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Katlama C, Bisshop F, Bogner J, Pérez Elías MJ, Di Giambenedetto S, Clarke E, Hodder S, Nwokolo N, Ait-Khaled M, Oyee J, Grove R, Wynne B, Okoli C, Jones B, Kisare M. Efficacy and safety of dolutegravir/lamivudine in virologically suppressed female participants: week 48 data from the pooled TANGO and SALSA studies. HIV Med 2024; 25:873-884. [PMID: 38760011 DOI: 10.1111/hiv.13643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 03/24/2024] [Indexed: 05/19/2024]
Abstract
OBJECTIVES Women represent >50% of people with HIV globally but have historically been underrepresented in clinical trials. We evaluated the efficacy and safety of switching to dolutegravir/lamivudine (DTG/3TC) vs continuing their current antiretroviral regimen (CAR) by sex assigned at birth (female and male) in virologically suppressed adults with HIV-1 without prior virological failure in a pooled analysis of two randomized controlled trials. METHODS This analysis included 48-week data from the phase 3 TANGO and SALSA studies. Primary and key secondary endpoints included proportions of participants with HIV-1 RNA ≥50 and <50 copies/mL at week 48, respectively. Safety was also assessed. RESULTS Of 1234 participants, 250 (DTG/3TC, n = 133; CAR, n = 117) were female at birth. Week 48 proportions of participants with Snapshot HIV-1 RNA ≥50 copies/mL were similar regardless of sex at birth (DTG/3TC vs CAR: female, <1% [1/133] vs 2% [2/117]; male, <1% [1/482] vs <1% [3/502]). Proportions with HIV-1 RNA <50 copies/mL were high across sexes and treatment groups (DTG/3TC vs CAR: female, 91% [121/133] vs 89% [104/117]; male, 94% [455/482] vs 94% [471/502]). Immunological response with DTG/3TC was slightly higher in female participants. Incidences of adverse events leading to withdrawal and serious adverse events were low and comparable between treatment groups and across sexes. Weight gain was higher with DTG/3TC than with CAR among female participants aged ≥50 years (treatment difference 2.08 kg [95% confidence interval 0.40-3.75]). CONCLUSIONS Results confirm the robustness of DTG/3TC as a switch option in virologically suppressed females with HIV-1, with outcomes similar to those in males.
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Affiliation(s)
- C Katlama
- AP-HP, Hôpital Pitié-Salpêtrière, Service de Maladies Infectieuses et Tropicales, INSERM-Sorbonne Universités, Paris, France
| | - F Bisshop
- Holdsworth House Medical Brisbane, Fortitude Valley, Queensland, Australia
| | - J Bogner
- Department of Medicine IV, LMU University Hospital, LMU Munich, Munich, Germany
| | | | - S Di Giambenedetto
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Università Cattolica del Sacro Cuore, Rome, Italy
| | - E Clarke
- Axess Sexual Health, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - S Hodder
- West Virginia Clinical and Translational Science Institute, Morgantown, West Virginia, USA
| | | | | | | | | | - B Wynne
- ViiV Healthcare, Durham, North Carolina, USA
| | - C Okoli
- ViiV Healthcare, Brentford, UK
| | - B Jones
- ViiV Healthcare, Brentford, UK
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Lindh M, Brännström J, Reepalu A, Svedhem V, Mellgren Å. Factors associated with sex differences in viral non-suppression in the Swedish InfCareHIV cohort: An observational real-world study. HIV Med 2024; 25:540-553. [PMID: 38196293 DOI: 10.1111/hiv.13607] [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: 09/15/2023] [Accepted: 12/16/2023] [Indexed: 01/11/2024]
Abstract
OBJECTIVES Women living with HIV are underrepresented in clinical trials assessing outcomes of antiretroviral treatment (ART), justifying the need for observational studies. We investigated differences in viral non-suppression between women and men in the Swedish InfCareHIV cohort and analysed results in relation to biological and socio-demographic variables and patient-reported outcome measures (PROMs). METHODS The study included people living with HIV (PLWH) aged ≥18 years, who initiated ART at least 6 months prior to inclusion. Data from the InfCareHIV registry 2011-2018 were collected. Associations between variables and HIV RNA ≥50 copies/mL were investigated in uni- and multivariable analyses using generalized estimating equations, providing relative risks (RRs) as effect size. RESULTS The study included 38% (n = 2981) women. Women were more likely to have HIV RNA ≥50 copies/mL than were men [RR = 1.20, 95% confidence interval (CI): 1.10-1.31]. After adjusting for origin and route of transmission, sex at birth was no longer associated with viral non-suppression. PROMs were available in 52.4% of PLWH, and items associated with viral non-suppression were impaired adherence in women (RR = 2.38, 95% CI: 1.79-3.17) and men (RR 1.84, 95% CI: 1.40-2.42), and experience of side effects in women (RR = 1.49, 95% CI: 1.10-2.02). CONCLUSIONS This observational study found a 20% higher relative risk of viral non-suppression in women than in men and the difference was associated with socio-demographic factors. The associations between PROMs and viral non-suppression varied between women and men. PROMs are important health outcomes that may identify PLWH in need of support to achieve viral non-suppression.
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Affiliation(s)
- Maria Lindh
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Södra Älvsborg Hospital, Department of Research, Education and Innovation, Borås, Sweden
- Department of Infectious Diseases, Södra Älvsborg Hospital, Borås, Sweden
| | - Johanna Brännström
- Division of Infection and Dermatology, Department of Medicine Huddinge, Karolinska Institute, Stockholm, Sweden
- Department of Infectious Diseases/Venhälsan, South Hospital, Stockholm, Sweden
| | - Anton Reepalu
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Lund, Sweden
- Department of Infectious Diseases, Skåne University Hospital, Malmö, Sweden
| | - Veronica Svedhem
- Division of Infection and Dermatology, Department of Medicine Huddinge, Karolinska Institute, Stockholm, Sweden
- Department of Infectious Diseases, Karolinska University Hospital, Huddinge, Sweden
| | - Åsa Mellgren
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Infectious Diseases, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
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Pierone Jr G, Brunet L, Fusco JS, Henegar CE, Sarkar S, Van Wyk J, Vannappagari V, Wohlfeiler MB, Fusco GP. Switching to Dolutegravir/Lamivudine Two-Drug Regimen: Durability and Virologic Outcomes by Age, Sex, and Race in Routine US Clinical Care. HIV AIDS (Auckl) 2024; 16:133-140. [PMID: 38645753 PMCID: PMC11032131 DOI: 10.2147/hiv.s452130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/13/2024] [Indexed: 04/23/2024] Open
Abstract
Purpose Two-drug regimens (2DR) may address drug-drug interactions and toxicity concerns. Dolutegravir/lamivudine (DTG/3TC) 2DR was approved in the US for both treatment-naïve and treatment-experienced individuals with a viral load <50 copies/mL. This study describes real-world DTG/3TC 2DR treatment outcomes among treatment-experienced individuals, stratified by age, sex, and race. Methods From the OPERA® cohort, people with HIV with a viral load <50 copies/mL who switched from a commonly used three-drug regimen to DTG/3TC 2DR as per the label between April 8, 2019 and April 30, 2021 were included. Incidence rates (Poisson regression) for loss of virologic control (first viral load ≥50 copies/mL), confirmed virologic failure (2 viral loads ≥200 copies/mL or discontinuation after 1 viral load ≥200 copies/mL), and DTG/3TC 2DR discontinuation were estimated overall and stratified by age, sex, and race. Results The 787 individuals included were followed for a median of 13.6 months (IQR: 8.2, 22.3). Confirmed virologic failure occurred in ≤5 individuals. Loss of virologic control occurred at a rate of 14.0 per 100 person-years (95% CI: 11.7, 16.8). DTG/3TC 2DR discontinuation occurred at a rate of 17.5 per 100 person-years (95% CI: 15.0, 20.3); 4% discontinued for treatment-related reasons (viremia, adverse diagnosis, side effect, lab abnormality). For all outcomes, incidence rates were comparable across strata of age, sex, and race. Conclusion This descriptive study demonstrates that DTG/3TC 2DR is an effective and well-tolerated treatment option for people with HIV with a viral load <50 copies/mL at switch, regardless of their age, sex, or race.
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Affiliation(s)
- Gerald Pierone Jr
- Department of Adult Primary Care, Whole Family Health Center, Vero Beach, FL, USA
| | | | | | - Cassidy E Henegar
- Epidemiology and Real World Evidence, ViiV Healthcare, Research Triangle Park, NC, USA
| | - Supriya Sarkar
- Epidemiology and Real World Evidence, ViiV Healthcare, Research Triangle Park, NC, USA
| | | | - Vani Vannappagari
- Epidemiology and Real World Evidence, ViiV Healthcare, Research Triangle Park, NC, USA
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Ciccullo A, Baldin G, Sterrantino G, Madeddu G, D'ettorre G, Mussini C, Di Giambenedetto S. Comment on: Long-term outcome of dolutegravir-containing regimens according to sex: data from the ICONA study. J Antimicrob Chemother 2023:7176284. [PMID: 37220765 DOI: 10.1093/jac/dkad151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Affiliation(s)
- Arturo Ciccullo
- Infectious Diseases Unit, San Salvatore Hospital, via L. Natali 1, 67100, L'Aquila, Italy
| | - Gianmaria Baldin
- Infectious Diseases Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Gaetana Sterrantino
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Giordano Madeddu
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Gabriella D'ettorre
- Department of Public Health and Infectious Diseases, Azienda Policlinico Umberto I, Rome, Italy
| | - Cristina Mussini
- Infectious and Tropical Diseases Unit, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Simona Di Giambenedetto
- Infectious Diseases Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
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