| | | | - Deborah Konkle-Parker
- Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, MS, USA
| | - Yanxun Xu
- Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, MDD, USA
- Division of Biostatistics and Bioinformatics at The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MDD, USA
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16
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Fabbiani M, Masini M, Rossetti B, Ciccullo A, Borghi V, Lagi F, Capetti A, Colafigli M, Panza F, Baldin G, Mussini C, Sterrantino G, Farinacci D, Montagnani F, Tumbarello M, Di Giambenedetto S. Efficacy and Durability of Dolutegravir- or Darunavir-Based Regimens in ART-Naïve AIDS- or Late-Presenting HIV-Infected Patients. Viruses 2023; 15:v15051123. [PMID: 37243208 DOI: 10.3390/v15051123] [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: 04/07/2023] [Revised: 05/01/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Since limited data are available, we aimed to compare the efficacy and durability of dolutegravir and darunavir in advanced naïve patients. METHODS Retrospective multicenter study including AIDS- or late-presenting (def. CD4 ≤ 200/µL) HIV-infected patients starting dolutegravir or ritonavir/cobicistat-boosted darunavir+2NRTIs. Patients were followed from the date of first-line therapy initiation (baseline, BL) to the discontinuation of darunavir or dolutegravir, or for a maximum of 36 months of follow-up. RESULTS Overall 308 patients (79.2% males, median age 43 years, 40.3% AIDS-presenters, median CD4 66 cells/µL) were enrolled; 181 (58.8%) and 127 (41.2%) were treated with dolutegravir and darunavir, respectively. Incidence of treatment discontinuation (TD), virological failure (VF, defined as a single HIV-RNA > 1000 cp/mL or two consecutive HIV-RNA > 50 cp/mL after 6 months of therapy or after virological suppression had been achieved), treatment failure (the first of TD or VF), and optimal immunological recovery (defined as CD4 ≥ 500/µL + CD4 ≥ 30% + CD4/CD8 ≥ 1) were 21.9, 5.2, 25.6 and 1.4 per 100 person-years of follow-up, respectively, without significant differences between dolutegravir and darunavir (p > 0.05 for all outcomes). However, a higher estimated probability of TD for central nervous system (CNS) toxicity (at 36 months: 11.7% vs. 0%, p = 0.002) was observed for dolutegravir, whereas darunavir showed a higher probability of TD for simplification (at 36 months: 21.3% vs. 5.7%, p = 0.046). CONCLUSIONS Dolutegravir and darunavir showed similar efficacy in AIDS- and late-presenting patients. A higher risk of TD due to CNS toxicity was observed with dolutegravir, and a higher probability of treatment simplification with darunavir.
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Affiliation(s)
- Massimiliano Fabbiani
- UOC Malattie Infettive e Tropicali, Azienda Ospedaliero-Universitaria Senese, 53100 Siena, Italy
| | - Melissa Masini
- UOC Malattie Infettive, Azienda USL Toscana Sud Est, PO San Donato, 52100 Arezzo, Italy
| | - Barbara Rossetti
- Division of Infectious Diseases, AUSL Toscana Sud Est, Grosseto Hospital, 58100 Grosseto, Italy
| | - Arturo Ciccullo
- Dipartimento di Sicurezza e Bioetica Sezione Malattie Infettive, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- UOC Malattie Infettive, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Vanni Borghi
- Clinica Malattie Infettive e Tropicali, Azienda Ospedaliero Universitaria di Modena, 41100 Modena, Italy
| | - Filippo Lagi
- SOD Malattie Infettive e Tropicali, Azienda Ospedaliero-Universitaria Careggi, 50134 Firenze, Italy
| | - Amedeo Capetti
- Divisione di Malattie Infettive, Dipartimento di Malattie Infettive, Ospedale Universitario Luigi Sacco, 20157 Milano, Italy
| | - Manuela Colafigli
- Unità di Dermatologia Infettiva e Allergologia, Istituto S. Gallicano IRCCS, 00144 Rome, Italy
| | - Francesca Panza
- UOC Malattie Infettive e Tropicali, Azienda Ospedaliero-Universitaria Senese, 53100 Siena, Italy
- Dipartimento di Biotecnologie Mediche, Università degli Studi di Siena, 53100 Siena, Italy
| | - Gianmaria Baldin
- Dipartimento di Sicurezza e Bioetica Sezione Malattie Infettive, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- UOC Malattie Infettive, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Cristina Mussini
- Clinica Malattie Infettive e Tropicali, Azienda Ospedaliero Universitaria di Modena, 41100 Modena, Italy
| | - Gaetana Sterrantino
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
| | - Damiano Farinacci
- Dipartimento di Sicurezza e Bioetica Sezione Malattie Infettive, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- UOC Malattie Infettive, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Francesca Montagnani
- UOC Malattie Infettive e Tropicali, Azienda Ospedaliero-Universitaria Senese, 53100 Siena, Italy
- Dipartimento di Biotecnologie Mediche, Università degli Studi di Siena, 53100 Siena, Italy
| | - Mario Tumbarello
- UOC Malattie Infettive e Tropicali, Azienda Ospedaliero-Universitaria Senese, 53100 Siena, Italy
- Dipartimento di Biotecnologie Mediche, Università degli Studi di Siena, 53100 Siena, Italy
| | - Simona Di Giambenedetto
- Dipartimento di Sicurezza e Bioetica Sezione Malattie Infettive, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- UOC Malattie Infettive, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
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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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Petrakis V, Steiropoulos P, Papanas N, Trypsianis G, Papazoglou D, Panagopoulos P. Quality of sleep in people living with HIV in the era of highly active antiretroviral treatment. Int J STD AIDS 2023; 34:191-202. [PMID: 36542510 DOI: 10.1177/09564624221146608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE Although HIV infection has become a chronic disease, people living with HIV (PLWHIV) often develop disorders that affect their quality of life. Sleep disturbances could occur in all stages of infection and lead to fatigue, increased risk for comorbidities and reduced adherence to treatment. The aim of the present study is to evaluate the quality of sleep in PLWHIV monitored at the HIV Unit of the University General Hospital of Evros (Greece). METHODS Patients completed self-reported questionnaires including restless legs syndrome (RLS) questionnaire, the Epworth Scale, the Athens Insomnia Scale, the Fatigue Severity Scale (FSS), the Hospital Anxiety and Depression Scale - HADS, the SleepF Quality Scale MOS, the STOP BANG questionnaire for obstructive sleep apnoea (OSA), the Pittsburgh Sleep Quality Index and the International Physical Activity Questionnaire. Sociodemographic and anthropometric characteristics, data of HIV infection and clinical factors were recorded. RESULTS A total of 154 patients, 120 males, were included in the study. The percentage of patients diagnosed with RLS was 26.6% and the corresponding percentage of insomnia 55.2%. OSA was documented in 35% of patients. High prevalence of depression (46.1%) and anxiety (54.54%) was reported. Detectable viral load, low CD4 cell count and limited physical activity (p < 0.001) were significant risk factors for increased incidence rate of sleep disturbances. Sleep disorders were not proven to be associated with newer antiretroviral regimens. CONCLUSIONS Sleep disturbances were reported in high frequency in PLWHIV affecting their quality of life and increasing symptoms of depression and anxiety. It is vital to add sleep assessment into routine care and find efficient interventions in order to improve quality of life, mental health and adherence to antiretroviral treatment.
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Affiliation(s)
- Vasileios Petrakis
- Department of Infectious Diseases, 2nd Department of Internal Medicine, University General Hospital Alexandroupolis, 387479Democritus University of Thrace, Alexandroupoli, Greece
| | - Paschalis Steiropoulos
- University Pneumonology Department, University General Hospital Alexandroupolis, 387479Democritus University of Thrace, Alexandroupoli, Greece
| | - Nikolaos Papanas
- Department of Infectious Diseases, 2nd Department of Internal Medicine, University General Hospital Alexandroupolis, 387479Democritus University of Thrace, Alexandroupoli, Greece
| | - Grigorios Trypsianis
- Department of Medical Statistics, Medical School, 387479Democritus University of Thrace, Alexandroupoli, Greece
| | - Dimitrios Papazoglou
- Department of Infectious Diseases, 2nd Department of Internal Medicine, University General Hospital Alexandroupolis, 387479Democritus University of Thrace, Alexandroupoli, Greece
| | - Periklis Panagopoulos
- Department of Infectious Diseases, 2nd Department of Internal Medicine, University General Hospital Alexandroupolis, 387479Democritus University of Thrace, Alexandroupoli, Greece
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Dolutegravir-containing HIV therapy reversibly alters mitochondrial health and morphology in cultured human fibroblasts and peripheral blood mononuclear cells. AIDS 2023; 37:19-32. [PMID: 36399361 DOI: 10.1097/qad.0000000000003369] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Given the success of combination antiretroviral therapy (cART) in treating HIV viremia, drug toxicity remains an area of interest in HIV research. Despite newer integrase strand transfer inhibitors (InSTIs), such as dolutegravir (DTG) and raltegravir (RAL), having excellent clinical tolerance, there is emerging evidence of off-target effects and toxicities. Although limited in number, recent reports have highlighted the vulnerability of mitochondria to these toxicities. The aim of the present study is to quantify changes in cellular and mitochondrial health following exposure to current cART regimens at pharmacological concentrations. A secondary objective is to determine whether any cART-associated toxicities would be modulated by human telomerase reverse transcriptase (hTERT). METHODS We longitudinally evaluated markers of cellular (cell count, apoptosis), and mitochondrial health [mitochondrial reactive oxygen species (mtROS), membrane potential (MMP) and mass (mtMass)] by flow cytometry in WI-38 human fibroblast with differing hTERT expression/localization and peripheral blood mononuclear cells. This was done after 9 days of exposure to, and 6 days following the removal of, seven current cART regimens, including three that contained DTG. Mitochondrial morphology was assessed by florescence microscopy and quantified using a recently developed deep learning-based pipeline. RESULTS Exposure to DTG-containing regimens increased apoptosis, mtROS, mtMass, induced fragmented mitochondrial networks compared with non-DTG-containing regimens, including a RAL-based combination. These effects were unmodulated by telomerase expression. All effects were fully reversible following removal of drug pressure. CONCLUSION Taken together, our observations indicate that DTG-containing regimens negatively impact cellular and mitochondrial health and may be more toxic to mitochondria, even among the generally well tolerated InSTI-based cART.
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20
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Foster EG, Gendelman HE, Bade AN. HIV-1 Integrase Strand Transfer Inhibitors and Neurodevelopment. Pharmaceuticals (Basel) 2022; 15:1533. [PMID: 36558984 PMCID: PMC9783753 DOI: 10.3390/ph15121533] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/01/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022] Open
Abstract
Children born to mothers, with or at risk, of human immunodeficiency virus type-1 (HIV-1) infection are on the rise due to affordable access of antiretroviral therapy (ART) to pregnant women or those of childbearing age. Each year, up to 1.3 million HIV-1-infected women on ART have given birth with recorded mother-to-child HIV-1 transmission rates of less than 1%. Despite this benefit, the outcomes of children exposed to antiretroviral drugs during pregnancy, especially pre- and post- natal neurodevelopment remain incompletely understood. This is due, in part, to the fact that pregnant women are underrepresented in clinical trials. This is underscored by any potential risks of neural tube defects (NTDs) linked, in measure, to periconceptional usage of dolutegravir (DTG). A potential association between DTG and NTDs was first described in Botswana in 2018. Incidence studies of neurodevelopmental outcomes associated with DTG, and other integrase strand transfer inhibitors (INSTIs) are limited as widespread use of INSTIs has begun only recently in pregnant women. Therefore, any associations between INSTI use during pregnancy, and neurodevelopmental abnormalities remain to be explored. Herein, United States Food and Drug Administration approved ARVs and their use during pregnancy are discussed. We provide updates on INSTI pharmacokinetics and adverse events during pregnancy together with underlying mechanisms which could affect fetal neurodevelopment. Overall, this review seeks to educate both clinical and basic scientists on potential consequences of INSTIs on fetal outcomes as a foundation for future scientific investigations.
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Affiliation(s)
- Emma G. Foster
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Howard E. Gendelman
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198, USA
- Department of Pharmaceutical Sciences, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Aditya N. Bade
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198, USA
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21
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Humphrey JM, Omodi V, Bernard C, Maina M, Thorne J, Mwangi A, Wools‐Kaloustian K, Patel RC. Contraception use and HIV outcomes among women initiating dolutegravir-containing antiretroviral therapy in Kenya: a retrospective cohort study. J Int AIDS Soc 2022; 25:e26046. [PMID: 36567432 PMCID: PMC9790976 DOI: 10.1002/jia2.26046] [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: 12/21/2021] [Accepted: 11/22/2022] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION The rollout of dolutegravir (DTG) in low- and middle-income countries was disrupted by a potential association reported with periconceptional DTG exposure among women living with HIV (WLHIV) and infant neural tube defects. This prompted countries to issue interim guidance limiting DTG use among women of reproductive potential to those on effective contraception. Data to understand the potential impact of such guidance on WLHIV are limited. METHODS We conducted a retrospective cohort analysis of WLHIV 15-49 years initiating DTG-containing antiretroviral treatment (ART) in Kenya from 2017 to 2020. We determined baseline effective (oral, injectable or lactational amenorrhea) and very effective (implant, intrauterine device or female sterilization) contraception use among women who initiated DTG before (Group 1) or during (Group 2) the interim guideline period. We defined incident contraception use in each group as the number of contraceptive methods initiated ≤180 days post-guideline (Group 1) or post-DTG initiation (Group 2). We determined the proportions of all women who switched from DTG- to non-nucleoside reverse transcriptase inhibitor (NNRTI)- (efavirenz or nevirapine) containing ART ≤12 months post-DTG initiation, compared their viral suppression (<1000 copies/ml) and conducted multivariable logistic regression to determine factors associated with switching from DTG to NNRTI-containing ART. RESULTS Among 5155 WLHIV in the analysis (median age 43 years), 89% initiated DTG after transitioning from an NNRTI. Baseline effective and very effective contraception use, respectively, by the group were: Group 1 (12% and 13%) and Group 2 (41% and 35%). Incident contraception use in each group was <5%. Overall, 498 (10%) women switched from DTG to an NNRTI. Viral suppression among those remaining on DTG versus switched to NNRTI was 95% and 96%, respectively (p = 0.63). In multivariable analysis, incident effective and very effective contraception use was not associated with switching. CONCLUSIONS Baseline, but not incident, effective contraception use was higher during the interim guideline period compared to before it, suggesting women already using effective contraception were preferentially selected to initiate DTG after the guideline was released. These findings reveal challenges in the implementation of policy which ties antiretroviral access to contraceptive use. Future guidance should capture nuances of contraception decision-making and support women's agency to make informed decisions.
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Affiliation(s)
- John M. Humphrey
- Department of MedicineIndiana University School of MedicineIndianapolisIndianaUSA
| | - Victor Omodi
- Academic Model Providing Access to Healthcare (AMPATH)EldoretKenya
| | - Caitlin Bernard
- Department of Obstetrics and GynecologyIndiana University School of MedicineIndianapolisIndianaUSA
| | - Mercy Maina
- Academic Model Providing Access to Healthcare (AMPATH)EldoretKenya
| | - Julie Thorne
- Department of Obstetrics and GynecologyUniversity of TorontoTorontoOntarioCanada
| | - Ann Mwangi
- Department of Behavioural ScienceSchool of MedicineMoi UniversityEldoretKenya
| | | | - Rena C. Patel
- Departments of Medicine and Global HealthWashington UniversitySeattleWashingtonUSA
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Real-World Effectiveness, Tolerability, and Safety of Dolutegravir/Lamivudine in Korea. Viruses 2022; 14:v14112558. [PMID: 36423167 PMCID: PMC9698877 DOI: 10.3390/v14112558] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/14/2022] [Accepted: 11/17/2022] [Indexed: 11/22/2022] Open
Abstract
Most studies on the real-world effectiveness and safety of dolutegravir/lamivudine (DTG/3TC) have been conducted in Western countries, and Asian reports are lacking. We evaluated the effectiveness and safety of DTG/3TC in Korean adult people living with HIV (PLWH). This retrospective study was conducted from July 2020 to July 2022 at a tertiary hospital in Korea. Those who were followed up for more than 12 months were included. We analyzed the baseline characteristics, effectiveness, resistant profiles, body weights, metabolic parameters, and safety of DTG/3TC treatment in 151 PLWH, dividing them into the treatment-naïve group and the switching group. The median DTG/3TC treatment durations in the treatment-naïve and switching groups were 507.5 and 525.0 days. In the treatment-naïve group, the viral RNA titer was undetectable at 6 and 12 months in 95% of patients. In the switching group, virologic suppression was well-maintained. Meanwhile, the creatinine levels were slightly elevated in both groups compared to baseline. Five participants complained of mild side effects, such as indigestion, constipation, diarrhea, and fatigue. However, no patient stopped treatment during the follow-up period. Since there was no virological failure or serious complications observed in this study, DTG/3TC may be a good treatment option for PLWH in Korea.
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Krankowska DC, Załęski A, Wiercińska-Drapało A. Frailty and prefrailty in people living with HIV, with focus on women living with HIV. Int J STD AIDS 2022; 33:1106-1110. [PMID: 36217985 DOI: 10.1177/09564624221127744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
With the increasing lifespan of people living with HIV (PLWH), frailty and prefrailty are becoming topics which require more attention. The reciprocal interactions between chronic inflammation, comorbidities and frailty demonstrate the complex pathophysiology of frailty and its consequences. Female sex, HIV infection without antiretroviral treatment, reduced CD4 cell count, depression and cardiovascular disease are some of the risk factors for frailty among PLWH. Frailty predisposes to falls and can therefore lead to more frequent fractures, hospitalization and death, especially in women with osteoporosis. Continuous antiretroviral treatment, prevention of comorbidities such as depression and diagnosis of prefrailty are crucial interventions to slow the development of frailty. This review summarizes the literature on frailty in people living with HIV and discusses frailty management strategies in order to improve the health outcomes in women living with HIV.
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Affiliation(s)
- Dagny C Krankowska
- Department of Infectious and Tropical Diseases and Hepatology, 37803Medical University of Warsaw, Poland.,Hospital for Infectious Diseases, Warsaw, Poland
| | - Andrzej Załęski
- Department of Infectious and Tropical Diseases and Hepatology, 37803Medical University of Warsaw, Poland.,Hospital for Infectious Diseases, Warsaw, Poland
| | - Alicja Wiercińska-Drapało
- Department of Infectious and Tropical Diseases and Hepatology, 37803Medical University of Warsaw, Poland.,Hospital for Infectious Diseases, Warsaw, Poland
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Bangalee A, Hanley S, Bangalee V. MEDICINE AND THE LAW. S Afr Med J 2022; 112:787-790. [PMID: 36472336 DOI: 10.7196/samj.2022.v112i10.16596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Indexed: 01/04/2023] Open
Abstract
Dolutegravir (DTG) is a pivotal antiretroviral medicine that has become the backbone of several HIV programmes, especially in sub-Saharan African countries. It has recently replaced efavirenz as the preferred third drug for people initiating antiretroviral therapy in South Africa (SA). Its tolerability, cost-effectiveness and favourable resistance profile have had a global influence on HIV management, including the recent revision of the World Health Organization antiretroviral guidelines. As with any medicine, however, informed decisions are important. Despite the several advantages DTG offers, additional data informing risks over benefits have emerged that warrant clinical attention before DTG is prescribed. This article aims to give the primary care provider an overview of the benefits and risks associated with the roll-out of DTG in SA.
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Affiliation(s)
- A Bangalee
- Department of Medical Virology, School of Medicine, Faculty of Health Sciences, University of Pretoria, South Africa; National Health Laboratory Service, Johannesburg, South Africa.
| | - S Hanley
- Department of Family Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa; Centre for the AIDS Programme of Research in South Africa, Umlazi Clinical Research Site, South Africa.
| | - V Bangalee
- Discipline of Pharmaceutical Sciences, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
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Mendes JC, Ceccato MDGB, Reis AMM, Costa AMGD, Pantuzza LLN, Furtado dos Santos S, Crepalde-Ribeiro K, Silveira MR. Active Pharmacovigilance Project on the safety profile of Dolutegravir in Brazil. AIDS Care 2022; 35:729-738. [PMID: 35578399 DOI: 10.1080/09540121.2022.2062289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
A quantitative descriptive study based on Brazilian Active Pharmacovigilance of Dolutegravir (DTG) Project was performed to describe the adverse drug reactions (ADRs) to DTG reported and to evaluate the noncompleteness of data from DTG active pharmacovigilance in Brazil. ADRs and clinical and individual data were obtained from information from the Pharmacovigilance Questionnaire from April 2017 to August 2019. The reported ADRs were classified using the Medical Dictionary for Regulatory Activities (MedDRA). In the evaluated period, 249,066 individuals using DTG participated in the active pharmacovigilance of DTG, with 3472 (1.39%) reporting ADRs at least once. A total of 6312 ADRs were reported, of which 57.56% were persistent and 81.46% were not serious according to the individuals' reports. Most of the reported ADRs were gastrointestinal, neurological and psychiatric. ADRs related to neural tube defects and serious neuropsychiatric ADRs have been reported. Completion of more than half of the fields in the Pharmacovigilance Questionnaire was excellent. The frequency of ADR was low in relation to the number of people living with HIV (PLHIV) using DTG in Brazil, which suggests good tolerability and safety of DTG. The DTG active pharmacovigilance database in Brazil showed good data completeness.
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Affiliation(s)
- Jullye Campos Mendes
- Programa de Pós Graduação em Medicamentos e Assistência Farmacêutica, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Maria das Graças Braga Ceccato
- Programa de Pós Graduação em Medicamentos e Assistência Farmacêutica, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Departamento de Farmácia Social, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Adriano Max Moreira Reis
- Programa de Pós Graduação em Medicamentos e Assistência Farmacêutica, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Departamento de Produtos Farmacêuticos, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Lais Lessa Neiva Pantuzza
- Programa de Pós Graduação em Medicamentos e Assistência Farmacêutica, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Simone Furtado dos Santos
- Programa de Pós Graduação em Medicamentos e Assistência Farmacêutica, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Kennedy Crepalde-Ribeiro
- Programa de Pós Graduação em Medicamentos e Assistência Farmacêutica, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Micheline Rosa Silveira
- Programa de Pós Graduação em Medicamentos e Assistência Farmacêutica, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Departamento de Farmácia Social, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Reversibility of Central Nervous System Adverse Events in Course of Art. Viruses 2022; 14:v14051028. [PMID: 35632768 PMCID: PMC9147522 DOI: 10.3390/v14051028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/08/2022] [Accepted: 05/09/2022] [Indexed: 01/03/2023] Open
Abstract
The purpose of this study is to evaluate the frequency of central nervous system adverse events (CNS-AE) on dolutegravir (DTG) and non-DTG containing ART, and their reversibility, in the observational prospective SCOLTA cohort. Factors associated with CNS-AE were estimated using a Cox proportional-hazards model. 4939 people living with HIV (PLWH) were enrolled in DTG (n = 1179) and non-DTG (n = 3760) cohorts. Sixty-six SNC-AE leading to ART discontinuation were reported, 39/1179 (3.3%) in DTG and 27/3760 (0.7%) in non-DTG cohort. PLWH naïve to ART, with higher CD4 + T count and with psychiatric disorders were more likely to develop a CNS-AE. The risk was lower in non-DTG than DTG-cohort (aHR 0.33, 95% CI 0.19−0.55, p < 0.0001). One-year follow-up was available for 63/66 PLWH with CNS-AE. AE resolution was reported in 35/39 and 23/24 cases in DTG and non-DTG cohorts, respectively. The probability of AE reversibility was not different based on ART class, sex, ethnicity, CDC stage, or baseline psychiatric disorder. At the same time, a lower rate of event resolution was found in PLWH older than 50 years (p = 0.017). In conclusion, CNS-AE leading to ART discontinuation was more frequent in DTG than non-DTG treated PLWH. Most CNS-AE resolved after ART switch, similarly in both DTG and non-DTG cohorts.
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Namulindwa A, Wasswa JH, Muyindike W, Tamukong R, Oloro J. Prevalence and factors associated with adverse drug events among patients on dolutegravir-based regimen at the Immune Suppression Syndrome Clinic of Mbarara Regional Referral Hospital, Uganda: a mixed design study. AIDS Res Ther 2022; 19:18. [PMID: 35366917 PMCID: PMC8976982 DOI: 10.1186/s12981-022-00442-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 03/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background In low income countries such as Uganda progress has been made towards achieving the United Nations AIDS programme 95-95-95 target however efforts are still impeded by pretreatment drug resistance and adverse drug events (ADEs) hence introduction of dolutegravir-based antiretroviral therapy as first-line treatment due to a higher genetic barrier to resistance, better tolerability and safety profile. However, recent studies have raised concerns regarding its safety in real-clinical settings due to ADEs and being a recently introduced drug there is need to actively monitor for ADEs, hence this study aimed to establish the prevalence and factors associated with ADEs among patients on dolutegravir-based regimen at the Immune Suppression Syndrome (ISS) Clinic- Mbarara Regional Referral Hospital (MRRH). Methods A mixed design study was conducted at ISS Clinic-MRRH among 375 randomly selected patients who had been exposed to DTG-based regimen for at-least 12 weeks. These were interviewed to obtain data on socio-demographics, dietary habits and their files reviewed for ADEs. Data entry was done using Epi-data 3.0 and exported to SPSS 25.0 for analysis. Prevalence was determined as a percentage, and ADE associated factors assessed using bivariate analysis, those found significant were further subjected to multivariate analysis and considered significant at P < 0.05. Results The prevalence of ADEs among patients on DTG-based regimen was found to be 33.1% (124/375) with 5.6% (7/124) participants discontinued from treatment due ADEs, 4 due to hyperglycemia and 3 liver toxicity. The commonly experienced ADE was allergy at 36.3%. Male sex (AOR 1.571, 95% CI 1.433–1.984), WHO stage one at entry to care (AOR 4.586, 95% CI 1.649–12.754), stage two (AOR 4.536, 95% CI 1.611–12.776), stage three (AOR 3.638, 95% CI 1.262–10.488), were significantly associated with ADEs. Patients with undetectable viral load at initiation of DTG-based regimen were 67.6% less likely to experience ADEs (AOR = 0.324, 95% CI 0.1167–0.629). Conclusion This study reports a prevalence of 33.1% of ADEs among patients on DTG-based regimen. The most commonly experienced ADE was allergy. Male sex, early HIV disease stage at entry into care and detectable viral load at initiation of DTG-based regimen were significantly associated with ADEs. It is crucial to actively monitor patients with these characteristics for ADEs.
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Ciccullo A, Baldin G, Borghi V, Lagi F, Latini A, d’Ettorre G, Oreni L, Fusco P, Capetti A, Fabbiani M, Giacomelli A, Grimaldi A, Madeddu G, Sterrantino G, Mussini C, Di Giambenedetto S. Real-Life Impact of Drug Toxicity on Dolutegravir Tolerability: Clinical Practice Data from a Multicenter Italian Cohort. Viruses 2022; 14:v14010163. [PMID: 35062367 PMCID: PMC8778073 DOI: 10.3390/v14010163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 01/08/2022] [Accepted: 01/11/2022] [Indexed: 11/23/2022] Open
Abstract
Dolutegravir (DTG) is currently one of the most used Integrase inhibitors (INI) in antiretroviral therapies (ARV) in both naïve and experienced people living with HIV (PLWHIV). We analyzed a multicenter cohort of PLWHIV, both naïve and experienced, starting an ARV including DTG. We enrolled 3775 PLWHIV: 2763 (73.2%) were males, with a median age of 50 years. During 9890.7 PYFU, we observed 930 discontinuations (9.4 per 100 PYFU). Estimated probabilities of maintaining DTG at three and five years were 75.1% and 67.2%, respectively. Treatment-naïve pts showed a lower probability of maintaining DTG at three and five years compared to treatment-experienced PLWHIV (log-rank p < 0.001). At a multivariate analysis, a longer time of virological suppression (aHR 0.994, p < 0.001) and having experienced a previous virological failure (aHR 0.788, p = 0.016) resulted protective against DTG discontinuation. Most discontinuations (84.0%) happened within the first 12 months of DTG initiation, in particular, 92.2% of discontinuations due to neuropsychiatric toxicity were observed in the first year. Our data confirm the overall good tolerability of DTG in clinical practice, with a low rate of discontinuations. CNS toxicity resulted the main reason for DTG discontinuation, with most related interruptions happening in the first year from DTG introduction.
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Affiliation(s)
- Arturo Ciccullo
- Infectious Diseases Unit, San Salvatore Hospital, 67100 L’Aquila, Italy;
- Correspondence:
| | - Gianmaria Baldin
- Mater Olbia Hospital, 07026 Olbia, Italy;
- Infectious Diseases Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy;
| | - Vanni Borghi
- Infectious and Tropical Diseases Unit, Azienda Ospedaliero Universitaria di Modena, 41125 Modena, Italy; (V.B.); (C.M.)
| | - Filippo Lagi
- Infectious and Tropical Diseases Unit, Careggi University Hospital, 50134 Florence, Italy; (F.L.); (G.S.)
| | - Alessandra Latini
- Infectious Dermatology and Allergology Unit, IFO S. Gallicano Institute (IRCCS), 00144 Rome, Italy;
| | - Gabriella d’Ettorre
- Department of Public Health and Infectious Diseases, Azienda Policlinico Umberto I, 00185 Rome, Italy;
| | - Letizia Oreni
- Infectious Diseases Unit, DIBIC Luigi Sacco, University of Milan, 20157 Milan, Italy; (L.O.); (A.G.)
| | - Paolo Fusco
- Infectious and Tropical Diseases Unit, Department of Medical and Surgical Sciences, “Magna Graecia” University of Catanzaro, 88100 Catanzaro, Italy;
| | - Amedeo Capetti
- 1st Division of Infectious Diseases, Luigi Sacco University Hospital, 20157 Milan, Italy;
| | - Massimiliano Fabbiani
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria Senese, 53100 Siena, Italy;
| | - Andrea Giacomelli
- Infectious Diseases Unit, DIBIC Luigi Sacco, University of Milan, 20157 Milan, Italy; (L.O.); (A.G.)
| | | | - Giordano Madeddu
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy;
| | - Gaetana Sterrantino
- Infectious and Tropical Diseases Unit, Careggi University Hospital, 50134 Florence, Italy; (F.L.); (G.S.)
| | - Cristina Mussini
- Infectious and Tropical Diseases Unit, Azienda Ospedaliero Universitaria di Modena, 41125 Modena, Italy; (V.B.); (C.M.)
| | - Simona Di Giambenedetto
- Infectious Diseases Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy;
- Department of Safety and Bioethics, Catholic University of the Sacred Heart, 00168 Rome, Italy
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Campbell L, Ibrahim F, Barbini B, Samarawickrama A, Orkin C, Fox J, Waters L, Gilleece Y, Tariq S, Post FA. Bone mineral density, kidney function and participant-reported outcome measures in women who switch from tenofovir disoproxil emtricitabine and a nonnucleoside reverse transcriptase inhibitor to abacavir, lamivudine and dolutegravir. HIV Med 2021; 23:362-370. [PMID: 34866304 DOI: 10.1111/hiv.13215] [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: 08/31/2021] [Revised: 11/09/2021] [Accepted: 11/16/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Tenofovir disoproxil fumarate (TDF) is associated with reduced bone mineral density (BMD). The aim of the study was to evaluate changes in BMD in women who switched from TDF, emtricitabine and a nonnucleoside reverse transcriptase inhibitor (TDF/FTC/NNRTI) to abacavir, lamivudine and dolutegravir (ABC/3TC/DTG). METHODS We conducted a randomized controlled trial in which women aged ≥ 40 years were randomized 1:2 to continue TDF/FTC/NNRTI or switch to ABC/3TC/DTG. We analysed changes in BMD at the hip and lumbar spine from baseline to week 96 using linear regression, and markers of bone turnover and kidney function using repeated measures mixed effects models with multiple imputation for missing data. We conducted exploratory analyses of weight, mental health, sleep and symptoms attributed to HIV infection and antiretroviral therapy. RESULTS Ninety-one women [mean (standard deviation) age 50.4 (6.6) years] were randomized. Women who switched to ABC/3TC/DTG maintained viral suppression and experienced improvements in BMD at the lumbar spine (but not the neck of the femur or the total hip), bone resorption markers and proteinuria (total protein, albumin and retinol-binding protein) and modest weight gain without changes in body mass index. Although mean anxiety, depression and sleep scores did not differ between the two study arms, anxiety, depression and sleep disturbance at baseline predicted ABC/3TC/DTG discontinuation for neuropsychiatric side effects [odds ratios (95% confidence intervals) 11.9 (2.0-71.6), 16.0 (2.6-97.9) and 10.0 (1.8-56.0), respectively]. CONCLUSIONS Switching from TDF/FTC/NNRTI to ABC/3TC/DTG improved the BMD of the lumbar spine and kidney function. These benefits need to be balanced against modest weight gain and the need for antiretroviral therapy substitutions in a proportion of participants.
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Affiliation(s)
- Lucy Campbell
- King's College London, London, UK.,King's College Hospital NHS Foundation Trust, London, UK
| | | | - Birgit Barbini
- King's College Hospital NHS Foundation Trust, London, UK
| | | | - Chloe Orkin
- Queen Mary University of London and Barts Health NHS Trust, London, UK
| | - Julie Fox
- King's College London, London, UK.,Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | | | - Yvonne Gilleece
- University Hospitals Sussex NHS Trust, Brighton, UK.,Brighton & Sussex Medical School, Brighton, UK
| | | | - Frank A Post
- King's College London, London, UK.,King's College Hospital NHS Foundation Trust, London, UK
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Van de Wijer L, van der Heijden W, van Verseveld M, Netea M, de Mast Q, Schellekens A, van der Ven A. Substance use, Unlike Dolutegravir, is Associated with Mood Symptoms in People Living with HIV. AIDS Behav 2021; 25:4094-4101. [PMID: 33903997 PMCID: PMC8602138 DOI: 10.1007/s10461-021-03272-2] [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] [Accepted: 04/16/2021] [Indexed: 11/28/2022]
Abstract
Contradictory data have been reported concerning neuropsychiatric side effects of the first-line antiretroviral drug dolutegravir, which may be partly due to lack of control groups or psychiatric assessment tools. Using validated self-report questionnaires, we compared mood and anxiety (DASS-42), impulsivity (BIS-11), and substance use (MATE-Q) between dolutegravir-treated and dolutegravir-naive people living with HIV (PLHIV). We analyzed 194, mostly male, PLHIV on long-term treatment of whom 82/194 (42.3%) used dolutegravir for a median (IQR) of 280 (258) days. Overall, 51/194 (26.3%) participants reported DASS-42 scores above the normal cut-off, 27/194 (13.5%) were classified as highly impulsive, and 58/194 (29.9%) regularly used recreational drugs. Regular substance use was positively associated with depression (p = 0.012) and stress scores (p = 0.045). We observed no differences between dolutegravir-treated and dolutegravir-naive PLHIV. Our data show that depressed and anxious moods and impulsivity are common in PLHIV and associate with substance use and not with dolutegravir use.
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Senneker T, Tseng A. An update on neuropsychiatric adverse effects with second-generation integrase inhibitors and nonnucleoside reverse transcriptase inhibitors. Curr Opin HIV AIDS 2021; 16:309-320. [PMID: 34475342 DOI: 10.1097/coh.0000000000000705] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Neuropsychiatric adverse effects (NPAE) associated with integrase strand transfer inhibitors (INSTIs) and nonnucleoside reverse transcriptase inhibitors (NNRTIs) are a growing concern, with higher rates in the real-world compared to phase III trials. This paper reviews the incidence, risk factors, and management of NPAE with second-generation INSTIs, INSTI/rilpivirine dual therapy, and doravirine. RECENT FINDINGS Recent cohort data confirm up to 8% NPAE-associated discontinuations for dolutegravir; NPAE with dolutegravir/rilpivirine therapy are higher than with dolutegravir alone, whereas bictegravir appears similar to dolutegravir. In contrast, NPAE with cabotegravir alone or with rilpivirine appears to be low. Doravirine has NPAE rates similar to rilpivirine and lower than efavirenz. Risk factors for NPAE include female gender, concurrent abacavir use, Sub-Saharan African descent, and age, whereas underlying psychiatric conditions do not appear to increase risk. Strategies to manage NPAE include changing administration time, therapeutic drug monitoring, or regimen modification including within-class INSTI changes. People experiencing NPAE with dolutegravir may tolerate bictegravir. SUMMARY Overall, mild to moderate NPAE are associated with INSTIs and newer NNRTIs. Rarely, more severe symptoms may occur and lead to treatment discontinuation. Clinicians should be aware of NPAE to identify and manage drug-related adverse effects.
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Affiliation(s)
- Tessa Senneker
- McGill University Health Centre, Montreal, Quebec
- Immunodeficiency Clinic, University Health Network
| | - Alice Tseng
- Immunodeficiency Clinic, University Health Network
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
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Lagi F, Botta A, Kiros ST, Meli M, Borchi B, Cavallo A, Pozzi M, Bartoloni A, Sterrantino G. Comparison of the efficacy, safety and durability of a switch to co-formulated RPV/TDF-TAF/FTC or DTG/ABC/3TC in virologically-suppressed HIV-1-infected patients in a single Italian centre: a cohort data analysis. Int J Antimicrob Agents 2021; 59:106465. [PMID: 34699933 DOI: 10.1016/j.ijantimicag.2021.106465] [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: 01/22/2021] [Revised: 10/01/2021] [Accepted: 10/09/2021] [Indexed: 11/17/2022]
Abstract
This study evaluated the efficacy, safety and durability of a switch to co-formulated RPV/TDF-TAF/FTC (RPV-STR) or DTG/ABC/3TC (DTG-STR) in virologically-suppressed HIV-positive patients in a single Italian centre. All HIV-infected ART-experienced patients switching to RPV-STR or DTG-STR with HIV-RNA <50 copies/mL were included. Outcomes were incidence rate and rate ratios for discontinuation due to all causes (DAC), to adverse events (DAE) and to virological failure (VF) after 4 years of follow-up. We included 402 patients (244 on RPV-STR, 158 on DTG-STR). At Year 4 of follow-up, 124 patients (30.8%) discontinued for any cause (71 on RPV-STR, 53 on DTG-STR). Fifteen patients experienced VF [13 (5.3%) on RPV-STR and 2 (1.3%) on DTG-STR; log-rank, P = 0.4413]. Overall, 46 patients (11.4%) had AEs (23 on RPV-STR, 23 on DTG-STR). Nausea/diarrhoea was more frequent with DTG-STR (4.4% vs. 0%) and neurological toxicity with RPV-STR (4.5% vs. 2.5%). The rate of DAC within the first 3 months was significantly higher with DTG-STR (aRR = 5.88, 95% CI 3.20-10.81; P < 0.001); similarly, the discontinuation rate due to AEs was significantly higher with DTG-STR compared with RPV-STR (aRR = 12.89, 95% CI 5.48-30.32; P < 0.001). No difference in VF was observed between the two groups (RR = 0.47, 95% CI 0.10-2.14; P = 0.335). Patients with undetectable viral load who switched to DTG-STR or RPV-STR maintained virological suppression with a low risk of VF. A higher discontinuation rate was observed with DTG-STR compared with RPV-STR, particularly within 3 months from switch.
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Affiliation(s)
- Filippo Lagi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Annarita Botta
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Seble Tekle Kiros
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Massimo Meli
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Beatrice Borchi
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Annalisa Cavallo
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Marco Pozzi
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Gaetana Sterrantino
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
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Taramasso L, De Vito A, Ricci ED, Orofino G, Squillace N, Menzaghi B, Molteni C, Gulminetti R, De Socio GV, Pellicanò GF, Sarchi E, Celesia BM, Calza L, Rusconi S, Valsecchi L, Martinelli CV, Cascio A, Maggi P, Vichi F, Angioni G, Guadagnino G, Cenderello G, Dentone C, Bandera A, Falasca K, Bonfanti P, Di Biagio A, Madeddu G, Bonfanti P, Di Biagio A, Ricci E, Sarchi E, Chichino G, Bolla C, Bellacosa C, Angarano G, Saracino A, Calza L, Menzaghi B, Farinazzo M, Angioni G, Bruno G, Celesia BM, Falasca K, Mastroianni A, Guadagnino G, Vichi F, Salomoni E, Martinelli C, Di Biagio A, Dentone C, Taramasso L, Bassetti M, Cenderello G, Molteni C, Piconi S, Pellicanò GF, Nunnari G, Valsecchi L, Cordier L, Parisini S, Rizzardini G, Rusconi S, Conti F, Bandera A, Gori A, Motta D, Puoti M, Bonfanti P, Squillace N, Migliorino GM, Maggi P, Martini S, Cascio A, Trizzino M, Gulminetti R, Pagnucco L, De Socio GV, Nofri M, Francisci D, Cibelli D, Parruti G, Madeddu G, Mameli MS, Orofino G, Guastavigna M. Durability of Dolutegravir-Based Regimens: A 5-Year Prospective Observational Study. AIDS Patient Care STDS 2021; 35:342-353. [PMID: 34524918 DOI: 10.1089/apc.2021.0089] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
This study evaluates the frequency and causes of dolutegravir (DTG) discontinuation along 5 years of follow-up, in both antiretroviral treatment (ART)-naive and experienced people living with HIV (PLWH). This is a prospective multi-center cohort study enrolling PLWH on DTG from July 2014 until November 2020. DTG-durability was investigated using the Kaplan-Meier survival curve. The Cox proportional-hazards model was used for estimating the hazard ratio (HR) of DTG discontinuation for any cause, and for adverse events (AEs). Nine hundred sixty-three PLWH were included, 25.3% were women and 28.0% were ART-naive. Discontinuations for any causes were 10.1 [95% confidence interval (95% CI) 8.9-11.5] per 100 person-years, similar in most regimens, with the apparent exception of tenofovir alafenamide/emtricitabine+DTG (p < 0.0001). In the multivariable Cox regression model, non-Caucasian ethnicity, age ≥50 years, and lower estimated glomerular filtration rate (eGFR) were associated with a higher probability of DTG interruption. The incidence rate of virological failure was 0.4 (95% CI 0.2-0.7) per 100 person-years, while the estimated discontinuation rate for AEs was 4.0 (3.2-4.9) per 100 person-years. Thirty-four DTG interruptions were due to grade ≥3 events (10 central nervous system, 6 hypersensitivity, 3 renal, 3 myalgia/asthenia, 3 abdominal pain, 2 gastrointestinal, and 7 other events). People with lower body mass index, age ≥50 years, and lower eGFR were at higher risk of AEs, while dual combinations were protective (HR 0.41 compared with abacavir/lamivudine/DTG, 95% CI 0.22-0.77). In this prospective observational study, we found high DTG durability and a low rate of virological failures. Dual therapies seemed protective toward AEs and might be considered, when feasible, a suitable option to minimize drug interactions and improve tolerability.
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Affiliation(s)
- Lucia Taramasso
- Infectious Disease Clinic, IRCCS Policlinico San Martino Hospital, Genoa, Italy
| | - Andrea De Vito
- Unit of Infectious and Tropical Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | | | - Giancarlo Orofino
- Unit of Infectious Diseases, “Divisione A”, Amedeo di Savoia Hospital, Torino, Italy
| | - Nicola Squillace
- Infectious Diseases Clinic, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Barbara Menzaghi
- Unit of Infectious Diseases, ASST della Valle Olona, Busto Arsizio Hospital, Busto Arsizio, Italy
| | - Chiara Molteni
- Infectious Disease Unit, Ospedale A. Manzoni, Lecco, Italy
| | - Roberto Gulminetti
- Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Giuseppe Vittorio De Socio
- Clinic of Infectious Diseases, Department of Medicine 2, Azienda Ospedaliera di Perugia, Santa Maria Hospital, Perugia, Italy
| | - Giovanni Francesco Pellicanò
- Unit of Infectious Diseases, Department of Human Pathology of the Adult and the Developmental Age ‘G. Barresi’, University of Messina, Messina, Italy
| | - Eleonora Sarchi
- Infectious Diseases Unit, SS. Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | | | - Leonardo Calza
- Department of Medical and Surgical Sciences, Clinics of Infectious Diseases, S. Orsola-Malpighi Hospital, “Alma Mater Studiorum” University of Bologna, Bologna, Italy
| | - Stefano Rusconi
- Infectious Diseases Unit, Department of Biomedical and Clinical Sciences ‘Luigi Sacco’, Università degli Studi di Milano, Milan, Italy
| | - Laura Valsecchi
- Infectious Disease Unit (I Divisione), ASST Fatebenefratelli Sacco, Milan, Italy
| | | | - Antonio Cascio
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Paolo Maggi
- Department of Infectious Disease, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Francesca Vichi
- Infectious Diseases Department, SOC 1, USLCENTROFIRENZE, Santa Maria Annunziata Hospital, Florence, Italy
| | | | - Giuliana Guadagnino
- Department of Infectious and Tropical Diseases, St. Annunziata Hospital, Cosenza, Italy
| | | | - Chiara Dentone
- Infectious Disease Clinic, IRCCS Policlinico San Martino Hospital, Genoa, Italy
| | - Alessandra Bandera
- Infectious Disease Unit, Department of Internal Medicine, Fondazione IRCCS Ca’ Granda, University of Milan, Ospedale Maggiore Policlinico, Milan, Italy
| | - Katia Falasca
- Clinic of Infectious Diseases, Department of Medicine and Science of Aging, University ‘G. d'Annunzio’ Chieti-Pescara, Chieti, Italy
| | - Paolo Bonfanti
- Infectious Diseases Clinic, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Antonio Di Biagio
- Infectious Diseases Clinic, Department of Health Sciences, University of Genoa, San Martino Hospital-IRCCS, Genoa, Italy
| | - Giordano Madeddu
- Unit of Infectious and Tropical Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
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Anderson AM, Tang B, Vaida F, Mcclernon D, Deutsch R, Cherner M, Cookson D, Crescini M, Grant I, Ellis RJ, Letendre SL. Low-Level HIV RNA in Cerebrospinal Fluid and Neurocognitive Performance: A Longitudinal Cohort Study. J Acquir Immune Defic Syndr 2021; 87:1196-1204. [PMID: 33901102 PMCID: PMC8596378 DOI: 10.1097/qai.0000000000002714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/29/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cognitive complications persist in persons with HIV during suppressive antiretroviral therapy (ART). Low levels of HIV during ART could contribute to these complications. In this study, we measured cerebrospinal fluid (CSF) HIV using a single-copy assay (SCA) to investigate a possible relationship between low-level HIV and cognition. DESIGN/METHODS SCA data were analyzed from 3 consecutively paired CSF-plasma specimens collected over a mean of 456 days from 96 participants on suppressive ART. Using mixed models, the presence of CSF HIV by SCA as a risk factor for worse neurocognitive performance was examined. RESULTS At baseline on the SCA, 45.8% of participants had detectable plasma HIV RNA (median 8 copies/mL and interquartile range = 3-17 among detectable values) and 17.7% had detectable CSF HIV RNA (median CSF concentration= 3 copies/mL and interquartile range= 2-13 among detectable values). The frequency of CSF HIV RNA detection declined over time in CSF (P = 0.018) with a trend toward decline in plasma (P = 0.064). Detectable CSF HIV RNA during the study was associated with worse performance in the domains of recall (P = 0.014) and motor (P = 0.040) and a trend with worse overall global performance (P = 0.078). Integrase inhibitor use, although very infrequent in this cohort, was associated with better performance in 2 domains. CONCLUSIONS Low-level CSF HIV RNA declines with time but is associated with worse cognitive performance in 2 domains. Additional research is needed to better understand the relationship between HIV RNA persistence during long-term ART and central nervous system complications in persons with HIV.
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Affiliation(s)
- Albert M. Anderson
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine
| | - Bin Tang
- Department of Psychiatry, University of California, San Diego
| | - Florin Vaida
- Department of Psychiatry, University of California, San Diego
| | | | - Reena Deutsch
- Department of Psychiatry, University of California, San Diego
| | - Mariana Cherner
- Department of Psychiatry, University of California, San Diego
| | - Debra Cookson
- Department of Psychiatry, University of California, San Diego
| | | | - Igor Grant
- Department of Psychiatry, University of California, San Diego
| | - Ronald J. Ellis
- Department of Psychiatry, University of California, San Diego
- Department of Neurosciences, University of California, San Diego
| | - Scott L. Letendre
- Department of Psychiatry, University of California, San Diego
- Department of Medicine, University of California, San Diego
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Amor-García MÁ, Rodríguez-González CG, Chamorro-de-Vega E, Herranz-Alonso A, Sanjurjo-Sáez M. Dolutegravir-Based Dual Therapies in HIV Pretreated Patients: A Real-Life Study in Madrid. Ann Pharmacother 2021; 56:401-411. [PMID: 34382435 DOI: 10.1177/10600280211038504] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Few studies describe the use of dolutegravir (DTG)-based dual therapies under routine clinical practice. OBJECTIVES To report real-life data on the use of DTG-based dual therapies in treatment-experienced patients. METHODS This was an observational, retrospective study. It included all treatment-experienced HIV patients starting a DTG-based dual therapy from 2014 to 2018. The primary end point was to identify the incidence and reasons for the switch. The secondary end points were to assess the effectiveness, safety, adherence, and costs after 48 weeks of treatment (W48). RESULTS The incidence of the switch to a DTG-based dual therapy increased from 1.6 patients per 1000 patient-years in 2014 to 38.6 in 2018. A total of 241 patients initiated this therapy: 113 (46.9%) patients started DTG plus rilpivirine (RPV), 72 (29.9%), DTG plus lamivudine (3TC), and 68 (28.2%), DTG plus boosted-darunavir (b-DRV). A total of 170 patients completed W48 of follow-up. By intention-to-treat analysis, 89.3% of virologically suppressed (VS) patients (94.3% with DTG plus b-DRV, 91.3% with DTG plus 3TC, and 87.2% with DTG plus RPV) and 56.7% of non-VS patients (71.4% with DTG plus RPV and 52.2% with DTG plus b-DRV) achieved a viral load <50 copies/mL at W48. The protocol-defined virological failure was 6.5%. Overall, 8.8% of patients had early discontinuation. The annual cost increased by €800 per patient ($916). CONCLUSIONS AND RELEVANCE The use of DTG-based dual therapies has increased in real life, showing a favorable effectiveness and safety profile. Treatment costs increased, except for the switch to DTG plus 3TC.
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Fabbiani M, Rossetti B, Ciccullo A, Oreni L, Lagi F, Celani L, Colafigli M, De Vito A, Mazzitelli M, Dusina A, Durante M, Montagnani F, Rusconi S, Capetti A, Sterrantino G, D'Ettorre G, Di Giambenedetto S. Efficacy and durability of two- vs. three-drug integrase inhibitor-based regimens in virologically suppressed HIV-infected patients: Data from real-life ODOACRE cohort. HIV Med 2021; 22:843-853. [PMID: 34318591 DOI: 10.1111/hiv.13146] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 07/05/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVES The aim of the present study was to compare the efficacy and durability of treatment switch to two-drug (2DR) vs. three-drug (3DR) integrase inhibitor (InSTI)-based regimens in a real-life setting. METHODS Within the ODOACRE cohort, we selected adult patients with HIV RNA < 50 copies/mL switching to an InSTI-based 2DR or 3DR. Survival analyses were performed to estimate the probability of virological failure (VF, defined as one HIV RNA > 1000 copies/mL or two consecutive HIV RNA > 50 copies/mL) and treatment discontinuation (TD, defined as any modification, intensification or interruption of the regimen), and to evaluate their predictors. RESULTS Overall, 1666 patients were included, of whom 1334 (80%) were treated with a 3DR (19.9%, 25.0% and 55.1% elvitegravir-, raltegravir- and dolutegravir-based, respectively) and 332 (20%) with a 2DR (79.2% dolutegravir + lamivudine and 20.8% dolutegravir + rilpivirine). Over a median (interquartile range) follow-up of 100 (52-150) weeks, 52 (3.1%) patients experienced VF with an incidence of 1.5/100 person-year of follow-up (PYFU). The estimated 96-week probability of VF was similar for the 2DR and 3DR groups (2.3% vs. 2.8%, P = 0.53), but it was higher for elvitegravir (4.9%) and raltegravir (5.0%) than for dolutegravir (1.5%) (P = 0.04). Four hundred (24%) patients discontinued their InSTI-based regimen, with an incidence of 11.3/100 PYFU. At 96 weeks, 3DRs showed a higher probability of TD for any reason (20.6% vs. 11.2%, P < 0.001) and TD for toxicity (9.0% vs. 6.6%, P = 0.02) when compared with 2DRs. A higher risk of TD for central nervous system toxicity was observed for dolutegravir than for elvitegravir and raltegravir (4.0% vs. 2.5% vs. 0.6%, P = 0.005). CONCLUSIONS In virologically suppressed HIV-infected patients, 2DRs showed an efficacy similar to 3DRs but with better tolerability.
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Affiliation(s)
- Massimiliano Fabbiani
- UOC Malattie Infettive e Tropicali, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Barbara Rossetti
- UOC Malattie Infettive e Tropicali, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Arturo Ciccullo
- UOC Malattie Infettive, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Letizia Oreni
- Infectious Diseases Unit, DIBIC Luigi Sacco, University of Milan, Milan, Italy
| | - Filippo Lagi
- Malattie Infettive e Tropicali, Dipartimento di Medicina Clinica e Sperimentale, Università di Firenze, Firenze, Italy
| | - Luigi Celani
- Department of Public Health and Infectious Diseases - "Sapienza" University of Rome, Rome, Italy
| | - Manuela Colafigli
- Infectious Dermatology and Allergology Unit, IFO S. Gallicano Institute (IRCCS), Rome, Italy
| | - Andrea De Vito
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Maria Mazzitelli
- Infectious and Tropical Diseases Unit, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Alex Dusina
- UOC Malattie Infettive, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Miriam Durante
- Dipartimento di Biotecnologie Mediche, Università degli Studi di Siena, Siena, Italy
| | - Francesca Montagnani
- UOC Malattie Infettive e Tropicali, Azienda Ospedaliero-Universitaria Senese, Siena, Italy.,Dipartimento di Biotecnologie Mediche, Università degli Studi di Siena, Siena, Italy
| | - Stefano Rusconi
- Infectious Diseases Unit, DIBIC Luigi Sacco, University of Milan, Milan, Italy
| | - Amedeo Capetti
- Division of Infectious Diseases, Department of Infectious Diseases, Luigi Sacco University Hospital, Milan, Italy
| | - Gaetana Sterrantino
- Malattie Infettive e Tropicali, Dipartimento di Medicina Clinica e Sperimentale, Università di Firenze, Firenze, Italy
| | - Gabriella D'Ettorre
- Department of Public Health and Infectious Diseases - "Sapienza" University of Rome, Rome, Italy
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Chimukangara B, Giandhari J, Lessells R, Yende-Zuma N, Sartorius B, Samuel R, Khanyile KS, Stray-Pedersen B, Moodley P, Metzner KJ, Padayatchi N, Naidoo K, De Oliveira T. Impact of pretreatment low-abundance HIV-1 drug-resistant variants on virological failure among HIV-1/TB-co-infected individuals. J Antimicrob Chemother 2021; 75:3319-3326. [PMID: 32772079 PMCID: PMC7566390 DOI: 10.1093/jac/dkaa343] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 07/03/2020] [Indexed: 11/23/2022] Open
Abstract
Objectives To determine the impact of pretreatment low-abundance HIV-1 drug-resistant variants (LA-DRVs) on virological failure (VF) among HIV-1/TB-co-infected individuals treated with NNRTI first-line ART. Methods We conducted a case–control study of 170 adults with HIV-1/TB co-infection. Cases had at least one viral load (VL) ≥1000 RNA copies/mL after ≥6 months on NNRTI-based ART, and controls had sustained VLs <1000 copies/mL. We sequenced plasma viruses by Sanger and MiSeq next-generation sequencing (NGS). We assessed drug resistance mutations (DRMs) using the Stanford drug resistance database, and analysed NGS data for DRMs at ≥20%, 10%, 5% and 2% thresholds. We assessed the effect of pretreatment drug resistance (PDR) on VF. Results We analysed sequences from 45 cases and 125 controls. Overall prevalence of PDR detected at a ≥20% threshold was 4.7% (8/170) and was higher in cases than in controls (8.9% versus 3.2%), P = 0.210. Participants with PDR at ≥20% had almost 4-fold higher odds of VF (adjusted OR 3.7, 95% CI 0.8–18.3) compared with those without, P = 0.104. PDR prevalence increased to 18.2% (31/170) when LA-DRVs at ≥2% were included. Participants with pretreatment LA-DRVs only had 1.6-fold higher odds of VF (adjusted OR 1.6, 95% CI 0.6–4.3) compared with those without, P = 0.398. Conclusions Pretreatment DRMs and LA-DRVs increased the odds of developing VF on NNRTI-based ART, although without statistical significance. NGS increased detection of DRMs but provided no additional benefit in identifying participants at risk of VF at lower thresholds. More studies assessing mutation thresholds predictive of VF are required to inform use of NGS in treatment decisions.
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Affiliation(s)
- Benjamin Chimukangara
- KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), College of Health Sciences, University of KwaZulu-Natal, Doris Duke Medical Research Institute, Durban, South Africa.,Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa.,Department of Virology, National Health Laboratory Service, University of KwaZulu-Natal, Durban, South Africa
| | - Jennifer Giandhari
- KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), College of Health Sciences, University of KwaZulu-Natal, Doris Duke Medical Research Institute, Durban, South Africa
| | - Richard Lessells
- KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), College of Health Sciences, University of KwaZulu-Natal, Doris Duke Medical Research Institute, Durban, South Africa
| | - Nonhlanhla Yende-Zuma
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa.,South African Medical Research Council (SAMRC), CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Durban, South Africa
| | - Benn Sartorius
- Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.,Health Metrics Sciences, University of Washington, Seattle, USA
| | - Reshmi Samuel
- Department of Virology, National Health Laboratory Service, University of KwaZulu-Natal, Durban, South Africa
| | - Khulekani S Khanyile
- KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), College of Health Sciences, University of KwaZulu-Natal, Doris Duke Medical Research Institute, Durban, South Africa
| | - Babill Stray-Pedersen
- Institute of Clinical Medicine, University of Oslo, Oslo University Hospital, Oslo, Norway
| | - Pravi Moodley
- Department of Virology, National Health Laboratory Service, University of KwaZulu-Natal, Durban, South Africa
| | - Karin J Metzner
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Nesri Padayatchi
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa.,South African Medical Research Council (SAMRC), CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Durban, South Africa
| | - Kogieleum Naidoo
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa.,South African Medical Research Council (SAMRC), CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Durban, South Africa
| | - Tulio De Oliveira
- KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), College of Health Sciences, University of KwaZulu-Natal, Doris Duke Medical Research Institute, Durban, South Africa.,Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
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Abstract
PURPOSE OF REVIEW The age of people with HIV) continues to rise, and yet older people have tended to be under-represented or excluded from premarketing studies of antiretroviral therapy (ART). In this review, we highlight special considerations for the use of ART in older people with HIV, with a focus on toxicities associated with specific antiretroviral agents or drug classes as well as key research questions moving forward. RECENT FINDINGS Like all people with HIV, older people with HIV should be started on ART as soon as possible, regardless of CD4 count, and with a regimen that includes an integrase strand transfer inhibitor (INSTI) and two nucleoside reverse transcriptase inhibitors. Important toxicities to consider when choosing an ART regimen include bone and renal effects related to tenofovir, weight gain related to INSTIs and tenofovir alafenamide, neurocognitive and neuropsychiatric toxicities related to efavirenz, and increased cardiovascular risk associated with abacavir and boosted protease inhibitors. With the ongoing importance of INSTIs as a component of preferred ART regimens, further characterization of INSTI-related weight gain is a critical current research priority in understanding ART toxicity. SUMMARY There are multiple potential toxicities of ART to consider when selecting a regimen for older people. Specific agents or drug classes have been implicated in adverse bone or renal effects, weight gain, neuropsychiatric and neurocognitive effects, and cardiovascular risk.
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Milinkovic A, Singh S, Simmons B, Pozniak A, Boffito M, Nwokolo N. Multimodality assessment of sleep outcomes in people living with HIV performed using validated sleep questionnaires. Int J STD AIDS 2021; 31:996-1003. [PMID: 32772688 DOI: 10.1177/0956462420941693] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Studies conducted in people living with HIV (PLHIV) report high rates of sleep disturbance, without a clear explanation as to cause or effect. Therefore, we proposed use of multiple validated questionnaires that would allow a more comprehensive evaluation of sleep quality in PLHIV. We administered eight validated sleep and wellbeing questionnaires, recording different aspects of sleep in order to provide a comprehensive description of sleep quality, quantity, daytime functioning, wakefulness, and general wellbeing. Associations with demographics and clinical data were analyzed by univariable/multivariable analyses. Of 254 subjects 99% were male (98% men who have sex with men), 88% white, mean age 41 (SD ± 9.9) years, HIV duration eight years (SD ± 6.3), 94% were on antiretroviral therapy, mean CD4 cell count was 724 cells/mm3, 81% had HIV RNA<40 copies/ml, 72% were university educated, and 60% used 'chemsex' drugs. Almost half (45%) reported poor sleep quality, 22% insomnia, 21% daytime sleepiness, and 33% fatigue. As individual factors, HIV duration ≥10 years, anxiety, depression, and recreational drug use were associated with poor quality sleep, fatigue, and poorer functional outcomes (p ≤ 0.05). The prevalence of sleep disturbance was high in our cohort of PLHIV. Sleep disturbance was associated with longer duration of HIV infection, depression, anxiety, and recreational drug use.
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Affiliation(s)
- Ana Milinkovic
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Suveer Singh
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.,Faculty of Medicine, Imperial College London, London, UK
| | - Bryony Simmons
- Faculty of Medicine, Imperial College London, London, UK
| | - Anton Pozniak
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.,The London School of Hygiene & Tropical Medicine, London, UK
| | - Marta Boffito
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.,Faculty of Medicine, Imperial College London, London, UK
| | - Nneka Nwokolo
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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Ciccullo A, Baldin G, Putaggio C, Di Giambenedetto S, Borghetti A. Comparative safety review of recommended, first-line single-tablet regimens in patients with HIV. Expert Opin Drug Saf 2021; 20:1317-1332. [PMID: 34018892 DOI: 10.1080/14740338.2021.1931115] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction Different single-tablet regimens (STRs), containing one or two nucleoside reverse transcriptase inhibitors (NRTIs) plus an anchor drug, are available for the use in naïve, HIV-infected patients. Despite some restrictions in the use of particular regimens in certain situations (e.g., HBV coinfection), International guidelines do not provide indications to prefer any regimen over others concerning the tolerability profile. We aimed to assess advantages and disadvantages of the most prescribed STRs.Areas covered An extensive review of articles published in English language was conducted on PubMed, looking for evidence about STRs in naïve, HIV-infected population. Safety outcomes of registrational trials were assessed, giving priority to studies directly comparing STRs included in our research (abacavir/lamivudine/dolutegravir, tenofovir alafenamide/emtricitabine/bictegravir, lamivudine/dolutegravir, tenofovir alafenamide/emtricitabine/darunavir/cobicistat, tenovofir disoproxil fumarate/lamivudine/doravirine). Data from cohort studies and meta-analyses were also assessed, extrapolating the main evidence about the combinations of interest.Expert opinion Integrase inhibitors (InsTIs)-based regimens have few interruptions for adverse events and few drug-related adverse events, with tenofovir alafenamide/emtricitabine/dolutegravir and lamivudine/dolutegravir being the most tolerable ones. However, neuropsychiatric adverse events and metabolic issues could prompt the alternative use of darunavir or doravirine-based combinations, even if a superior safety profile of these combinations over InSTIs has yet to be demonstrated.
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Affiliation(s)
| | - Gianmaria Baldin
- Mater Olbia Hospital, Olbia, Italia.,UOC Malattie Infettive, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italia
| | - Cristina Putaggio
- Dipartimento di Sicurezza e Bioetica Sezione Malattie Infettive, Università Cattolica Del Sacro Cuore, Roma, Italy
| | - Simona Di Giambenedetto
- UOC Malattie Infettive, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italia.,Dipartimento di Sicurezza e Bioetica Sezione Malattie Infettive, Università Cattolica Del Sacro Cuore, Roma, Italy
| | - Alberto Borghetti
- UOC Malattie Infettive, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italia
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George JW, Mattingly JE, Roland NJ, Small CM, Lamberty BG, Fox HS, Stauch KL. Physiologically Relevant Concentrations of Dolutegravir, Emtricitabine, and Efavirenz Induce Distinct Metabolic Alterations in HeLa Epithelial and BV2 Microglial Cells. Front Immunol 2021; 12:639378. [PMID: 34093527 PMCID: PMC8173175 DOI: 10.3389/fimmu.2021.639378] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 05/04/2021] [Indexed: 11/13/2022] Open
Abstract
Microglia, the resident brain phagocytes, likely play a key role in human immunodeficiency virus (HIV) infection of the central nervous system (CNS) and subsequent neuropathogenesis; however, the nature of the infection-induced changes that yield damaging CNS effects and the stimuli that provoke microglial activation remains elusive, especially in the current era of using antiretroviral (ARV) drugs for ARV therapy (ART). Altered microglial metabolism can modulate cellular functionality and pathogenicity in neurological disease. While HIV infection itself alters brain energy metabolism, the effect of ARV drugs, particularly those currently used in treatment, on metabolism is understudied. Dolutegravir (DTG) and emtricitabine (FTC) combination, together with tenofovir (TAF or TDF), is one of the recommended first line treatments for HIV. Despite the relatively good tolerability and safety profile of FTC, a nucleoside reverse transcriptase inhibitor, and DTG, an integrase inhibitor, adverse side effects have been reported and highlight a need to understand off-target effects of these medications. We hypothesized that similar to previous ART regimen drugs, DTG and FTC side effects involve mitochondrial dysfunction. To increase detection of ARV-induced mitochondrial effects, highly glycolytic HeLa epithelial cells were forced to rely on oxidative phosphorylation by substituting galactose for glucose in the growth media. We assessed ATP levels, resazurin oxidation-reduction (REDOX), and mitochondrial membrane potential following 24-hour exposure (to approximate effects of one dose equivalent) to DTG, FTC, and efavirenz (EFV, a known mitotoxic ARV drug). Further, since microglia support productive HIV infection, act as latent HIV cellular reservoirs, and when dysfunctional likely contribute to HIV-associated neurocognitive disorders, the experiments were repeated using BV2 microglial cells. In HeLa cells, FTC decreased mitochondrial REDOX activity, while DTG, similar to EFV, impaired both mitochondrial ATP generation and REDOX activity. In contrast to HeLa cells, DTG increased cellular ATP generation and mitochondrial REDOX activity in BV2 cells. Bioenergetic analysis revealed that DTG, FTC, and EFV elevated BV2 cell mitochondrial respiration. DTG and FTC exposure induced distinct mitochondrial functional changes in HeLa and BV2 cells. These findings suggest cell type-specific metabolic changes may contribute to the toxic side effects of these ARV drugs.
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Affiliation(s)
- Joseph W George
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, United States
| | - Jane E Mattingly
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, United States
| | - Nashanthea J Roland
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, United States
| | - Cassandra M Small
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, United States
| | - Benjamin G Lamberty
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, United States
| | - Howard S Fox
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, United States
| | - Kelly L Stauch
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, United States
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Olliges E, Bührlen B, Fischer F, Boesecke C, Kümmerle T, Schneider J, Weidlich S, Cordes C, Heiken H, Stellbrink HJ, Krznaric I, Scholten S, Jensen BEO, Wolf E, Ronel J, Spinner CD, On Behalf Of The Dualis Study Group. Health-related quality-of-life in people living with HIV after switching to dual therapy with ritonavir-boosted darunavir + dolutegravir: a DUALIS sub-study. AIDS Care 2021; 34:698-707. [PMID: 33896276 DOI: 10.1080/09540121.2021.1916873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The DUALIS study demonstrated efficacy and safety of switching to dolutegravir plus ritonavir-boosted darunavir (DRV/r) (2DR) as compared to standard-of-care-therapy with two nucleoside reverse transcriptase inhibitors + DRV/r (3DR) in pretreated people living with HIV (PLWH), 48 weeks after switching. This DUALIS sub-study investigates health-related-quality-of-life (HrQoL) in this study-population. The Hospital Anxiety and Depression Scale (HADS) and the Medical Outcome Survey-HIV (MOS-HIV) were used assessing anxiety and depression symptoms, respectively HrQoL. Data were collected at baseline, 4, 24, and 48 weeks after randomization. Outcome scores were dichotomized and used as criteria in longitudinal models identifying differential developments. Odds ratios (ORs) with 95% confidence intervals (CIs) were computed as main measures of effects. ORs<1 indicate better results for HADS, and worse for MOS-HIV scores in the 2DR compared to 3DR group. In total, 263 subjects were randomized and treated (2DR n=131, 3DR n=132; median age 48 years). Significant different progressions could only be found for HADS-Depression scores (OR=.87, 95% CI: .78, .98, p=.02). While HADS-Depression scores decreased in the 2DR group, they increased in 3DR group. This sub-study showed no disadvantages regarding HrQoL in PLWH after switching to DTG+DRV/r. Considering lifelong requirements for antiretroviral medication, close attention to HrQL is required.
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Affiliation(s)
- Elisabeth Olliges
- Department of Psychosomatic Medicine and Psychotherapy, Klinik Barmelweid AG, Barmelweid, Switzerland
| | - Bernhard Bührlen
- Psymeta GmbH, Clinical Research Organisation, Schafisheim, Switzerland
| | - Franz Fischer
- Psymeta GmbH, Clinical Research Organisation, Schafisheim, Switzerland
| | | | | | - Jochen Schneider
- School of Medicine, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Simon Weidlich
- School of Medicine, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | | | | | | | | | | | | | | | - Joram Ronel
- Department of Psychosomatic Medicine and Psychotherapy, Klinik Barmelweid AG, Barmelweid, Switzerland.,Department of Psychosomatic Medicine and Psychotherapy, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Christoph D Spinner
- School of Medicine, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
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O’Halloran JA, Wang K, Spence AB, Williams DW, Dastgheyb R, Fitzgerald KC, Kamkwalala AR, Maki PM, Sharma A, Gustafson DR, Milam J, Weber KM, Adimora AA, Ofotokun I, Fischl MA, Konkle-Parker D, Lahiri CD, Sheth AN, Xu Y, Rubin LH. Integrase Strand Transfer Inhibitor Start or Switch Impacts Learning in Women With HIV. J Acquir Immune Defic Syndr 2021; 86:593-599. [PMID: 33394812 PMCID: PMC8319920 DOI: 10.1097/qai.0000000000002608] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 12/07/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Integrase strand transfer inhibitors (INSTIs) are first-line regimens for HIV treatment. We aimed to examine their impact on cognitive performance and depressive symptoms in women with HIV (WWH). SETTING Women's Interagency HIV Study, a multisite, prospective, cohort study. METHODS WWH who started or switched to INSTI-based antiretroviral therapy (ART) and completed neuropsychological testing and the Center for Epidemiological Studies-Depression (CES-D) scale before and after INSTI start/switch were included in the analyses. Primary outcomes were demographically corrected cognitive domain T-scores. Linear mixed-effects models adjusted for relevant covariates were used to examine effects of start/switch of any INSTI and individual INSTI drugs on cognition and CES-D scores. RESULTS Six hundred thirty-nine WWH, median age 49 (interquartile range 12) years, 66% Black non-Hispanic, had neuropsychological and CES-D scale data before and after INSTI start/switch. Although 14% started INSTI-based ART, the remainder switched to INSTI-based ART from another regimen. Overall, any INSTI use was associated with poorer learning post-INSTI. Specifically, use of dolutegravir and elvitegravir, but not raltegravir, was associated with poorer learning. In analyses restricted to INSTI switch, any INSTI use, and dolutegravir use, was associated with poorer learning. Among those switching from a PI-based regimen, INSTIs overall and dolutegravir remained associated with poorer learning; switching from a nonnucleoside reverse transcriptase inhibitor to dolutegravir was also associated with poorer learning. INSTI start/switch was not related to depressive symptom changes. CONCLUSIONS INSTI use was associated with poorer learning among WWH. These changes were mainly observed in elvitegravir and dolutegravir users, indicating that the impact of INSTI on cognition in WWH may not be a class effect.
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Affiliation(s)
- Jane A O’Halloran
- Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Kunbo Wang
- Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, MD
| | - Amanda B. Spence
- Departments of Psychiatry and Psychology, University of Illinois at Chicago, Chicago, IL
| | - Dionna W. Williams
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, MD
- Division of Clinical Pharmacology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Raha Dastgheyb
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Asante R. Kamkwalala
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Pauline M. Maki
- Departments of Psychiatry and Psychology, University of Illinois at Chicago, Chicago, IL
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - Deborah R. Gustafson
- Department of Neurology, State University of New York Downstate Health Sciences University, Brooklyn, NY
| | - Joel Milam
- Institute for Health Promotion & Disease Prevention Research, University of Southern California, Los Angeles, California
| | - Kathleen M. Weber
- CORE Center, Cook County Health and Hektoen Institute of Medicine, Chicago, IL
| | - Adaora A. Adimora
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Igho Ofotokun
- Emory University School of Medicine, Department of Medicine, Infectious Disease Division and Grady Health Care System, Atlanta, GA, USA
| | | | - Deborah Konkle-Parker
- Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, Mississippi
| | - Cecile D. Lahiri
- Emory University School of Medicine, Department of Medicine, Infectious Disease Division and Grady Health Care System, Atlanta, GA, USA
| | - Anandi N. Sheth
- Emory University School of Medicine, Department of Medicine, Infectious Disease Division and Grady Health Care System, Atlanta, GA, USA
| | - Yanxun Xu
- Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, MD
- Division of Biostatistics and Bioinformatics at The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Leah H. Rubin
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD
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Williams DW, Li Y, Dastgheyb R, Fitzgerald KC, Maki PM, Spence AB, Gustafson DR, Milam J, Sharma A, Adimora AA, Ofotokun I, Fischl MA, Konkle-Parker D, Weber KM, Xu Y, Rubin LH. Associations between Antiretroviral Drugs on Depressive Symptomatology in Homogenous Subgroups of Women with HIV. J Neuroimmune Pharmacol 2021; 16:181-194. [PMID: 31933016 PMCID: PMC7430262 DOI: 10.1007/s11481-019-09899-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 12/09/2019] [Indexed: 12/31/2022]
Abstract
Antiretroviral therapy (ART) is inconsistently associated with depression. These associations may depend on factors such as biological sex, age, and health status. Identifying such factors may help optimize treatment of HIV and depression. We implemented a novel approach to examine interindividual variability in the association between ART agents and depressive symptoms. 3434 women living with HIV (WLWH) from the Women's Interagency HIV Study (WIHS) were computationally divided into subgroups based on sociodemographic (e.g., age) and longitudinal (from 1995 to 2016) behavioral and clinical profiles (e.g., substance use, HIV RNA, CD4 counts). Five subgroups (n's ranged from 482 to 802) were identified and characterized as those with: controlled HIV/vascular comorbidities; profound HIV legacy effects; younger women [<45 years of age] with hepatitis C; primarily 35-55 year olds; and poorly controlled HIV/substance use. Within each subgroup, we examined associations between ART agents used over the past 6 months and item-level depressive symptoms on the Center for Epidemiologic Studies Depression Scale. Tenofovir (4 of 5 subgroups) followed by efavirenz, emtricitabine, stavudine, lopinavir, etravirine, nelfinavir, ritonavir, and maraviroc were the most common agents associated with depressive symptoms, although the pattern and directionality varied by subgroup. For example, lopinavir was associated with fewer symptoms among the subgroup with a legacy HIV effect but more symptoms among the subgroup with well-controlled HIV/vascular comorbidities. Unexpectedly, dolutegravir and raltegravir were not associated with depressive symptoms among any subgroup. Findings underscore marked interindividual variability in ART agents on depression in WLWH. Sociodemographic, clinical, and behavioral factors are important determinants of the relationship between ART agents and depressive symptoms in WLWH. Graphical Abstract Are antiretroviral agents a risk factor for depressive symptoms in women with HIV? We examined associations between ART-agents and depressive symptoms among similar subgroups of women with HIV from the Women's Interagency HIV Study. The patterns of associations depended on sociodemographic, clinical, and behavioral characteristics of women.
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Affiliation(s)
- Dionna W Williams
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Division of Clinical Pharmacology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yuliang Li
- Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, MD, USA
| | - Raha Dastgheyb
- Department of Neurology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street/ Meyer 6-113, Baltimore, MD, 21287-7613, USA
| | - Kathryn C Fitzgerald
- Department of Neurology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street/ Meyer 6-113, Baltimore, MD, 21287-7613, USA
| | - Pauline M Maki
- Departments of Psychiatry and Psychology, University of Illinois at Chicago, Chicago, IL, USA
| | - Amanda B Spence
- Department of Medicine, Division of Infectious Disease and Travel Medicine, Georgetown University, Washington, DC, USA
| | - Deborah R Gustafson
- Department of Neurology, SUNY-Downstate Health Sciences University, Brooklyn, NY, USA
| | - Joel Milam
- Institute for Health Promotion & Disease Prevention Research, University of Southern California, Los Angeles, CA, USA
| | | | - Adaora A Adimora
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Igho Ofotokun
- Department of Medicine, Division of Infectious Diseases, Emory University, Atlanta, GA, USA
| | | | - Deborah Konkle-Parker
- Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, MS, USA
| | - Kathleen M Weber
- CORE Center, Cook County Health and Hektoen Institute of Medicine, Chicago, IL, USA
| | - Yanxun Xu
- Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, MD, USA
- Division of Biostatistics and Bioinformatics at The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Leah H Rubin
- Department of Neurology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street/ Meyer 6-113, Baltimore, MD, 21287-7613, USA.
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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45
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Tabak F, Zerdali E, Altuntaş O, Gunduz A, Bolukcu S, Mete B, Nakir IY, Kumbasar Karaosmanoglu H, Yildiz DS, Meric Koc M, Dokmetas İ. Efficacy and safety of co-formulated elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide in HIV-positive patients: real-world data. Int J STD AIDS 2021; 32:562-569. [PMID: 33599173 DOI: 10.1177/0956462420983692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide (E/C/F/TAF) is a recommended and widely used regimen for HIV infection. In this study, we aimed to determine the efficacy and safety of E/C/F/TAF in people living with HIV (PLWH), who are either treatment-naïve or switched from any tenofovir disoproxil fumarate-containing regimen. For switched patients, we aimed to determine the impact of switching from tenofovir disoproxil fumarate (TDF) to TAF on lipid profile and kidney functions. METHODS ACTHIV-IST Study Group produced a database, and five dedicated HIV centres in Istanbul entered data of PLWH who switched from any TDF-containing regimen to E/C/F/TAF and treatment-naïve patients who were initiated with the E/C/F/TAF regimen between January 2017 and December 2019. Clinical findings, viral parameters, lipid studies, renal function tests, adverse events and adherence to the treatment were recorded in this prospective observational study. RESULTS The study included a total of 614 switched and treatment-naïve patients. Of 430 treatment-experienced patients, 89% (382) were men, and the mean age was 42 ± 12 years. Among them, 47% (181/382) self-identified as men who have sex with men (MSM). The median duration of HIV diagnosis was 54 ± 29 months. The median duration of E/C/F/TAF use was 20 ± 36 months and that of previous treatment was 23 ± 18 months. HIV-RNA was undetectable at baseline and month 12 in 84.1% (360/428) and 86.1% (328/381) of patients, respectively (p > 0.05). Mean CD4 counts were 708 ± 287 cells/µL and 802 ± 305 cells/µL at baseline and month 12, respectively (p < 0.001). Serum creatinine levels remained stable during the treatment period. Mean total cholesterol levels at baseline and month 12 were 172 and 211 mg/dL (p < 0.01), LDL-cholesterol 104 and 138 mg/dL (p < 0.01), HDL-cholesterol 39 and 49 mg/dL (p < 0.01) and triglycerides 134 and 174 mg/dL (p < 0.01), respectively. The treatment was generally well tolerated. Eight patients discontinued the therapy (drug interaction: 3; lost to follow-up: 1; pregnancy: 1; pulmonary tuberculosis: 1; side effect: 1; patient's decision: 1). Of 184 treatment-naïve patients, 88% (162) were men, and the mean age was 36.5± 12 years. Among them, 50% (81/162) self-identified as MSM. The mean duration of HIV infection was 21.6 ± 17.1 months. The mean duration of E/C/F/TAF use was 16 ± 4 months. HIV-RNA was undetectable at baseline and month 12 in 1% and 89.1% of patients, respectively. Mean CD4 counts at baseline and month 12 were 469 ± 223 cells/µL and 740 ± 298 cells/µL, respectively. During the treatment period, creatinine levels remained stable. Total cholesterol, LDL-cholesterol, triglyceride and also HDL-cholesterol levels increased. Mean total cholesterol levels at baseline and month 12 were 167 and 211 mg/dL (p < 0.01), LDL-cholesterol 108 and 143 mg/dL (p < 0.01), HDL-cholesterol 41 and 47 mg/dL (p < 0.01) and triglycerides 136 and 172 mg/dL, respectively (p < 0.01). The treatment was generally well tolerated. Three patients discontinued the therapy (drug interaction: 1; non-responder: 1; patient's decision: 1). CONCLUSION Starting with or switching to E/C/F/TAF in PLWH effectively suppresses HIV infection, is associated with an increase in CD4 cell count and is well tolerated in a real-life setting. Renal functions remained stable during the treatment. E/C/F/TAF use was associated with an increase in LDL-cholesterol and triglyceride levels along with an increase in HDL-cholesterol levels.
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Affiliation(s)
- Fehmi Tabak
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpasa School of Medicine, 532719Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Esra Zerdali
- Department of Infectious Diseases and Clinical Microbiology, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ozlem Altuntaş
- Department of Infectious Diseases and Clinical Microbiology, Bakirkoy Dr.Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Alper Gunduz
- Department of Infectious Diseases and Clinical Microbiology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Sibel Bolukcu
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, 221265Bezmialem Vakıf University, Istanbul, Turkey
| | - Bilgul Mete
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpasa School of Medicine, 532719Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Inci Y Nakir
- Department of Infectious Diseases and Clinical Microbiology, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Hayat Kumbasar Karaosmanoglu
- Department of Infectious Diseases and Clinical Microbiology, Bakirkoy Dr.Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Dilek S Yildiz
- Department of Infectious Diseases and Clinical Microbiology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Meliha Meric Koc
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, 221265Bezmialem Vakıf University, Istanbul, Turkey
| | - İlyas Dokmetas
- Department of Infectious Diseases and Clinical Microbiology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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46
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HIV Infection and Related Mental Disorders. Brain Sci 2021; 11:brainsci11020248. [PMID: 33671125 PMCID: PMC7922767 DOI: 10.3390/brainsci11020248] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 01/13/2023] Open
Abstract
Over the more than thirty-year period of the human immunodeficiency virus type 1 (HIV-1) epidemic, many data have been accumulated indicating that HIV infection predisposes one to the development of mental pathologies. It has been proven that cognitive disorders in HIV-positive individuals are the result of the direct exposure of the virus to central nervous system (CNS) cells. The use of antiretroviral therapy has significantly reduced the number of cases of mental disorders among people infected with HIV. However, the incidence of moderate to mild cognitive impairment at all stages of HIV infection is still quite high. This review describes the most common forms of mental pathology that occur in people living with HIV and presents the current concepts on the possible pathogenetic mechanisms of the influence of human immunodeficiency virus (HIV-1) and its viral proteins on the cells of the CNS and the CNS’s functions. This review also provides the current state of knowledge on the impact of the antiretroviral therapy on the development of mental pathologies in people living with HIV, as well as current knowledge on the interactions between antiretroviral and psychotropic drugs that occur under their simultaneous administration.
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47
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Povar-Echeverría M, Comet-Bernad M, Gasso-Sánchez A, Ger-Buil A, Navarro-Aznarez H, Martínez-Álvarez R, Arazo-Garcés P. Neuropsychiatric adverse effects of dolutegravir in real-life clinical practice. Enferm Infecc Microbiol Clin 2021. [DOI: 10.1016/j.eimce.2020.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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48
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Hyle EP, Scott JA, Sax PE, Millham LRI, Dugdale CM, Weinstein MC, Freedberg KA, Walensky RP. Clinical Impact and Cost-effectiveness of Genotype Testing at Human Immunodeficiency Virus Diagnosis in the United States. Clin Infect Dis 2021; 70:1353-1363. [PMID: 31055599 DOI: 10.1093/cid/ciz372] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 05/03/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND US guidelines recommend genotype testing at human immunodeficiency virus (HIV) diagnosis ("baseline genotype") to detect transmitted drug resistance (TDR) to nonnucleoside reverse transcriptase inhibitors (NNRTIs), nucleoside reverse transcriptase inhibitors (NRTIs), and protease inhibitors. With integrase strand inhibitor (INSTI)-based regimens now recommended as first-line antiretroviral therapy (ART), the of baseline genotypes is uncertain. METHODS We used the Cost-effectiveness of Preventing AIDS Complications model to examine the clinical impact and cost-effectiveness of baseline genotype compared to no baseline genotype for people starting ART with dolutegravir (DTG) and an NRTI pair. For people with no TDR (83.8%), baseline genotype does not alter regimen selection. Among people with transmitted NRTI resistance (5.8%), baseline genotype guides NRTI selection and informs subsequent ART after adverse events (DTG AEs, 14%). Among people with transmitted NNRTI resistance (7.2%), baseline genotype influences care only for people with DTG AEs switching to NNRTI-based regimens. The 48-week virologic suppression varied (40%-92%) depending on TDR. Costs included $320/genotype and $2500-$3000/month for ART. RESULTS Compared to no baseline genotype, baseline genotype resulted in <1 additional undiscounted quality-adjusted life-day (QALD), cost an additional $500/person, and was not cost-effective (incremental cost-effectiveness ratio: $420 000/quality-adjusted life-year). In univariate sensitivity analysis, clinical benefits of baseline genotype never exceeded 5 QALDs for all newly diagnosed people with HIV. Baseline genotype was cost-effective at current TDR prevalence only under unlikely conditions, eg, DTG-based regimens achieving ≤50% suppression of transmitted NRTI resistance. CONCLUSIONS With INSTI-based first-line regimens in the United States, baseline genotype offers minimal clinical benefit and is not cost-effective.
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Affiliation(s)
- Emily P Hyle
- Medical Practice Evaluation Center, Department of Medicine.,Division of Infectious Diseases, Massachusetts General Hospital.,Harvard Medical School, Boston.,Harvard University Center for AIDS Research, Cambridge
| | | | - Paul E Sax
- Harvard Medical School, Boston.,Division of Infectious Diseases and Department of Medicine, Brigham and Women's Hospital
| | | | - Caitlin M Dugdale
- Medical Practice Evaluation Center, Department of Medicine.,Division of Infectious Diseases, Massachusetts General Hospital.,Harvard Medical School, Boston
| | - Milton C Weinstein
- Harvard Medical School, Boston.,Department of Health Policy and Management, Harvard T.H. Chan School of Public Health
| | - Kenneth A Freedberg
- Medical Practice Evaluation Center, Department of Medicine.,Division of Infectious Diseases, Massachusetts General Hospital.,Harvard Medical School, Boston.,Harvard University Center for AIDS Research, Cambridge.,Department of Health Policy and Management, Harvard T.H. Chan School of Public Health.,Division of General Internal Medicine, Massachusetts General Hospital, Boston
| | - Rochelle P Walensky
- Medical Practice Evaluation Center, Department of Medicine.,Division of Infectious Diseases, Massachusetts General Hospital.,Harvard Medical School, Boston.,Harvard University Center for AIDS Research, Cambridge.,Division of General Internal Medicine, Massachusetts General Hospital, Boston
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49
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Kamkwalala AR, Wang K, O’Halloran J, Williams DW, Dastgheyb R, Fitzgerald KC, Spence AB, Maki PM, Gustafson DR, Milam J, Sharma A, Weber KM, Adimora AA, Ofotokun I, Sheth AN, Lahiri CD, Fischl MA, Konkle-Parker D, Xu Y, Rubin LH. Starting or Switching to an Integrase Inhibitor-Based Regimen Affects PTSD Symptoms in Women with HIV. AIDS Behav 2021; 25:225-236. [PMID: 32638219 PMCID: PMC7948485 DOI: 10.1007/s10461-020-02967-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
As the use of Integrase inhibitor (INSTI)-class antiretroviral medications becomes more common to maintain long-term viral suppression, early reports suggest the potential for CNS side-effects when starting or switching to an INSTI-based regimen. In a population already at higher risk for developing mood and anxiety disorders, these drugs may have significant effects on PTSD scale symptom scores, particularly in women with HIV (WWH). A total of 551 participants were included after completing ≥ 1 WIHS study visits before and after starting/switching to an INSTI-based ART regimen. Of these, 14% were ART naïve, the remainder switched from primarily a protease inhibitor (PI) or non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimen. Using multivariable linear mixed effects models, we compared PTSD Civilian Checklist subscale scores before and after a "start/switch" to dolutegravir (DTG), raltegravir (RAL), or elvitegravir (EVG). Start/switch to EVG improved re-experiencing subscale symptoms (P's < 0.05). Switching to EVG improved symptoms of avoidance (P = 0.01). Starting RAL improved arousal subscale symptoms (P = 0.03); however, switching to RAL worsened re-experiencing subscale symptoms (P < 0.005). Starting DTG worsened avoidance subscale symptoms (P = 0.03), whereas switching to DTG did not change subscale or overall PTSD symptoms (P's > 0.08). In WWH, an EVG-based ART regimen is associated with improved PTSD symptoms, in both treatment naïve patients and those switching from other ART. While a RAL-based regimen was associated with better PTSD symptoms than in treatment naïve patients, switching onto a RAL-based regimen was associated with worse PTSD symptoms. DTG-based regimens either did not affect, or worsened symptoms, in both naïve and switch patients. Further studies are needed to determine mechanisms underlying differential effects of EVG, RAL and DTG on stress symptoms in WWH.
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Affiliation(s)
- Asante R. Kamkwalala
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kunbo Wang
- Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, MD
| | - Jane O’Halloran
- Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Dionna W. Williams
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, MD,Division of Clinical Pharmacology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Raha Dastgheyb
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Amanda B. Spence
- Department of Medicine, Division of Infectious Disease and Travel Medicine, Georgetown University, Washington, DC
| | - Pauline M. Maki
- Departments of Psychiatry, Psychology and OB/GYN, University of Illinois at Chicago, Chicago, IL
| | - Deborah R. Gustafson
- Department of Neurology, State University of New York Downstate Health Sciences University, Brooklyn, NY
| | - Joel Milam
- Institute for Health Promotion & Disease Prevention Research, University of Southern California, Los Angeles, California
| | | | - Kathleen M. Weber
- CORE Center, Cook County Health and Hektoen Institute of Medicine, Chicago, IL
| | - Adaora A. Adimora
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Igho Ofotokun
- Department of Medicine, Division of Infectious Diseases, Emory University, Atlanta, GA
| | - Anandi N. Sheth
- Department of Medicine, Division of Infectious Diseases, Emory University, Atlanta, GA
| | - Cecile D. Lahiri
- Department of Medicine, Division of Infectious Diseases, Emory University, Atlanta, GA
| | | | - Deborah Konkle-Parker
- Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, Mississippi
| | - Yanxun Xu
- Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO,Division of Biostatistics and Bioinformatics at The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Leah H. Rubin
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD,Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD,Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD
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50
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Ciccullo A, Baldin G, Borghi V, Sterrantino G, Madeddu G, Latini A, d'Ettorre G, Lanari A, Mazzitelli M, Colafigli M, Capetti AF, Oreni L, Lagi F, Rusconi S, Di Giambenedetto S. Overall Tolerability of Integrase Inhibitors in Clinical Practice: Results from a Multicenter Italian Cohort. AIDS Res Hum Retroviruses 2021; 37:4-10. [PMID: 32998526 DOI: 10.1089/aid.2020.0078] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
International guidelines recommend the use of integrase strand transfer inhibitor (INI)-based regimens as first-line antiretroviral (ARV) in both naive and experienced HIV-infected patients. We analyzed a multicenter cohort of HIV-infected patients, both naive and experienced, starting an ARV, including an INI. Chi-square test and nonparametric tests were used to assess differences in categorical and continuous variables, respectively. Kaplan-Meier survival analysis was performed to estimate the probability of maintaining the study drug and Cox-regression analysis to evaluate predictors of discontinuation. We enrolled 4,343 patients: 3,143 (72.4%) were males, with a median age of 49 years (interquartile range 41-55). Naive patients were 733 (16.9%), of whom 168 (22.9%) were AIDS presenters. Overall, 2,282 patients (52.5%) started dolutegravir (DTG), 1,426 (32.8%) raltegravir (RAL), and 635 (14.7%) elvitegravir (EVG). During 10,032 patient years of follow-up (PYFU), we observed 1,278 discontinuations (13 per 100 PYFU); 448 of them (35%) due to simplification and 355 (28%) to toxicities (98 for central nervous system toxicity). Reasons of discontinuation were different between INIs. Estimated probability of maintaining DTG at 3 and 4 years were 81.5% [95% confidence interval (CI): 80.5-82.5] and 76.3% (95% CI: 73.9-78.7), respectively; RAL 61.6% (95% CI: 60.2-63.0) and 54.1% (95% CI: 52.7-55.5); EVG 71.6% (95% CI: 69.2-74.0) and 68.3% (95% CI: 65.3-71.3) (p < .001). At a multivariable analysis, being on a RAL-based ARV [vs. DTG, adjusted hazard ratio (aHR) 2.9, 95% CI: 2.3-3.6, p < .001], a EVG-based ARV (vs. DTG, aHR 1.3 95% CI: 1.1-1.7, p = .049), and a peak HIV-RNA >500k cp/mL (aHR 1.3, 95% CI: 1.1-1.6, p = .006) predicted INI discontinuation. Our data confirm the good tolerability of INIs in clinical practice. Differences emerge between the three drugs in reasons for discontinuation.
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Affiliation(s)
- Arturo Ciccullo
- Section of Infectious Diseases, Department of Safety and Bioethics, Catholic University of the Sacred Heart, Rome, Italy
- Infectious Diseases Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Gianmaria Baldin
- Section of Infectious Diseases, Department of Safety and Bioethics, Catholic University of the Sacred Heart, Rome, Italy
- Mater Olbia Hospital, Olbia, Italy
| | - Vanni Borghi
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Gaetana Sterrantino
- Division of Tropical and Infectious Diseases, ‘Careggi’ Hospital, Florence, Italy
| | - Giordano Madeddu
- Department of Clinical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Alessandra Latini
- Infectious Dermatology and Allergology Unit, IFO S. Gallicano Institute (IRCCS), Rome, Italy
| | - Gabriella d'Ettorre
- Department of Public Health and Infectious Diseases, Azienda Policlinico Umberto I, Rome, Italy
| | - Alessandro Lanari
- Infectious Diseases Unit, AOU Senese, Siena, Italy
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Maria Mazzitelli
- Department of Medical and Surgical Sciences, Unit of Infectious and Tropical Diseases, Magna Graecia University, Catanzaro, Italy
| | - Manuela Colafigli
- Infectious Dermatology and Allergology Unit, IFO S. Gallicano Institute (IRCCS), Rome, Italy
| | - Amedeo Ferdinando Capetti
- Division of Infectious Diseases, Department of Infectious Diseases, Luigi Sacco University Hospital, Milan, Italy
| | - Letizia Oreni
- Infectious Diseases Unit, DIBIC Luigi Sacco, University of Milan, Milan, Italy
| | - Filippo Lagi
- Division of Tropical and Infectious Diseases, ‘Careggi’ Hospital, Florence, Italy
| | - Stefano Rusconi
- Infectious Diseases Unit, DIBIC Luigi Sacco, University of Milan, Milan, Italy
| | - Simona Di Giambenedetto
- Section of Infectious Diseases, Department of Safety and Bioethics, Catholic University of the Sacred Heart, Rome, Italy
- Infectious Diseases Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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