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Januszka J, Drwiega E, Burgos R, Smith R, Badowski M. Real-world prevalence of integrase inhibitor resistance and virological failure since adoption as guideline-preferred therapy. Drugs Context 2024; 13:2023-12-4. [PMID: 38770371 PMCID: PMC11104290 DOI: 10.7573/dic.2023-12-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 04/04/2024] [Indexed: 05/22/2024] Open
Abstract
Background Limited data reporting real-world prevalence of integrase strand transfer inhibitor resistance (INSTI-R) in the USA are available because their recommendation as first-line treatment in 2017. Reported national surveillance data in the USA estimated INSTI-R to be 6.3% as of 2018. This article aims to describe estimated prevalence of INSTI-R within a single clinic network in Chicago, IL, USA, and identify risk factors for resistance and virological failure (VF). Methods This was a retrospective, single-centre study of adults with HIV starting an INSTI-containing regimen between September 2017 and 2020. The primary endpoint was the difference in INSTI-R of the sample population compared with the national prevalence. Other outcomes included VF and documented INSTI-R mutations. Results Of 948 participants screened, 321 were included. Eight people had baseline INSTI-R testing results available, of which five had INSTI-R at baseline for an estimated prevalence of 1.6%. This estimation was significantly less than the national estimated prevalence of 6.3% (p<0.001). VF occurred in 26 (7.8%) individuals. Because no participants acquired INSTI-R during the study period, investigators were unable to identify risk factors associated with the development of INSTI-R. People with high pre-treatment viral loads had 1.21 (95% CI 1.05-1.39) higher odds of VF. Conclusions Amongst participants on INSTI-containing regimens, INSTI-R rates were estimated to be lower than the estimated national prevalence. Detectable pre-switch viral loads were more associated with VF than undetectable viral loads.
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Affiliation(s)
- Jenna Januszka
- College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA
| | - Emily Drwiega
- College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA
| | - Rodrigo Burgos
- College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA
| | - Renata Smith
- College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA
| | - Melissa Badowski
- College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA
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2
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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3
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Wu X, Zhang L, Lu Z, Li Y, He Y, Zhao F, Peng Q, Zhou X, Wang H, Zou H. Longitudinal trajectories of weight changes among people living with HIV on antiretroviral therapy: A group-based study. iScience 2023; 26:108259. [PMID: 38026178 PMCID: PMC10665799 DOI: 10.1016/j.isci.2023.108259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/07/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Weight changes vary among people living with HIV (PLHIV) on different antiretroviral therapy (ART) regimens. Here, we performed multi-trajectory modeling fitting growth mixture models (GMM) to identify longitudinal weight change trajectories of PLHIV. Multiple logistic regression was used to assess correlates of rapid weight gains; 12,683 PLHIV (median age: 34 years [interquartile range 29-42], 91.1% male) who initiated ART at the Third People's Hospital of Shenzhen, China, between January 2003 and September 2022 were included. We identified two trajectories: slow (70.5%) and rapid weight gains (29.5%). PLHIV who initiated ART with dolutegravir- (adjusted odds ratio [aOR] 2.46, 1.92-3.15), raltegravir- (2.74, 1.96-3.82), and lopinavir (1.62, 1.36-1.94)-based regimens were more likely to have rapid weight gains compared with efavirenz-based regimen. The monitoring of nutritional status should be strengthened for PLHIV who initiated these regimens during regular ART follow-ups.
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Affiliation(s)
- Xinsheng Wu
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Lukun Zhang
- National Clinical Research Centre for Infectious Diseases, The Third People’s Hospital of Shenzhen and The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Zhen Lu
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Yuwei Li
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Yun He
- National Clinical Research Centre for Infectious Diseases, The Third People’s Hospital of Shenzhen and The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Fang Zhao
- National Clinical Research Centre for Infectious Diseases, The Third People’s Hospital of Shenzhen and The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Qiaoli Peng
- National Clinical Research Centre for Infectious Diseases, The Third People’s Hospital of Shenzhen and The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Xinyi Zhou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Hui Wang
- National Clinical Research Centre for Infectious Diseases, The Third People’s Hospital of Shenzhen and The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | - Huachun Zou
- School of Public Health, Fudan University, Shanghai, China
- School of Public Health, Southwest Medical University, Luzhou, China
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
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4
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Wu X, Wu G, Ma P, Wang R, Li L, Chen Y, Xu J, Li Y, Li Q, Yang Y, Wang L, Xin X, Qiao Y, Fu G, Huang X, Su B, Zhang T, Wang H, Zou H. Associations of modern initial antiretroviral therapy regimens with all-cause mortality in people living with HIV in resource-limited settings: a retrospective multicenter cohort study in China. Nat Commun 2023; 14:5334. [PMID: 37660054 PMCID: PMC10475132 DOI: 10.1038/s41467-023-41051-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/21/2023] [Indexed: 09/04/2023] Open
Abstract
Despite the proven virological advantages, there remains some controversy regarding whether first-line integrase strand transfer inhibitors (INSTIs)-based antiretroviral therapy (ART) contributes to reducing mortality of people living with HIV (PLHIV) in clinical practice. Here we report a retrospective study comparing all-cause mortality among PLHIV in China who were on different initial ART regimens (nevirapine, efavirenz, dolutegravir, lopinavir, and others [including darunavir, raltegravie, elvitegravir and rilpivirine]) between 2017 and 2019. A total of 41,018 individuals were included across China, representing 21.3% of newly reported HIV/AIDS cases collectively in the country during this period. Only the differences in all-cause mortality of PLHIV between the efavirenz group and the nevirapine group, the dolutegravir group and the nevirapine group, and the lopinavir group and the nevirapine group, were observed in China. After stratifying the cause of mortality, we found that the differences in mortality between initial ART regimens were mainly observed in AIDS-related mortality.
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Grants
- HZ is supported by the Shenzhen Science and Technology Innovation Commission Basic Research Program [JCYJ20190807155409373], the Natural Science Foundation of China Excellent Young Scientists Fund [82022064], Natural Science Foundation of China International/Regional Research Collaboration Project [72061137001], the Sanming Project of Medicine in Shenzhen [SZSM201811071], the High Level Project of Medicine in Longhua, Shenzhen [HLPM201907020105], Special Support Plan for High-Level Talents of Guangdong Province [2019TQ05Y230], the Fundamental Research Funds for the Central Universities [58000-31620005], Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences [2020-JKCS-030]. GW is supported by the Chongqing Talents Program for Innovative and Entrepreneurial Pioneers [cstc2021ycjh-bgzxm0097], the Chongqing Natural Science Foundation Project [cstc2021jcyj-msxmX1171], the Chinese State Key Laboratory of Infectious Disease Prevention and Control [2021SKLID303]. PM is supported by the Health Science and Technology Project of Tianjin Health Commission [ZC20037], the Tianjin Key Medical Discipline (Specialty) Construction Project [Infectious Diseases ZD02]. LL is supported by the National Key Research and Development Program of China [2022YFC2304800], the Science and Technology Project of Guangzhou [20220020285]. XH is supported by the Public Health Talent Grant by Beijing Municipal Health Commission [Global Health Governance-02-12; 2022-1-007], the Capital Health Development Research [2022-2-2185; 2022-1G-3011]. BS is supported by the High-Level Public Health Specialized Talents Project of Beijing Municipal Health Commission [2022-2-018], the National Key R&D Program of China [2021YFC2301900; 2021YFC2301905], the Beijing Key Laboratory for HIV/AIDS Research [BZ0089]. All funding parties did not have any role in the design of the study or in the explanation of the data.
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Affiliation(s)
- Xinsheng Wu
- Shenzhen Campus of Sun Yat-sen University, Shenzhen, PR China
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, PR China
| | - Guohui Wu
- Institute for AIDS/STD Control and Prevention, Chongqing Center for Disease Control and Prevention, Chongqing, PR China
| | - Ping Ma
- Department of Infectious Diseases, Tianjin Second People's Hospital, Tianjin, PR China
- Tianjin Association of STD/AIDS Prevention and Control, Tianjin, PR China
| | - Rugang Wang
- Dalian Public Health Clinical Center, Dalian, PR China
| | - Linghua Li
- Infectious Disease Center, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, PR China
| | - Yuanyi Chen
- Shenzhen Campus of Sun Yat-sen University, Shenzhen, PR China
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, PR China
| | - Junjie Xu
- Clinical Research Academy, Peking University Shenzhen Hospital, Peking University, Shenzhen, PR China
| | - Yuwei Li
- Shenzhen Campus of Sun Yat-sen University, Shenzhen, PR China
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, PR China
| | - Quanmin Li
- Infectious Disease Center, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, PR China
| | - Yuecheng Yang
- Dehong Prefecture Center for Disease Control and Prevention, Dehong, PR China
| | - Lijing Wang
- Shijiazhuang Fifth Hospital, Shijiazhuang, PR China
| | - Xiaoli Xin
- No.6 People's Hospital of Shenyang, Shenyang, PR China
| | - Ying Qiao
- No.2 Hospital of Hohhot, Hohhot, PR China
| | - Gengfeng Fu
- Department of STD/AIDS Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, PR China.
| | - Xiaojie Huang
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, PR China.
| | - Bin Su
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, PR China.
| | - Tong Zhang
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, PR China.
| | - Hui Wang
- National Clinical Research Centre for Infectious Diseases, The Third People's Hospital of Shenzhen and The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, PR China.
| | - Huachun Zou
- School of Public Health, Fudan University, Shanghai, PR China.
- School of Public Health, Southwest Medical University, Luzhou, PR China.
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
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5
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Ngoufack Jagni Semengue E, Santoro MM, Ndze VN, Ka'e AC, Yagai B, Nka AD, Dambaya B, Takou D, Teto G, Fabeni L, Colizzi V, Perno CF, Ceccherini-Silberstein F, Fokam J. HIV-1 integrase resistance associated mutations and the use of dolutegravir in Sub-Saharan Africa: A systematic review and meta-analysis. PLOS Glob Public Health 2022; 2:e0000826. [PMID: 36962573 PMCID: PMC10021461 DOI: 10.1371/journal.pgph.0000826] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 09/12/2022] [Indexed: 11/12/2022]
Abstract
As sub-Saharan Africa (SSA) countries are transitioning to dolutegravir (DTG)-based ART, baseline data are required for optimal monitoring of therapeutic response. In this frame, we sought to generate up-to-date evidence on the use of integrase-strand transfer inhibitors (INSTI) and associated drug resistance mutations (DRMs) within SSA. In this systematic review and meta-analysis, we included randomized and non-randomized trials, cohort-studies, cross-sectional studies, and case-reports published on INSTI or integrase DRMs in SSA. We included studies of patients exposed to DTG, raltegravir (RAL) or elvitegravir (EVG). Primary outcomes were "the rate of virological control (VC:<50copies/ml)" and "the presence of DRMs" on INSTI-based regimens among patients in SSA. We synthesised extracted data using subgroup analysis, and random effect models were used where appropriate. Additional analyses were conducted to assess study heterogeneity. We identified 1,916 articles/citations through database searches, of which 26 were included in the analysis pertaining to 5,444 patients (mean age: 37±13 years), with 67.62% (3681/5444) female. Specifically, 46.15% (12/26) studies focused on DTG, 26.92% (7/26) on RAL, 23.08% (6/26) on both DTG and RAL, and 3.85% (1/26) on EVG. We found an increasing use of DTG overtime (0% before 2018 to 100% in 2021). Median treatment duration under INSTI-based regimens was 12 [9-36] months. Overall, the rate of VC was 88.51% [95%CI: 73.83-97.80] with DTG vs. 82.49% [95%CI: 55.76-99.45] and 96.55% [95%CI: 85.7-100.00] with RAL and EVG, respectively. In univariate analysis, VC with DTG-containing vs. other INSTI-regimens was significantly higher (OR = 1.44 [95%CI: 1.15-1.79], p = 0.0014). Among reported DRMs at failure, the only DTG resistance-mutations were G118R and R263K. In SSA, DTG presents a superiority effect in VC compared to other INSTIs. Nonetheless, the early detection of INSTI-DRMs calls for sentinel surveillance for a successful transition and a sustained efficacy of DTG in SSA. PROSPERO Registration Number: CRD42019122424.
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Affiliation(s)
- Ezechiel Ngoufack Jagni Semengue
- Chantal Biya International Reference Center for Research on HIV/AIDS Prevention and Management, Yaoundé, Cameroon
- Evangelical University of Cameroon, Bandjoun, Cameroon
- University of Rome "Tor Vergata", Rome, Italy
| | | | | | - Aude Christelle Ka'e
- Chantal Biya International Reference Center for Research on HIV/AIDS Prevention and Management, Yaoundé, Cameroon
- Evangelical University of Cameroon, Bandjoun, Cameroon
- Doctoral School of Microbiology, Immunology, Infectious Diseases and Transplants, MIMIT, University of Rome "Tor Vergata", Rome, Italy
| | - Bouba Yagai
- Chantal Biya International Reference Center for Research on HIV/AIDS Prevention and Management, Yaoundé, Cameroon
| | - Alex Durand Nka
- Chantal Biya International Reference Center for Research on HIV/AIDS Prevention and Management, Yaoundé, Cameroon
- Evangelical University of Cameroon, Bandjoun, Cameroon
- University of Rome "Tor Vergata", Rome, Italy
| | - Beatrice Dambaya
- Chantal Biya International Reference Center for Research on HIV/AIDS Prevention and Management, Yaoundé, Cameroon
| | - Desiré Takou
- Chantal Biya International Reference Center for Research on HIV/AIDS Prevention and Management, Yaoundé, Cameroon
| | - Georges Teto
- Chantal Biya International Reference Center for Research on HIV/AIDS Prevention and Management, Yaoundé, Cameroon
| | - Lavinia Fabeni
- Laboratory of Virology, National Institute for Infectious Diseases "Lazzaro Spallanzani" -IRCCS, Rome, Italy
| | - Vittorio Colizzi
- Chantal Biya International Reference Center for Research on HIV/AIDS Prevention and Management, Yaoundé, Cameroon
- Evangelical University of Cameroon, Bandjoun, Cameroon
- University of Rome "Tor Vergata", Rome, Italy
- Chair of Biotechnology-UNESCO, University of Rome "Tor Vergata", Rome, Italy
| | - Carlo-Federico Perno
- Chantal Biya International Reference Center for Research on HIV/AIDS Prevention and Management, Yaoundé, Cameroon
- Bambino Gesu Children's Hospital, Rome, Italy
| | - Francesca Ceccherini-Silberstein
- University of Rome "Tor Vergata", Rome, Italy
- Doctoral School of Microbiology, Immunology, Infectious Diseases and Transplants, MIMIT, University of Rome "Tor Vergata", Rome, Italy
| | - Joseph Fokam
- Chantal Biya International Reference Center for Research on HIV/AIDS Prevention and Management, Yaoundé, Cameroon
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
- National HIV Drug Resistance Working Group, Ministry of Public Health, Yaounde, Cameroon
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Ndashimye E, Li Y, Reyes PS, Avino M, Olabode AS, Kityo CM, Kyeyune F, Nankya I, Quiñones-Mateu ME, Barr SD, Arts EJ. High-level resistance to bictegravir and cabotegravir in subtype A- and D-infected HIV-1 patients failing raltegravir with multiple resistance mutations. J Antimicrob Chemother 2021; 76:2965-2974. [PMID: 34453542 DOI: 10.1093/jac/dkab276] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 07/02/2021] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES The second-generation integrase strand transfer inhibitor (INSTI) bictegravir is becoming accessible in low- and middle-income countries (LMICs), and another INSTI, cabotegravir, has recently been approved as a long-acting injectable. Data on bictegravir and cabotegravir susceptibility in raltegravir-experienced HIV-1 subtype A- and D-infected patients carrying drug resistance mutations (DRMs) remain very scarce in LMICs. PATIENTS AND METHODS HIV-1 integrase (IN)-recombinant viruses from eight patients failing raltegravir-based third-line therapy in Uganda were genotypically and phenotypically tested for susceptibility to bictegravir and cabotegravir. Ability of these viruses to integrate into human genomes was assessed in MT-4 cells. RESULTS HIV-1 IN-recombinant viruses harbouring single primary mutations (N155H or Y143R/S) or in combination with secondary INSTI mutations (T97A, M50I, L74IM, E157Q, G163R or V151I) were susceptible to both bictegravir and cabotegravir. However, combinations of primary INSTI-resistance mutations such as E138A/G140A/G163R/Q148R or E138K/G140A/S147G/Q148K led to decreased susceptibility to both cabotegravir (fold change in EC50 values from 429 to 1000×) and bictegravir (60 to 100×), exhibiting a high degree of cross-resistance. However, these same IN-recombinant viruses showed impaired integration capacity (14% to 48%) relative to the WT HIV-1 NL4-3 strain in the absence of drug. CONCLUSIONS Though not currently widely accessible in most LMICs, bictegravir and cabotegravir offer a valid alternative to HIV-infected individuals harbouring subtype A and D HIV-1 variants with reduced susceptibility to first-generation INSTIs but previous exposure to raltegravir may reduce efficacy, more so with cabotegravir.
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Affiliation(s)
- Emmanuel Ndashimye
- Department of Microbiology and Immunology, Western University, London, Canada.,Joint Clinical Research Centre, Kampala, Uganda.,Center for AIDS Research Uganda Laboratories, Joint Clinical Research Centre, Kampala, Uganda
| | - Yue Li
- Department of Microbiology and Immunology, Western University, London, Canada
| | - Paul S Reyes
- Department of Microbiology and Immunology, Western University, London, Canada
| | - Mariano Avino
- Department of Pathology and Laboratory Medicine, Western University, London, Canada
| | - Abayomi S Olabode
- Department of Pathology and Laboratory Medicine, Western University, London, Canada
| | | | - Fred Kyeyune
- Joint Clinical Research Centre, Kampala, Uganda.,Center for AIDS Research Uganda Laboratories, Joint Clinical Research Centre, Kampala, Uganda
| | - Immaculate Nankya
- Joint Clinical Research Centre, Kampala, Uganda.,Center for AIDS Research Uganda Laboratories, Joint Clinical Research Centre, Kampala, Uganda
| | | | - Stephen D Barr
- Department of Microbiology and Immunology, Western University, London, Canada
| | - Eric J Arts
- Department of Microbiology and Immunology, Western University, London, Canada
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7
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Seatla KK, Maruapula D, Choga WT, Ntsipe T, Mathiba N, Mogwele M, Kapanda M, Nkomo B, Ramaabya D, Makhema J, Mmalane M, Mine M, Kasvosve I, Lockman S, Moyo S, Gaseitsiwe S. HIV-1 Subtype C Drug Resistance Mutations in Heavily Treated Patients Failing Integrase Strand Transfer Inhibitor-Based Regimens in Botswana. Viruses 2021; 13:v13040594. [PMID: 33807382 PMCID: PMC8066386 DOI: 10.3390/v13040594] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/22/2021] [Accepted: 03/28/2021] [Indexed: 11/16/2022] Open
Abstract
There are limited real-world mutational and virological outcomes data of treatment-experienced persons diagnosed with HIV-1 subtype C (HIV-1 C) who are failing Integrase Strand Transfer Inhibitor-based regimens. Requisition forms sent for HIV-1 genotypic resistance testing (GRT) between May 2015 and September 2019 were reviewed and participants experiencing virologic failure while on dolutegravir (DTG) or raltegravir (RAL) cART at sampling recruited. Sanger sequencing of the HIV-1 Pol gene was performed from residual plasma samples and drug resistance mutational (DRM) analysis performed using the Stanford University HIV drug resistance database. 40 HIV-1C integrase sequences were generated from 34 individuals, 24 of whom were on DTG cART, three on RAL cART and seven on an unknown (DTG or RAL)-anchored cART at time of GRT. 11/34 (32%) individuals had DRMs to DTG and other integrase inhibitors. 7/11 (64%) patients had exposure to a RAL-based cART at the time of sampling. Out of the 11 individuals with DRMs, one (9%) had 2-class, 6 (55%) had 3-class, and 4 (36%) had 4-class multidrug-resistant HIV-1C. 7/11 individuals (64%) are currently virologically suppressed. Of the four individuals not virologically suppressed, three had extensive DRMs involving 4-classes of ARV drugs and one individual has demised. Resistance to DTG occurs more often in patients exposed to RAL cART. Individuals with 4-class DRMs plus integrase T97 and E157Q mutations appear to have worse outcomes. There is a need for frequent VL monitoring and GRT amongst treatment-experienced HIV-1C diagnosed individuals.
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Affiliation(s)
- Kaelo K. Seatla
- Botswana Harvard AIDS Institute Partnership, Gaborone 0000, Botswana; (D.M.); (W.T.C.); (N.M.); (M.M.); (J.M.); (M.M.); (S.L.); (S.M.); (S.G.)
- School of Allied Health Professions, Faculty of Health Sciences, University of Botswana, Gaborone 0000, Botswana;
- Correspondence: ; Tel.: +267-390-2671; Fax: +267-390-1284
| | - Dorcas Maruapula
- Botswana Harvard AIDS Institute Partnership, Gaborone 0000, Botswana; (D.M.); (W.T.C.); (N.M.); (M.M.); (J.M.); (M.M.); (S.L.); (S.M.); (S.G.)
- School of Allied Health Professions, Faculty of Health Sciences, University of Botswana, Gaborone 0000, Botswana;
| | - Wonderful T. Choga
- Botswana Harvard AIDS Institute Partnership, Gaborone 0000, Botswana; (D.M.); (W.T.C.); (N.M.); (M.M.); (J.M.); (M.M.); (S.L.); (S.M.); (S.G.)
- Division of Human Genetics, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa
| | - Tshenolo Ntsipe
- National Health Laboratory, Ministry of Health & Wellness, Gaborone 0000, Botswana; (T.N.); (M.M.)
| | - Nametso Mathiba
- Botswana Harvard AIDS Institute Partnership, Gaborone 0000, Botswana; (D.M.); (W.T.C.); (N.M.); (M.M.); (J.M.); (M.M.); (S.L.); (S.M.); (S.G.)
| | - Mompati Mogwele
- Botswana Harvard AIDS Institute Partnership, Gaborone 0000, Botswana; (D.M.); (W.T.C.); (N.M.); (M.M.); (J.M.); (M.M.); (S.L.); (S.M.); (S.G.)
| | - Max Kapanda
- Botswana Ministry of Health and Wellness, Gaborone 0000, Botswana; (M.K.); (B.N.); (D.R.)
| | - Bornapate Nkomo
- Botswana Ministry of Health and Wellness, Gaborone 0000, Botswana; (M.K.); (B.N.); (D.R.)
| | - Dinah Ramaabya
- Botswana Ministry of Health and Wellness, Gaborone 0000, Botswana; (M.K.); (B.N.); (D.R.)
| | - Joseph Makhema
- Botswana Harvard AIDS Institute Partnership, Gaborone 0000, Botswana; (D.M.); (W.T.C.); (N.M.); (M.M.); (J.M.); (M.M.); (S.L.); (S.M.); (S.G.)
| | - Mompati Mmalane
- Botswana Harvard AIDS Institute Partnership, Gaborone 0000, Botswana; (D.M.); (W.T.C.); (N.M.); (M.M.); (J.M.); (M.M.); (S.L.); (S.M.); (S.G.)
| | - Madisa Mine
- National Health Laboratory, Ministry of Health & Wellness, Gaborone 0000, Botswana; (T.N.); (M.M.)
| | - Ishmael Kasvosve
- School of Allied Health Professions, Faculty of Health Sciences, University of Botswana, Gaborone 0000, Botswana;
| | - Shahin Lockman
- Botswana Harvard AIDS Institute Partnership, Gaborone 0000, Botswana; (D.M.); (W.T.C.); (N.M.); (M.M.); (J.M.); (M.M.); (S.L.); (S.M.); (S.G.)
- Division of Infectious Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Department of Immunology & Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Sikhulile Moyo
- Botswana Harvard AIDS Institute Partnership, Gaborone 0000, Botswana; (D.M.); (W.T.C.); (N.M.); (M.M.); (J.M.); (M.M.); (S.L.); (S.M.); (S.G.)
- Department of Immunology & Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Simani Gaseitsiwe
- Botswana Harvard AIDS Institute Partnership, Gaborone 0000, Botswana; (D.M.); (W.T.C.); (N.M.); (M.M.); (J.M.); (M.M.); (S.L.); (S.M.); (S.G.)
- Department of Immunology & Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
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