Real-life data of immune recovery using bictegravir/emtricitabine/tenofovir alafenamide in virologically suppressed people living with HIV. Results at 48-96 weeks of RETROBIC Study

Neuropsychiatric adverse events in people with HIV initiating a new integrase strand transfer inhibitor-based regimen in Italy: findings from the NEURO-INSTI study

BACKGROUND

Although clinical trials reported a low and comparable rate of central nervous system (CNS)/neuropsychiatric (NP) disturbances among people with HIV (PWH) receiving integrase strand transfer inhibitors (INSTI) or other antiretroviral therapy (ART), higher rates of these disturbances have been reported in clinical practice. Our aim was to compare the occurrence of CNS-NP disorders in the different INSTI drugs.

METHODS

Using data from the SCOLTA project, a multicenter observational study following PWH who start antiretrovirals to identify adverse events (AEs) in real-life, we performed a retrospective analysis (NEURO-INSTI) to assess incidence rates (IRs) and 95% confidence intervals (95% CI) of CNS/NP AEs and related interruptions. Observation was truncated at the first occurrence of any CNS/NP AEs, even if not causing treatment discontinuation. IRs were calculated as number of first occurrences/100 person-years follow-up (PYFU). To identify risk factors for CNS/NP AEs occurrence, a Cox regression analysis for competing risks was used (hazard ratio, HR, and 95% CI), including variables associated with the outcome at a p level < 0.20 in the univariate analysis.

RESULTS

We analyzed a sample of 2,922 PWH (mean age 47.2 years, 74.7% males) enrolled in raltegravir (RAL), dolutegravir (DTG), elvitegravir (EVG), and bictegravir (BIC) INSTI-cohorts since 2007. Over a median observation time of 28 months (interquartile range 14-45), 126 CNS/NP AEs and 72 related discontinuations occurred; IRs were 1.59/100 PYFU (95% CI, 1.34-1.90) and 0.91/100 PYFU (95% CI 0.72-1.15), respectively. In multivariate models, intravenous drug use history (IVDUh), current abacavir use, RAL use, and psychiatric illnesses were associated with a higher risk of CNS/NP AEs. IVDUh and current abacavir use were also associated with treatment discontinuation. Using an INSTI as a first-line therapy and starting with CD4 ≥ 350 cell/µL also increased the likelihood of discontinuation. Compared to DTG, BIC and EVG showed lower risks of CNS/NP AEs (adjusted HR 0.27, 95% CI 0.10-0.74, and 0.51, 95% CI 0.22-1.20, respectively), while RAL showed a higher risk (aHR 2.52, 95% CI 1.57-4.05).

CONCLUSIONS

Among PWH on INSTI treatment, IVDUh, concurrent psychiatric illness, abacavir and RAL use increased the risk of CNS/NP AEs occurrence. PWH on BIC were less likely to experience CNS/NP AEs and related treatment discontinuations.

Effectiveness, safety and discontinuation rates of bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) in people with HIV using real-world data: a systematic review and meta-analysis

BACKGROUND

The use of bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) is based on the results of robust clinical trials.

OBJECTIVES

To assess the effectiveness and safety of BIC/FTC/TAF in treatment-naïve (TN) and treatment-experienced (TE) people with HIV using available real-world cohort studies.

METHODS

Systematic review and meta-analysis of publications and communications identified via Boolean search in Medline, PubMed and Embase, and conference abstracts reporting retrospective real-world use of BIC/FTC/TAF, published until 31 January 2024. The primary endpoint was the proportion of TN and TE people with HIV with viral load (VL) < 50 copies/mL at 48 weeks while on treatment.

RESULTS

Of the 38 identified publications and conference abstracts, for the present analysis we included 12 publications (comprising 792 TN and 6732 TE individuals). For the three publications including 507 TN participants reporting the primary outcome, VL suppression was 97% [95% confidence intervals (CI): 89-100]. For the nine publications including 4946 TE participants reporting the primary outcome, VL suppression was 95% (95% CI: 94-96), with suppression >93% in all studies. Total discontinuations at 48 weeks in TE individuals were 3% (95% CI: 2-5), 1% (95% CI: 0-2) due to side effects. A total of four publications with 151 TE individuals with previous presence of M184V substitution were identified, reporting a suppression rate at 48 weeks of 95% (95% CI: 88-100).

CONCLUSIONS

Real-world studies demonstrate low discontinuation rates and high rates of virologic suppression in individuals treated with BIC/FTC/TAF, both TN and TE with and without previous detection of M184V substitution.

Comparative Effectiveness of Switching to Bictegravir From Dolutegravir-, Efavirenz-, or Raltegravir-Based Antiretroviral Therapy Among Individuals With HIV Who are Virologically Suppressed

Background

We aimed to determine the effectiveness of switching to bictegravir in maintaining an undetectable viral load (<50 copies/mL) among people with HIV (PWH) as compared with continuing dolutegravir-, efavirenz-, or raltegravir-based antiretroviral therapy using nationwide observational data from Mexico.

Methods

We emulated 3 target trials comparing switching to bictegravir vs continuing with dolutegravir, efavirenz, or raltegravir. Eligibility criteria were PWH aged ≥16 years with a viral load <50 copies/mL and at least 3 months of current antiretroviral therapy (dolutegravir, efavirenz, or raltegravir) between July 2019 and September 2021. Weekly target trials were emulated during the study period, and individuals were included in every emulation if they continued to be eligible. The main outcome was the probability of an undetectable viral load at 3 months, which was estimated via an adjusted logistic regression model. Estimated probabilities were compared via differences, and 95% CIs were calculated via bootstrap. Outcomes were also ascertained at 12 months, and sensitivity analyses were performed to test our analytic choices.

Results

We analyzed data from 3 028 619 PWH (63 581 unique individuals). The probability of an undetectable viral load at 3 months was 2.9% (95% CI, 1.9%-3.8%), 1.3% (95% CI, .9%-1.6%), and 1.2% (95% CI, .8%-1.7%) higher when switching to bictegravir vs continuing with dolutegravir, efavirenz, and raltegravir, respectively. Similar results were observed at 12 months and in other sensitivity analyses.

Conclusions

Our findings suggest that switching to bictegravir could be more effective in maintaining viral suppression than continuing with dolutegravir, efavirenz, or raltegravir.