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Villabona-Arenas CJ, Eymard-Duvernay S, Aghokeng A, Guichet E, Toure-Kane C, Bado G, Koulla-Shiro S, Delaporte E, Ciaffi L, Peeters M. Short Communication: Nucleoside Reverse Transcriptase Inhibitors with Reduced Predicted Activity Do Not Impair Second-Line Therapy with Lopinavir/Ritonavir or Darunavir/Ritonavir. AIDS Res Hum Retroviruses 2018; 34:477-480. [PMID: 29575909 DOI: 10.1089/aid.2017.0290] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Second-line therapy randomized trials with lopinavir/ritonavir question the value of resistance testing to guide nucleoside reverse transcriptase inhibitor (NRTI) selection. In this study, we investigated the association between baseline drug resistance and treatment outcome after 104 weeks of second-line therapy with NRTIs and either darunavir/ritonavir or lopinavir/ritonavir in West-central Africa. We did an observational analysis of data from 387 individuals in a randomized, open-label 2LADY trial in Burkina Faso, Cameroon, and Senegal. We modeled the association between RTI drug resistance mutations (DRMs) and virological failure (VF) (viral load [VL] <50 copies/mL) at week 104 using logistic regressions. Covariates included baseline VL and CD4+ count, demographic, and adherence data. Overall, 193 (49.9%), 150 (38.8%), and 44 (11.4%) individuals had, respectively, low/none (genotypic susceptibility score [GSS] <1), intermediate (GSS = 1), and high predicted NRTI activity (GSS >1) in their prescribed second-line regimen. The average number of DRMs by drug class, the proportion of individuals by GSS category, and the duration of first-line therapy were not associated with VF (p > .05). High VL at switch was the only consistent prognostic factor for VF after multivariate adjustment (p < .01). Suboptimal adherence, high predicted RTI activity, or low NRTI mutations were associated with VF (p < .05) when using higher end points for VF or in the intention-to-treat analysis. In conclusion, the use of RTIs with predicted reduced activity does not impair second-line protease inhibitor-based therapy. Therefore, HIV care in resource-limited settings should prioritize strategies to improve adherence and targeted VL testing over drug resistance testing for selecting NRTIs during a protease-based second-line switch.
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Affiliation(s)
- Christian Julian Villabona-Arenas
- Unité mixte Internationale Recherches Translationnelles sur le VIH et les Maladies Infectieuses (TransVIH-MI, UMI 233 IRD/U1175 Inserm), Institut de Recherche pour le Développement (IRD), Université de Montpellier, Montpellier, France
- Laboratoire d'Informatique, de Robotique et de Microélectronique de Montpellier (LIRMM), Institut de Biologie Computationnelle (IBC), Université de Montpellier, Montpellier, France
| | - Sabrina Eymard-Duvernay
- Unité mixte Internationale Recherches Translationnelles sur le VIH et les Maladies Infectieuses (TransVIH-MI, UMI 233 IRD/U1175 Inserm), Institut de Recherche pour le Développement (IRD), Université de Montpellier, Montpellier, France
| | - Avelin Aghokeng
- Unité mixte Internationale Recherches Translationnelles sur le VIH et les Maladies Infectieuses (TransVIH-MI, UMI 233 IRD/U1175 Inserm), Institut de Recherche pour le Développement (IRD), Université de Montpellier, Montpellier, France
- Centre de Recherche sur les Maladies Emergentes er Réemergentes (CREMER), IMPM-IRD, Yaoundé, Cameroon
| | - Emilande Guichet
- Unité mixte Internationale Recherches Translationnelles sur le VIH et les Maladies Infectieuses (TransVIH-MI, UMI 233 IRD/U1175 Inserm), Institut de Recherche pour le Développement (IRD), Université de Montpellier, Montpellier, France
| | - Coumba Toure-Kane
- Laboratoire de Virologie, Université Cheikh Anta Diop, Dakar, Senegal
| | - Guillaume Bado
- Day Care Unit, Hôpital Souro Sanou, Bobo-Dioulasso, Burkina-Faso
| | - Sinata Koulla-Shiro
- Faculté de Médecine et des Sciences Biomédicales, Université de Yaoundé, Yaoundé, Cameroon
| | - Eric Delaporte
- Unité mixte Internationale Recherches Translationnelles sur le VIH et les Maladies Infectieuses (TransVIH-MI, UMI 233 IRD/U1175 Inserm), Institut de Recherche pour le Développement (IRD), Université de Montpellier, Montpellier, France
| | - Laura Ciaffi
- Unité mixte Internationale Recherches Translationnelles sur le VIH et les Maladies Infectieuses (TransVIH-MI, UMI 233 IRD/U1175 Inserm), Institut de Recherche pour le Développement (IRD), Université de Montpellier, Montpellier, France
| | - Martine Peeters
- Unité mixte Internationale Recherches Translationnelles sur le VIH et les Maladies Infectieuses (TransVIH-MI, UMI 233 IRD/U1175 Inserm), Institut de Recherche pour le Développement (IRD), Université de Montpellier, Montpellier, France
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Sörstedt E, Carlander C, Flamholc L, Hejdeman B, Svedhem V, Sönnerborg A, Gisslén M, Yilmaz A. Effect of dolutegravir in combination with Nucleoside Reverse Transcriptase Inhibitors (NRTIs) on people living with HIV who have pre-existing NRTI mutations. Int J Antimicrob Agents 2018; 51:733-738. [PMID: 29371105 DOI: 10.1016/j.ijantimicag.2018.01.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 12/19/2017] [Accepted: 01/13/2018] [Indexed: 11/25/2022]
Abstract
Until the introduction of dolutegravir (DTG), people living with HIV (PLWH) who have developed nucleoside reverse transcriptase inhibitor (NRTI) mutations have had few other treatment options outside of regimens based on ritonavir-boosted protease inhibitors (PI/r). Here we report treatment results among PLWH in Sweden with pre-existing NRTI mutations on antiretroviral treatment (ART) with DTG and one to two NRTIs. All PLWH on ART with DTG and one to two NRTIs with pre-existing NRTI mutations were retrospectively identified from the National InfCare HIV database. As controls, PLWH on PI/r and one to two NRTIs, matched according to Genotypic Susceptibility Score and observation time, were included. Data were collected as long as the study population was on treatment with DTG; controls were monitored for the same interval. Outcome was classified as either treatment success or failure. In total, 244 participants (122 individuals treated with DTG and 122 individuals treated with PI/r) were included. Median observation time was 78 weeks (interquartile range 50-98 weeks) for participants on DTG and 75 weeks (50-101 weeks) for individuals on PI/r. Viral failure was detected in four individuals treated with DTG and three individuals treated with PI/r, resulting in similar success rates of 96.7% and 97.5%, respectively. No new mutations were found among participants with treatment failure. DTG in combination with one to two NRTIs was as efficient as PI/r in individuals with pre-existing NRTI mutations in this setting. It may be considered an alternative to PI/r-based ART even in the presence of NRTI resistance.
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Affiliation(s)
- Erik Sörstedt
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, 413 90 Gothenburg, Sweden.
| | - Christina Carlander
- Department of Infectious Diseases, Hospital of Västmanland Västerås, 721 89 Västerås, Sweden
| | - Leo Flamholc
- Department of Infectious Diseases, Malmö University Hospital, 205 02 Malmö, Sweden
| | - Bo Hejdeman
- Department of Clinical Science and Education, Sodersjukhuset, Karolinska Institute, 141 86 Stockholm, Sweden; Unit of Infectious Diseases/Venhälsan, Södersjukhuset, SE-118 83 Stockholm, Sweden
| | - Veronica Svedhem
- Department of Infectious Diseases, Karolinska Institute, Karolinska University Hospital, 141 86 Stockholm, Sweden
| | - Anders Sönnerborg
- Department of Infectious Diseases, Karolinska Institute, Karolinska University Hospital, 141 86 Stockholm, Sweden; Department of Clinical Microbiology, Karolinska Institute, Karolinska University Hospital, 141 86 Stockholm, Sweden
| | - Magnus Gisslén
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, 413 90 Gothenburg, Sweden
| | - Aylin Yilmaz
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, 413 90 Gothenburg, Sweden
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