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Pedro L, Zagalo A, Tavares R, Pacheco P, Oliveira J, Vaz Pinto I, Serrão R, Tavares S, Brito P, Maltez F, Neves I, Carvalho A, Teófilo E, Almeida J, Lains I. Treatment patterns and preferences of people living with HIV starting or switching antiretroviral therapy: Real-world evidence from Portugal. Int J STD AIDS 2024:9564624241263122. [PMID: 39052505 DOI: 10.1177/09564624241263122] [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: 07/27/2024]
Abstract
BACKGROUND There is a lack of up-to-date real-life evidence on antiretroviral therapy (ART) strategies among people living with HIV (PLWH) in Portugal. This study aimed to describe the treatment strategy used in PLWH either initiating or switching ART. METHODS Non-interventional, cross-sectional, multicenter study carried out between December 2019 and October 2021 in Portugal. RESULTS A total of 237 PLWH were included in this study, 171 of whom were ART-experienced and 66 were ART-naïve. The study showed that triple regimens were the most common ART strategy and integrase strand transfer inhibitors-based therapy was the most frequently used therapeutic class in both ART-naïve and ART-experienced PLWH. Nevertheless, about a third of PLWH who started a triple regimen transitioned to a dual regimen. Patient-reported outcomes revealed high HIV literacy and similar ART preferences in both groups. CONCLUSIONS This real-world study showed that triple regimens were the most widely used ART strategy, even after the European AIDS Clinical Society guidelines introduced the recommendation of a dual regimen for naïve patients. The cohorts of this study presented a high level of HIV literacy at the time of inclusion. Our findings highlighted that taking pills only once a day is considered a very important feature for most patients.
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Affiliation(s)
- Liliana Pedro
- Department of Internal Medicine, Hospital de Portimão, Centro Hospitalar Universitário Do Algarve, Portimão, Portugal
| | - Alexandra Zagalo
- Department of Infectious Diseases, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
| | - Raquel Tavares
- Department of Infectiology, Hospital Beatriz Ângelo, Loures, Portugal
| | - Patrícia Pacheco
- Department of Infectiology, Hospital Prof. Dr Fernando da Fonseca, Amadora, Portugal
| | - Joaquim Oliveira
- Department of Infectiology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Inês Vaz Pinto
- Department of Internal Medicine, Hospital de Cascais, Cascais, Portugal
| | - Rosário Serrão
- Department of Infectious Diseases, Hospital de São João, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Sandra Tavares
- Department of Infectiology, Hospital de Vila Real, Centro Hospitalar Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Paula Brito
- Department of Infectiology, Hospital Garcia de Orta, Almada, Portugal
| | - Fernando Maltez
- Department of Infectiology, Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal
| | - Isabel Neves
- Department of Infectiology, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
| | | | - Eugénio Teófilo
- Department of Internal Medicine, Hospital dos Capuchos, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal
| | - Joana Almeida
- Medical Affairs Department, MSD Portugal, Paço de Arcos, Portugal
| | - Inês Lains
- Medical Affairs Department, MSD Portugal, Paço de Arcos, Portugal
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2
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Martinez E. Lenacapavir plus two bNAbs: feasible, with some caveats. Lancet HIV 2024; 11:e132-e133. [PMID: 38307099 DOI: 10.1016/s2352-3018(23)00329-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 12/04/2023] [Indexed: 02/04/2024]
Affiliation(s)
- Esteban Martinez
- Hospital Clínic, University of Barcelona, Barcelona 08036, Spain; CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.
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3
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Henegar C, Letang E, Wang R, Hicks C, Fox D, Jones B, de Ruiter A, Vannappagari V. A Comprehensive Literature Review of Treatment-Emergent Integrase Resistance with Dolutegravir-Based Regimens in Real-World Settings. Viruses 2023; 15:2426. [PMID: 38140667 PMCID: PMC10747437 DOI: 10.3390/v15122426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/08/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
After a decade of dolutegravir (DTG) use in various antiretroviral therapy combinations and in diverse populations globally, it is critical to identify HIV strains with reduced drug susceptibility and monitor emergent resistance in people living with HIV who experience virologic failure while on DTG-based regimens. We searched the PubMed, Embase, and Cochrane databases to identify studies that reported DTG resistance-associated mutations (RAMs) emerging under selection pressure. Our review showed that RAMs conferring resistance to DTG were rare in 2-drug and 3-drug regimens used in real-world cohorts, corroborating data from clinical trials. The potency of DTG in maintaining virologic suppression was demonstrated, even in cases of pre-existing resistance to companion drugs in the regimen. Estimates of DTG RAMs depended on the population and certain risk factors, including monotherapy, baseline resistance or lack of genotypic testing, treatment history and prior virologic failure, and suboptimal treatment adherence. The RAMs detected after virologic failure, often in heavily treatment-experienced individuals with prior exposure to integrase strand transfer inhibitors, were G118R, E138K, G140A/C/R/S, Q148H/K/R, N155H, and R263K. Overall, these data highlight the durable effectiveness and high barrier to resistance of DTG as part of combination antiretroviral therapy in a wide variety of settings.
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Affiliation(s)
- Cassidy Henegar
- ViiV Healthcare, 406 Blackwell Street, Suite 300, Durham, NC 27701, USA; (R.W.); (C.H.); (D.F.); (V.V.)
| | - Emilio Letang
- ViiV Healthcare, P.T.M., Severo Ochoa 2, 28760 Tres Cantos, Madrid, Spain
| | - Ruolan Wang
- ViiV Healthcare, 406 Blackwell Street, Suite 300, Durham, NC 27701, USA; (R.W.); (C.H.); (D.F.); (V.V.)
| | - Charles Hicks
- ViiV Healthcare, 406 Blackwell Street, Suite 300, Durham, NC 27701, USA; (R.W.); (C.H.); (D.F.); (V.V.)
| | - Dainielle Fox
- ViiV Healthcare, 406 Blackwell Street, Suite 300, Durham, NC 27701, USA; (R.W.); (C.H.); (D.F.); (V.V.)
| | - Bryn Jones
- ViiV Healthcare, 980 Great West Road, Brentford TW8 9GS, Middlesex, UK
| | | | - Vani Vannappagari
- ViiV Healthcare, 406 Blackwell Street, Suite 300, Durham, NC 27701, USA; (R.W.); (C.H.); (D.F.); (V.V.)
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4
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Alavian G, Abbasian L, Khalili H, Alinaghi SAS, Hasannezhad M, Ashtiani MF, Manshadi SAD. Tenofovir alafenamide plus dolutegravir as a switch strategy in HIV-infected patients: a pilot randomized controlled trial. Daru 2023; 31:145-153. [PMID: 37540331 PMCID: PMC10624796 DOI: 10.1007/s40199-023-00470-2] [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: 04/12/2023] [Accepted: 07/05/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND Currently, two-drug antiretroviral regimens are emerging fields in life-long treatment in people living with HIV. OBJECTIVES This randomized non-inferiority open-label controlled trial was designed to compare the 48-week efficacy and safety of tenofovir alafenamide plus dolutegravir versus the standard triple therapy in virologically suppressed people living with HIV. To the best of our knowledge this combination has not been studied before. METHODS This open-label randomized controlled trial was conducted in treatment-experienced people with HIV who had HIV-RNA < 47 copies/mL for at least two years. Patients received either tenofovir alafenamide plus dolutegravir combination (26 patients) or a standard three-drug regimen (29 patients). The primary outcome was the proportion of patients maintaining HIV-RNA < 47 copies/mL during 48 weeks, and the secondary outcomes were CD4 cell count changes, the adherence rate, and adverse drug reactions, all over 48 weeks of study. RESULTS HIV viral load remained undetectable (HIV-RNA < 47 copies/mL) during the 48 weeks of the study in both arms. The absolute CD4 cell count change was not significant between the two groups. The overall proportion of adverse effects in each group was comparable. The rate of adherence to treatment was acceptable in both groups, and no significant difference was observed. CONCLUSIONS Treatment simplification with tenofovir alafenamide plus dolutegravir regimen as maintenance therapy was non-inferior in terms of efficacy and safety compared to the standard triple therapy. Comparing efficacy of antiretroviral therapy.
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Affiliation(s)
- Golbarg Alavian
- Department of Clinical Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Ladan Abbasian
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran.
- Department of Infectious & Tropical Diseases, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Keshavarz Blvd, Tehran, Iran.
| | - Hossein Khalili
- Department of Clinical Pharmacy (Pharmacotherapy), Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Ahmad Seyed Alinaghi
- Iranian Research Center for HIV/AIDS (IRCHA), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Malihe Hasannezhad
- Department of Infectious Diseases, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoumeh Farrokh Ashtiani
- Department of Infectious Diseases, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Ali Dehghan Manshadi
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
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5
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Armenia D, Gagliardini R, Alteri C, Svicher V, Cento V, Borghi V, Vergori A, Cicalini S, Forbici F, Fabeni L, Bertoli A, Brugneti M, Gennari W, Malagnino V, Andreoni M, Mussini C, Antinori A, Perno CF, Santoro MM, Ceccherini-Silberstein F. Temporal trend of drug-resistance and APOBEC editing in PBMC genotypic resistance tests from HIV-1 infected virologically suppressed individuals. J Clin Virol 2023; 168:105551. [PMID: 37573167 DOI: 10.1016/j.jcv.2023.105551] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND We aimed at evaluating the temporal trend of drug-resistance and APOBEC editing from HIV-DNA genotypic resistance tests (GRT) in virologically suppressed individuals. MATERIAL AND METHODS Major resistance mutations (MRM), genotypic susceptibility score (GSS) for the current regimen and APOBEC-related mutations (APO-M) were evaluated. Potential changes in trends of MRM and APO-M over-time were assessed and predictors of MRM detection or sub-optimal GSS (GSS<2) at HIV-DNA-GRT were estimated through logistic regression analyses. RESULTS Among the 1126 individuals included, 396 (35.2%) harboured at least one MRM (23.4% to NRTI, 18.8% to NNRTI, 7.7% to PI and 1.4% to INSTI [N=724]); 132 (12.3%) individuals showed a GSS <2. APO-M and stop codons were found in 229 (20.3%) and 105 (9.3%) individuals, respectively. APO-DRMs were found in 16.8% of individuals and were more likely observed in those individuals with stop codons (40.0%) compared to those without (14.4%, P<0.001). From 2010 to 2021 no significant changes of resistance or APO-M were found. Positive predictors of MRM detection at HIV-DNA GRT were drug abuse, subtype B infection, and a prolonged and complex treatment history. Perinatal infection and having at least 2 stop codons were associated with a current suboptimal regimen. CONCLUSIONS In virologically suppressed individuals, resistance in HIV-DNA and the extent of APOBEC editing were generally stable in the last decade. A careful evaluation of APOBEC editing might be helpful to improve the reliability of HIV-DNA GRT. Further investigations are required to understand how to apply the estimation of APOBEC editing in refining genotypic evaluation.
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Affiliation(s)
- D Armenia
- UniCamillus, Saint Camillus International University of Health Sciences, Rome, Italy
| | - R Gagliardini
- National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - C Alteri
- University of Milan, Milan, Italy
| | - V Svicher
- Department of Experimental Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133, Rome, Italy
| | - V Cento
- Humanitas Research Hospital, IRCCS, Milan, Italy
| | - V Borghi
- University of Modena and Reggio Emilia, Modena, Italy
| | - A Vergori
- National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - S Cicalini
- National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - F Forbici
- National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - L Fabeni
- National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - A Bertoli
- Department of Experimental Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133, Rome, Italy; Polyclinic of Rome "Tor Vergata", Rome, Italy
| | - M Brugneti
- Polyclinic of Rome "Tor Vergata", Rome, Italy
| | - W Gennari
- University of Modena and Reggio Emilia, Modena, Italy
| | - V Malagnino
- Polyclinic of Rome "Tor Vergata", Rome, Italy
| | - M Andreoni
- Polyclinic of Rome "Tor Vergata", Rome, Italy
| | - C Mussini
- University of Modena and Reggio Emilia, Modena, Italy
| | - A Antinori
- National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - C F Perno
- Bambino Gesù Children's Hospital, Rome, Italy
| | - M M Santoro
- Department of Experimental Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133, Rome, Italy.
| | - F Ceccherini-Silberstein
- Department of Experimental Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133, Rome, Italy
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6
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Goebel MC, Guajardo E, Giordano TP, Patel SM. The New Era of Long-Acting Antiretroviral Therapy: When and Why to Make the Switch. Curr HIV/AIDS Rep 2023; 20:271-285. [PMID: 37733184 DOI: 10.1007/s11904-023-00665-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2023] [Indexed: 09/22/2023]
Abstract
PURPOSE OF REVIEW Despite the availability of safe and effective oral combination antiretroviral therapy, barriers to maintaining viral suppression remain a challenge to ending the HIV epidemic. Long-acting injectable antiretroviral therapy was developed as an alternative to daily oral therapy. This review summarizes the current literature on the efficacy of long-acting cabotegravir plus rilpivirine for the treatment of HIV-1, reasons to switch to injectable therapy, and barriers to switching. RECENT FINDINGS Long-acting cabotegravir plus rilpivirine is safe and effective in maintaining HIV-1 virologic suppression. Ideal candidates for switching to long-acting cabotegravir plus rilpivirine are virologically suppressed on oral regimens with good adherence and no history of virologic failure or baseline resistance. Indications to switch to injectable therapy include patient preference, the potential for improved adherence, and avoidance of adverse effects. Implementation research is needed to assess and overcome system barriers. Long-acting cabotegravir plus rilpivirine is a novel alternative to oral antiretrovirals, with the potential to improve adherence and quality of life in people with HIV.
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Affiliation(s)
- Melanie C Goebel
- Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine Houston, Houston, TX, USA.
| | - Emmanuel Guajardo
- Section of Infectious Diseases, Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA
- Southeast Louisiana Veterans Health Care System (SLVHCS), New Orleans, LA, USA
| | - Thomas P Giordano
- Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine Houston, Houston, TX, USA
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center Houston, TX, USA
| | - Shital M Patel
- Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine Houston, Houston, TX, USA
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7
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Rich SN, Nasta P, Quiros-Roldan E, Fusco P, Tondinelli A, Costa C, Fornabaio C, Mazzini N, Prosperi M, Torti C, Carosi G. Convenience, efficacy, safety, and durability of INSTI-based antiretroviral therapies: evidence from the Italian MaSTER cohort. Eur J Med Res 2023; 28:292. [PMID: 37596688 PMCID: PMC10436514 DOI: 10.1186/s40001-023-01276-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 08/08/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND Integrase strand transferase inhibitors (INSTI), including raltegravir (RAL), elvitegravir (ELV), and dolutegravir (DTG), have demonstrated better efficacy and tolerability than other combination antiretroviral therapy (cART) classes in clinical trials; however, studies of sustainability of INSTI-containing therapy in the long-term are sparse. The purpose of this study was to provide an epidemiological overview comparing the outcome performance of different INSTI-based regimens longitudinally, including the metrics of efficacy, safety, convenience, and durability among a large, nationally representative cohort of persons living with HIV in Italy. METHODS We selected subjects in the MaSTER cohort (an Italian multicenter, hospital-based cohort established in the mid-1990s that currently has enrolled over 24,000 PLWH) who initiated an INSTI-based regimen either when naïve or following a regimen switch. Cox proportional hazards regression models were fitted to evaluate associations between therapy interruptions and age, sex, nationality, transmission risk group, viral suppression status, CD4 + T-cell count, diagnosis year, cART status (naïve or experienced), and hepatitis coinfection. Results were stratified by cART INSTI type. RESULTS There were 8173 participants who initiated an INSTI-based cART regimen in the MaSTER cohort between 2009 and 2017. The population was majority male (72.6%), of Italian nationality (88.6%), and cART-experienced (83.0%). Mean age was 49.7 (standard deviation: 13.9) years. In total, interruptions of the 1st INSTI-based treatment were recorded in 34% of cases. The most frequently cited reason for interruption among all three drug types was safety problems. In the survival analysis, past history of cART use was associated with higher hazards of interruption due to poor efficacy for all three drug types when compared to persons who were cART naïve. Non-viral suppression and CD4 + T-cell count < 200/mm3 at baseline were associated with higher hazards of interruption due to efficacy, safety, and durability reasons. Non-Italian nationality was linked to higher hazards of efficacy interruption for RAL and EVG. Age was negatively associated with interruption due to convenience and positively associated with interruption due to safety reasons. People who injects drugs (PWID) were associated with higher hazards of interruption due to convenience problems. Hepatitis coinfection was linked to higher hazards of interruption due to safety concerns for people receiving RAL. CONCLUSION One-third of the population experienced an interruption of any drugs included in INSTI therapy in this study. The most frequent reason for interruption was safety concerns which accounted for one-fifth of interruptions among the full study population, mainly switched to DTG. The hazard for interruption was higher for low baseline CD4 + T-cell counts, higher baseline HIV-RNA, non-Italian nationality, older age, PWID and possible co-infections with hepatitis viruses. The risk ratio was higher for past history of cART use compared to persons who were cART naive, use of regimens containing 3 drugs compared to regimens containing 2 drugs. Durability worked in favor of DTG which appeared to perform better in this cohort compared to RAL and EVG, though length of follow-up was significantly shorter for DTG. These observational results need to be confirmed in further perspective studies with longer follow-up.
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Affiliation(s)
- Shannan N Rich
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
| | - Paola Nasta
- University Division of Infectious and Tropical Diseases, University of Brescia and Brescia ASST Spedali Civili Hospital, Brescia, Italy
| | - Eugenia Quiros-Roldan
- University Division of Infectious and Tropical Diseases, University of Brescia and Brescia ASST Spedali Civili Hospital, Brescia, Italy
| | - Paolo Fusco
- Unit of Infectious and Tropical Diseases, Department of Medical and Surgical Sciences, ''Magna Graecia'' University, Catanzaro, Italy
| | - Alice Tondinelli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Cecilia Costa
- Infectious Diseases Unit, S. Maria Annunziata Hospital, Florence, Italy
| | | | | | - Mattia Prosperi
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
| | - Carlo Torti
- Unit of Infectious and Tropical Diseases, Department of Medical and Surgical Sciences, ''Magna Graecia'' University, Catanzaro, Italy.
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8
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Armenia D, Forbici F, Bertoli A, Berno G, Malagnino V, Gagliardini R, Borghi V, Gennari W, Cicalini S, Buonomini A, Teti E, Lanini S, Latini A, Sarmati L, Mussini C, Andreoni M, Antinori A, Perno C, Ceccherini-Silberstein F, Santoro M. Bictegravir/emtricitabine/tenofovir alafenamide ensures high rates of virological suppression maintenance despite previous resistance in PLWH who optimize treatment in clinical practice. J Glob Antimicrob Resist 2022; 30:326-334. [DOI: 10.1016/j.jgar.2022.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/12/2022] [Accepted: 06/25/2022] [Indexed: 11/16/2022] Open
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9
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Rojas J, de Lazzari E, Negredo E, Domingo P, Tiraboschi J, Ribera E, Abdulghani N, Puig J, Mateo MG, Podzamczer D, Gutierrez MM, Paredes R, Clotet B, Gatell JM, Blanco JL, Martínez E. Efficacy and safety of switching to dolutegravir plus lamivudine versus continuing triple antiretroviral therapy in virologically suppressed adults with HIV at 48 weeks (DOLAM): a randomised non-inferiority trial. Lancet HIV 2021; 8:e463-e473. [PMID: 34358497 DOI: 10.1016/s2352-3018(21)00100-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 04/25/2021] [Accepted: 04/28/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Simplified antiretroviral therapy (ART) regimens are desirable for people with HIV. We investigated the efficacy and safety of switching from triple ART to dual dolutegravir plus lamivudine therapy. METHODS DOLAM is a phase 4, randomised, open-label, non-inferiority trial, done at six HIV clinics in Catalonia, Spain. Adults with HIV-1 receiving a triple ART regimen, aged 18 years or older, with virological suppression, a CD4 nadir of at least 200 cells per μL, who were HBsAg-negative, and without previous viral failure or resistance mutations to study drugs were eligible. Participants underwent computer-generated randomisation, stratified by the class of the third drug, and were assigned (1:1) to switch to oral dolutegravir 50 mg and lamivudine 300 mg once daily or to continue triple ART for 48 weeks. The primary endpoint was the proportion of people with an HIV RNA value of at least 50 copies per mL at week 48 (US Food and Drug Administration snapshot algorithm, 8% non-inferiority margin). Both the primary and safety outcomes were evaluated in the intention-to-treat exposed population. The study is completed and was registered with EudraCT 201500027435. FINDINGS Between July 7, 2015, and Oct 31, 2018, 265 participants were randomly assigned to switch to dolutegravir plus lamivudine (n=131) or to maintain triple ART (n=134) and all received at least one dose. Nine (7%) participants in the dual therapy group and ten (7%) in the triple therapy group were excluded before 48 weeks, mostly due to treatment discontinuations or virological failure. Participants were predominantly male (116 [87%] of 134 in the triple ART group and 111 [85%] of 131 in the dolutegravir plus lamivudine group). The difference in the proportion of participants with HIV RNA values of at least 50 copies per mL at 48 weeks between the dual therapy group (three [2%] of 131) and triple therapy group (two [1%] of 134) was 0·8 percentage points (95% CI -3·3 to 5·2), showing non-inferiority of dolutegravir plus lamivudine dual therapy compared with triple ART. 73 (56%) of 131 participants allocated to dual therapy had 150 adverse effects, compared with 78 (58%) of 134 participants allocated to triple therapy who also had 150 adverse events (p=0·68). Drug discontinuation due to adverse effects occurred in four people in the triple therapy group and three people in the dual therapy group. INTERPRETATION Our findings show the efficacy and safety of dolutegravir plus lamivudine as a simplified therapy switch option for selected people with HIV with virological suppression on triple ART. FUNDING Instituto de Salud Carlos III, Red de Investigación en Sida, and ViiV Healthcare.
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Affiliation(s)
| | | | - Eugenia Negredo
- Hospital Germans Trias i Pujol, Badalona, Spain; Lluita Contra La Sida Foundation, Badalona, Spain; Universitat de Vic-Universitat Central de Catalunya, Barcelona, Spain
| | | | | | | | | | - Jordi Puig
- Hospital Germans Trias i Pujol, Badalona, Spain; Lluita Contra La Sida Foundation, Badalona, Spain
| | | | | | | | - Roger Paredes
- Hospital Germans Trias i Pujol, Badalona, Spain; Lluita Contra La Sida Foundation, Badalona, Spain; Universitat de Vic-Universitat Central de Catalunya, Barcelona, Spain; IrsiCaixa AIDS Research Institute, Badalona, Spain
| | - Bonaventura Clotet
- Hospital Germans Trias i Pujol, Badalona, Spain; Lluita Contra La Sida Foundation, Badalona, Spain; Universitat de Vic-Universitat Central de Catalunya, Barcelona, Spain; IrsiCaixa AIDS Research Institute, Badalona, Spain
| | - Jose M Gatell
- University of Barcelona, Barcelona, Spain; ViiV Healthcare, Brentford, UK
| | - Jose L Blanco
- Hospital Clínic-IDIBAPS, Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - Esteban Martínez
- Hospital Clínic-IDIBAPS, Barcelona, Spain; University of Barcelona, Barcelona, Spain.
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10
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Schafer JJ, Pandit NS, Cha A, Huesgen E, Badowski M, Sherman EM, Cocohoba J, Shimada A, Keith SW. Incidence and Severity of Drug Interactions Before and After Switching Antiretroviral Therapy to Bictegravir/Emtricitabine/Tenofovir Alafenamide in Treatment-Experienced Patients. Open Forum Infect Dis 2020; 8:ofaa625. [PMID: 33511239 PMCID: PMC7813207 DOI: 10.1093/ofid/ofaa625] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 12/15/2020] [Indexed: 12/13/2022] Open
Abstract
Background Switching antiretroviral therapy (ART) in people with HIV (PWH) can influence their risk for drug–drug interactions (DDIs). The purpose of this study was to assess changes in the incidence and severity of DDIs among PWH who switched their ART to bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF). Methods This was a multicenter retrospective cohort study of PWH on ART and at least 1 concomitant medication (CM) who switched to BIC/FTC/TAF between 3/2018 and 6/2019. Using the University of Liverpool’s HIV Drug Interaction Database, 2 DDI analyses were performed for each patient. The first assessed patients’ preswitch ART regimens with their CM list. The second assessed the same CM list with BIC/FTC/TAF. Each ART-CM combination was given a score of 0 (no or potential weak interaction), 1 (potential interaction), or 2 (contraindicated interaction). A paired t test analyzed changes in total DDI scores following ART switches, and linear regression examined factors contributing to DDI score reductions. Results Among 411 patients, 236 (57%) had at least 1 DDI present at baseline. On average, baseline DDI scores (SD) were 1.4 (1.8) and decreased by 1 point (95% CI, –1.1 to –0.8) after patients switched to BIC/FTC/TAF (P < .0001). After adjusting for demographics, baseline ART, and CM categories, switching to BIC/FTC/TAF led to significant DDI score reductions in patients receiving CMs for cardiovascular disease, neurologic/psychiatric disorders, chronic pain, inflammation, gastrointestinal/urologic conditions, and conditions requiring hormonal therapy. Conclusions Treatment-experienced PWH eligible to switch their ART may experience significant declines in number and severity of DDIs if switched to BIC/FTC/TAF.
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Affiliation(s)
- Jason J Schafer
- Department of Pharmacy Practice, Jefferson College of Pharmacy, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Neha S Pandit
- Department of Pharmacy Practice and Science, University of Maryland Baltimore School of Pharmacy, Baltimore, Maryland, USA
| | - Agnes Cha
- Brooklyn Hospital Center, Brooklyn, New York, USA
| | - Emily Huesgen
- Department of Pharmacy Practice, Indiana University Health, Indianapolis, Indianapolis, USA
| | - Melissa Badowski
- Section of Infectious Diseases Pharmacotherapy, Department of Pharmacy Practice, University of Illinois at Chicago, College of Pharmacy, Chicago, Illinois, USA
| | - Elizabeth M Sherman
- Department of Pharmacy Practice, College of Pharmacy, Nova Southeastern University, Fort Lauderdale, Florida, USA.,Division of Infectious Diseases, Memorial Healthcare System, Hollywood, Florida, USA
| | - Jennifer Cocohoba
- Department of Clinical Pharmacy, University of California San Francisco School of Pharmacy, San Francisco, California, USA
| | - Ayako Shimada
- Division of Biostatistics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Scott W Keith
- Division of Biostatistics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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