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de Lazzari E, Negredo EB, Domingo P, Tiraboschi JM, Ribera E, Abdulghani N, Alba V, Fernández-Arroyo S, Viladés C, Peraire J, Gatell JM, Blanco JL, Vidal F, Rull A, Martinez E. Multiomics plasma effects of switching from triple antiretroviral regimens to dolutegravir plus lamivudine. J Antimicrob Chemother 2024; 79:1133-1141. [PMID: 38546974 PMCID: PMC11062938 DOI: 10.1093/jac/dkae083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 03/06/2024] [Indexed: 05/03/2024] Open
Abstract
INTRODUCTION The DOLAM trial revealed that switching from triple antiretroviral therapy (three-drug regimen; 3DR) to dolutegravir plus lamivudine (two-drug regimen; 2DR) was virologically non-inferior to continuing 3DR after 48 weeks of follow-up. Weight increased with 2DR relative to 3DR but it did not impact on metabolic parameters. METHODS Multiomics plasma profile was performed to gain further insight into whether this therapy switch might affect specific biological pathways. DOLAM (EudraCT 201500027435) is a Phase 4, randomized, open-label, non-inferiority trial in which virologically suppressed persons with HIV treated with 3DR were assigned (1:1) to switch to 2DR or to continue 3DR for 48 weeks. Untargeted proteomics, metabolomics and lipidomics analyses were performed at baseline and at 48 weeks. Univariate and multivariate analyses were performed to identify changes in key molecules between both therapy arms. RESULTS Switching from 3DR to 2DR showed a multiomic impact on circulating plasma concentration of N-acetylmuramoyl-L-alanine amidase (Q96PD5), insulin-like growth factor-binding protein 3 (A6XND0), alanine and triglyceride (TG) (48:0). Correlation analyses identified an association among the up-regulation of these four molecules in persons treated with 2DR. CONCLUSIONS Untargeted multiomics profiling studies identified molecular changes potentially associated with inflammation immune pathways, and with lipid and glucose metabolism. Although these changes could be associated with potential metabolic or cardiovascular consequences, their clinical significance remains uncertain. Further work is needed to confirm these findings and to assess their long-term clinical consequences.
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Affiliation(s)
- Elisa de Lazzari
- Hospital Clinic - IDIBAPS, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Universitat de Barcelona, Barcelona, Spain
| | - Eugenia B Negredo
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Lluita contra les Infeccions, Hospital Universitari Germans Trias i Pujol, Badalona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pere Domingo
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Esteve Ribera
- Hospital Universitario de la Vall d’Hebron, Barcelona, Spain
| | | | - Verònica Alba
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Infection and Immunity Research Group (INIM), Institut Investigació Sanitària Pere Virgili (IISPV), Tarragona, Spain
- Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
- Universitat Rovira i Virgili (URV), Tarragona, Spain
| | - Salvador Fernández-Arroyo
- Eurecat, Centre Tecnològic de Catalunya, Centre for Omic Sciences, Joint Unit Eurecat-Universitat Rovira i Virgili, Unique Scientific and Technical Infrastructure (ICTS), 43204 Reus, Spain
| | - Consuelo Viladés
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Infection and Immunity Research Group (INIM), Institut Investigació Sanitària Pere Virgili (IISPV), Tarragona, Spain
- Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
- Universitat Rovira i Virgili (URV), Tarragona, Spain
| | - Joaquim Peraire
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Infection and Immunity Research Group (INIM), Institut Investigació Sanitària Pere Virgili (IISPV), Tarragona, Spain
- Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
- Universitat Rovira i Virgili (URV), Tarragona, Spain
| | - Jose M Gatell
- Universitat de Barcelona, Barcelona, Spain
- ViiV Healthcare, Barcelona, Spain
| | - Jose L Blanco
- Hospital Clinic - IDIBAPS, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Francesc Vidal
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Infection and Immunity Research Group (INIM), Institut Investigació Sanitària Pere Virgili (IISPV), Tarragona, Spain
- Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
- Universitat Rovira i Virgili (URV), Tarragona, Spain
| | - Anna Rull
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Infection and Immunity Research Group (INIM), Institut Investigació Sanitària Pere Virgili (IISPV), Tarragona, Spain
- Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
- Universitat Rovira i Virgili (URV), Tarragona, Spain
| | - Esteban Martinez
- Hospital Clinic - IDIBAPS, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Universitat de Barcelona, Barcelona, Spain
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Vasylyev M, Wit FWNM, Jordans CCE, Soetekouw R, van Lelyveld SFL, Kootstra GJ, Delsing CE, Ammerlaan HSM, van Kasteren MEE, Brouwer AE, Leyten EMS, Claassen MAA, Hassing RJ, den Hollander JG, van den Berge M, Roukens AHE, Bierman WFW, Groeneveld PHP, Lowe SH, van Welzen BJ, Richel O, Nellen JF, van den Berk GEL, van der Valk M, Rijnders BJA, Rokx C. Dolutegravir/Lamivudine Is Noninferior to Continuing Dolutegravir- and Non-Dolutegravir-Based Triple-Drug Antiretroviral Therapy in Virologically Suppressed People With Human Immunodeficiency Virus: DUALING Prospective Nationwide Matched Cohort Study. Open Forum Infect Dis 2024; 11:ofae160. [PMID: 38567196 PMCID: PMC10986854 DOI: 10.1093/ofid/ofae160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 03/15/2024] [Indexed: 04/04/2024] Open
Abstract
Background Confirming the efficacy of dolutegravir/lamivudine in clinical practice solidifies recommendations on its use. Methods Prospective cohort study (DUALING) in 24 human immunodeficiency virus (HIV) treatment centers in the Netherlands. HIV RNA-suppressed cases were on triple-drug antiretroviral regimens without prior virological failure or resistance and started dolutegravir/lamivudine. Cases were 1:2 matched to controls on triple-drug antiretroviral regimens by the use of dolutegravir-based regimens, age, sex, transmission route, CD4+ T-cell nadir, and HIV RNA zenith. The primary endpoint was the treatment failure rate in cases versus controls at 1 year by intention-to-treat and on-treatment analyses with 5% noninferiority margin. Results The 2040 participants were 680 cases and 1380 controls. Treatment failure in the 390 dolutegravir-based cases versus controls occurred in 8.72% and 12.50% (difference: -3.78% [95% confidence interval {CI}, -7.49% to .08%]) by intention-to-treat and 1.39% and 0.80% (difference: 0.59% [95% CI, -.80% to 1.98%]) by on-treatment analyses. The treatment failure risk in 290 non-dolutegravir-based cases was also noninferior to controls. Antiretroviral regimen modifications unrelated to virological failure explained the higher treatment failure rate by intention-to-treat. A shorter time on triple-drug antiretroviral therapy and being of non-Western origin was associated with treatment failure. Treatment failure, defined as 2 consecutive HIV RNA >50 copies/mL, occurred in 4 cases and 5 controls but without genotypic resistance detected. Viral blips occured comparable in cases and controls but cases gained more weight, especially when tenofovir-based regimens were discontinued. Conclusions In routine care, dolutegravir/lamivudine was noninferior to continuing triple-drug antiretroviral regimens after 1 year, supporting the use of dolutegravir/lamivudine in clinical practice. Clinical Trials Registration NCT04707326.
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Affiliation(s)
- Marta Vasylyev
- Section of Infectious Diseases, Department of Internal Medicine, and Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Carlijn C E Jordans
- Section of Infectious Diseases, Department of Internal Medicine, and Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Robin Soetekouw
- Department of Internal Medicine, Spaarne Gasthuis, Haarlem/Hoofddorp, The Netherlands
| | | | - Gert-Jan Kootstra
- Department of Internal Medicine, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Corine E Delsing
- Department of Internal Medicine, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Heidi S M Ammerlaan
- Department of Internal Medicine, Catharina Ziekenhuis Eindhoven, Eindhoven, The Netherlands
| | - Marjo E E van Kasteren
- Department of Internal Medicine, Elisabeth Tweesteden Ziekenhuis, Tilburg, The Netherlands
| | - Annemarie E Brouwer
- Department of Internal Medicine, Elisabeth Tweesteden Ziekenhuis, Tilburg, The Netherlands
| | - Eliane M S Leyten
- Department of Internal Medicine, Haaglanden Medisch Centrum, The Hague, The Netherlands
| | - Mark A A Claassen
- Department of Internal Medicine, Rijnstate Ziekenhuis, Arnhem, The Netherlands
| | - Robert-Jan Hassing
- Department of Internal Medicine, Rijnstate Ziekenhuis, Arnhem, The Netherlands
| | - Jan G den Hollander
- Department of Internal Medicine, Maasstadziekenhuis, Rotterdam, The Netherlands
| | - Marcel van den Berge
- Department of Internal Medicine, Admiraal de Ruyter Ziekenhuis, Vlissingen, The Netherlands
| | - Anna H E Roukens
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - Wouter F W Bierman
- Section of Infectious Diseases, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Selwyn H Lowe
- Infectious Diseases and Infection Prevention, Department of Internal Medicine and Department of Medical Microbiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Berend J van Welzen
- Department of Internal Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Olivier Richel
- Section of Infectious Diseases, Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jeannine F Nellen
- Amsterdam Infection and Immunity Institute, Department of Infectious Diseases, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Marc van der Valk
- Stichting HIV Monitoring, Amsterdam, The Netherlands
- Amsterdam Infection and Immunity Institute, Department of Infectious Diseases, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Bart J A Rijnders
- Section of Infectious Diseases, Department of Internal Medicine, and Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Casper Rokx
- Section of Infectious Diseases, Department of Internal Medicine, and Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
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Sequera-Arquelladas S, Hidalgo-Tenorio C, López-Cortés L, Gutiérrez A, Santos J, Téllez F, Omar M, Ferra-Murcia S, Fernández E, Javier R, García-Vallecillos C, Pasquau J. DOLAMA 200: Effectiveness and Safety of a Dual Therapy with Dolutegravir Plus Lamivudine in Treatment-Experienced HIV-1 Infected Real World Participants in Spain. Viruses 2024; 16:259. [PMID: 38400035 PMCID: PMC10893067 DOI: 10.3390/v16020259] [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: 12/20/2023] [Revised: 01/14/2024] [Accepted: 02/01/2024] [Indexed: 02/25/2024] Open
Abstract
The continuous pharmacological advances in antiretroviral treatment (ART) and the increasing understanding of HIV drug resistance has led to a change in the paradigm of ART optimization in the setting of the viral suppression of treatment-experienced patients with the emerging evidence of the effectiveness and safety of dual therapies. The aim of this study is to determine the antiviral efficacy and safety of switching to Dolutegravir + Lamivudine in people living with HIV, and to analyze the rate of patients with virologic failure (VF). A total of 200 patients were included with a median age of 51 years, 189 cells/µL of nadir CD4+, 13 years on ART and four previous ART regimens. Among the 168 patients who completed a follow-up at 48 weeks, a total of five VFs occurred, resulting in a 2.98% (5/168) VF rate. The results of the intention-to-treat analysis were a VF rate of 2.54% (5/197), and the rate of patients/year with viral suppression was 98.3% (298/303) in the observed data analysis. We observed a significant improvement in mean CD4 lymphocytes, the CD4/CD8 ratio and lipid profiles. The optimization of ART to DTG plus 3TC is a cost-effective switch option for treatment-experienced HIV patients, and also improves their lipid profiles.
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Affiliation(s)
- Sergio Sequera-Arquelladas
- Unit of Infectious Diseases, Instituto de Investigación Biosanitario de Granada (IBS-Granada), Virgen de las Nieves University Hospital, 18014 Granada, Spain; (C.H.-T.); (R.J.); (C.G.-V.); (J.P.)
| | - Carmen Hidalgo-Tenorio
- Unit of Infectious Diseases, Instituto de Investigación Biosanitario de Granada (IBS-Granada), Virgen de las Nieves University Hospital, 18014 Granada, Spain; (C.H.-T.); (R.J.); (C.G.-V.); (J.P.)
| | - Luis López-Cortés
- Department of Infectious Diseases, Virgen del Rocio University Hospitals, 41013 Seville, Spain; (L.L.-C.); (A.G.)
| | - Alicia Gutiérrez
- Department of Infectious Diseases, Virgen del Rocio University Hospitals, 41013 Seville, Spain; (L.L.-C.); (A.G.)
| | - Jesús Santos
- IBIMA Plataforma BIONAND, Unit of Infectious Diseases, Virgen de la Victoria University Hospital, 29010 Málaga, Spain;
| | - Francisco Téllez
- Unit of Infectious Diseases, Puerto Real Universitary Hospital, 11510 Cádiz, Spain;
| | - Mohamed Omar
- Unit of Infectious Diseases, Hospital Complex of Jaen, 23007 Jaén, Spain;
| | - Sergio Ferra-Murcia
- Unit of Infectious Diseases, Hospital Torrecárdenas Hospital, 04009 Almería, Spain;
| | - Elisa Fernández
- Internal medicine Service, Hospital Poniente, 04700 Almería, Spain;
| | - Rosario Javier
- Unit of Infectious Diseases, Instituto de Investigación Biosanitario de Granada (IBS-Granada), Virgen de las Nieves University Hospital, 18014 Granada, Spain; (C.H.-T.); (R.J.); (C.G.-V.); (J.P.)
| | - Coral García-Vallecillos
- Unit of Infectious Diseases, Instituto de Investigación Biosanitario de Granada (IBS-Granada), Virgen de las Nieves University Hospital, 18014 Granada, Spain; (C.H.-T.); (R.J.); (C.G.-V.); (J.P.)
| | - Juan Pasquau
- Unit of Infectious Diseases, Instituto de Investigación Biosanitario de Granada (IBS-Granada), Virgen de las Nieves University Hospital, 18014 Granada, Spain; (C.H.-T.); (R.J.); (C.G.-V.); (J.P.)
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De Socio GV, Tordi S, Altobelli D, Gidari A, Zoffoli A, Francisci D. Dolutegravir/Lamivudine versus Tenofovir Alafenamide/Emtricitabine/Bictegravir as a Switch Strategy in a Real-Life Cohort of Virogically Suppressed People Living with HIV. J Clin Med 2023; 12:7759. [PMID: 38137828 PMCID: PMC10743626 DOI: 10.3390/jcm12247759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 12/01/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND The aim of the study is to evaluate the effectiveness, safety, and tolerability of a two-drug regimen (2-DR) dolutegravir/lamivudine (DTG/3TC) versus a three-drug regimen (3-DR) tenofovir alafenamide/emtricitabine/bictegravir (TAF/FTC/BIC) in a real-life cohort of HIV-1 virologically suppressed treatment-experienced (TE) people living with HIV (PLWH). METHODS This was a single-center, retrospective, observational study analyzing adult TE PLWH who started the 2-DR or 3-DR between January 2018 and January 2023. All PLWH with a viral load (VL) <50 copies/mL at the time of switching, and a follow-up of more than 6 months or interruption of treatment at any time, were included. RESULTS A total of 324 PLWH were included; of these, 110 (34%) were on the 2-DR and 214 (66%) were on the 3-DR. Most patients remained on therapy in both groups (93.6% 2-DR versus 90.2% 3-DR) and, at the last control, 99.1% achieved VL < 50 copies/mL with the 2-DR versus 97.2% with the 3-DR (p = 0.260). No virological failures occurred in either group. Adverse events occurred in a few cases: four (3.6%) in the 2-DR group and five (2.3%) in the 3-DR group (p = 0.500). The median follow-up-time was 19.6 months for the 2-DR and 27.5 months for the 3-DR. CONCLUSION Our study shows a similar effectiveness and safety profile in virologically suppressed PLWH switching to DTG/3TC or TAF/FTC/BIC.
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Affiliation(s)
| | - Sara Tordi
- Correspondence: (G.V.D.S.); (S.T.); Tel.: +39-0755783262 (S.T.)
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Kabra M, Barber TJ, Allavena C, Marcelin AG, Di Giambenedetto S, Pasquau J, Gianotti N, Llibre JM, Rial-Crestelo D, De Miguel-Buckley R, Blick G, Turner M, Harrison C, Wynne T, Verdier G, Parry CM, Jones B, Okoli C, Donovan C, Priest J, Letang E. Virologic Response to Dolutegravir Plus Lamivudine in People With Suppressed Human Immunodeficiency Virus Type 1 and Historical M184V/I: A Systematic Literature Review and Meta-analysis. Open Forum Infect Dis 2023; 10:ofad526. [PMID: 38033982 PMCID: PMC10686367 DOI: 10.1093/ofid/ofad526] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Indexed: 12/02/2023] Open
Abstract
Background To investigate the impact of the M184V/I mutation on virologic response to dolutegravir plus lamivudine (DTG + 3TC) in suppressed-switch populations, a meta-analysis was performed using virologic outcomes from people with human immunodeficiency virus type 1 (PWH) with and without M184V/I before DTG + 3TC switch in real-world studies identified via systematic literature review. Sensitivity analyses were performed using data from PWH with M184V/I in interventional studies identified via targeted literature review. Methods Single-arm meta-analyses using common- and random-effects models were used to estimate proportions of PWH with virologic failure (VF) among real-world populations with and without M184V/I and interventional study participants with M184V/I at 24, 48, and 96 weeks. Results Literature reviews identified 5 real-world studies from 3907 publications and 51 abstracts meeting inclusion criteria and 5 interventional studies from 1789 publications and 3 abstracts. All time points had low VF incidence in PWH with M184V/I (real-world: 1.43%-3.81%; interventional: 0.00%) and without (real-world: 0.73%-2.37%). Meta-analysis-estimated proportions (95% confidence interval) with VF were low at weeks 24, 48, and 96, respectively, for PWH with M184V/I (real-world: 0.01 [.00-.04], 0.03 [.01-.06], and 0.04 [.01-.07]; interventional: 0.00 [.00-.02], 0.00 [.00-.01], and 0.00 [.00-.03]) and without (real-world: 0.00 [.00-.02], 0.02 [.01-.04], and 0.02 [.00-.05]). One real-world study (n = 712) reported treatment-emergent M184V at VF in 1 of 652 (0.15%) PWH without prior M184V/I. Conclusions Results suggest that prior M184V/I has minimal impact on virologic suppression after switching to DTG + 3TC and provide reassurance when considering switching regimens in virologically suppressed PWH with incomplete treatment history or limited treatment options.
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Affiliation(s)
| | - Tristan J Barber
- Ian Charleson Day Centre, Royal Free London National Health Service Foundation Trust, London, United Kingdom
- Institute for Global Health, University College London, London, United Kingdom
| | - Clotilde Allavena
- Department of Infectious and Tropical Diseases, Centre Hospitalier Universitaire Hôtel-Dieu, Nantes, France
| | - Anne-Geneviève Marcelin
- Sorbonne Université, Inserm, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Assistance Publique–Hôpitaux de Paris, Laboratoire de Virologie, Hôpital Pitié-Salpêtrière, Paris, France
| | - Simona Di Giambenedetto
- Laboratory and Infectious Diseases Sciences, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico and Department of Safety and Bioethics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Juan Pasquau
- Unit of Infectious Diseases, Virgen de las Nieves University Hospital, Granada, Spain
| | - Nicola Gianotti
- Infectious Diseases Unit, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale San Raffaele, Milan, Italy
| | - Josep M Llibre
- Infectious Diseases Division and Fight Infections Foundation, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - David Rial-Crestelo
- HIV Unit, Hospital Universitario 12 de Octubre, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
| | - Rosa De Miguel-Buckley
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
- Infectious Diseases Unit, Hospital Universitario La Paz, Madrid, Spain
| | - Gary Blick
- Health Care Advocates International, Stratford, Connecticut, USA
| | | | | | | | | | | | - Bryn Jones
- ViiV Healthcare, Brentford, United Kingdom
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Mendoza I, Lázaro A, Espinosa A, Sánchez L, Horta AM, Torralba M. Effectiveness, durability and safety of dolutegravir and lamivudine versus bictegravir, emtricitabine and tenofovir alafenamide in a real-world cohort of HIV-infected adults. PLoS One 2023; 18:e0291480. [PMID: 37773939 PMCID: PMC10540944 DOI: 10.1371/journal.pone.0291480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 08/24/2023] [Indexed: 10/01/2023] Open
Abstract
OBJECTIVE Dolutegravir plus lamivudine (2-DR) is suggested as an initial and switch option in HIV-1 treatment. The aim of this study was to analyze the effectiveness, durability, and safety of 2-DR compared to bictegravir/emtricitabine/tenofovir alafenamide (3-DR). PATIENTS AND METHODS This was an observational, ambispective study that included all treatment-naïve (TN) and treatment-experienced (TE) people living with HIV/AIDS (PLWH), who started 2-DR or 3-DR between 01 July 2018, and 31 January 2022. The primary endpoint was non-inferiority, at 24 and 48 weeks, of 2-DR vs 3-DR regarding the percentage of PLWH with viral load (VL)<50 and 200 copies/mL in TN (12% margin) and VL≥50 and 200 copies/mL in TE (4% margin). Durability of response and safety were also measured. RESULTS 292 PLWH were included (39 TN and 253 TE). In TN PLWH, non-inferiority was not achieved at 24 weeks (17; 95% CI -17 to 51 p = 0.348). By week 48, all PLWH on 3-DR maintained VL<50 copies/mL compared to 70% of PLWH on 2-DR although without reaching statistical significance (-33; 95% CI -60 to -10 p = 0.289). Non-inferiority was not achieved in TE PLWH either at 24 (0.4; 95% CI -9 to 10 p = 1) or at 48 weeks (4.5; 95% CI -0.5 to 9 p = 0.132). In TN, the risk of treatment discontinuation was similar between groups (HR: 0.31, p = 0.07); similar rates were also found in TE (HR: 1.3, p = 0.38). TE PLWH on 2-DR showed a better safety profile compared to 3-DR (p = 0.017). CONCLUSION Our results did not show non-inferiority in terms of virological effectiveness. Additionally, durability and safety of 2-DR were confirmed to be similar to 3-DR.
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Affiliation(s)
- Inés Mendoza
- Pharmacy Department, Hospital Universitario de Guadalajara, Guadalajara, Spain
- Alcalá University, Alcalá de Henares, Spain
| | - Alicia Lázaro
- Pharmacy Department, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - Alfredo Espinosa
- Internal Medicine Department, Research Unit, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - Lorenzo Sánchez
- Internal Medicine Department, Research Unit, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - Ana María Horta
- Pharmacy Department, Hospital Universitario de Guadalajara, Guadalajara, Spain
- Alcalá University, Alcalá de Henares, Spain
| | - Miguel Torralba
- Alcalá University, Alcalá de Henares, Spain
- Internal Medicine Department, Research Unit, Hospital Universitario de Guadalajara, Guadalajara, Spain
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Palmier E, De Miguel R, Montejano R, Busca C, Micán R, Ramos L, Cadiñanos J, Serrano L, Bernardino JI, Pérez-Valero I, Valencia E, Arribas JR, Montes ML, González-García J, Martín-Carbonero L. Three-year efficacy of switching to dolutegravir plus lamivudine: A real-world study. HIV Med 2023; 24:1013-1019. [PMID: 37194419 DOI: 10.1111/hiv.13500] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 04/18/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Dolutegravir (DTG) plus lamivudine (3TC) has proven highly efficacious as a switching strategy in virologically suppressed people with HIV (PWH). As this strategy was introduced relatively recently, real-world, long-term durability studies are lacking. METHODS We performed a retrospective review of treatment-experienced patients who started DTG + 3TC in a cohort of PWH. HIV-RNA <50 copies/mL was analysed at 144 weeks in an intention-to-treat (ITT) analysis (missing = failure) and a per-protocol (PP) analysis (patients with missing data or changes for reasons other than virological failure were excluded). RESULTS The study population comprised 358 PWH (19% women). Median age and time with HIV infection were 51.7 and 13.4 years, respectively. The median number of previous antiretroviral combinations was three. Previous virological failure was reported in 27.1% of patients, and the M184V resistance mutation was detected in 17 patients. At 144 weeks, the percentage of individuals with HIV-RNA <50 copies/mL was 77.4% (277/358) in the ITT analysis and 95.5% (277/290) in the PP analysis. A total of 68 participants were excluded from the PP analysis (data missing, 25, discontinuation due to toxicity, 19; other, 16; death, 8). Two people with virological failure selected resistance-associated mutations (M184V and M184V + R263K). HIV-RNA remained undetectable in 17 patients with a previous history of the M184V mutation. CONCLUSION Our results confirm the real-world, long-term efficacy, tolerability and high genetic barrier of DTG + 3TC in treatment-experienced PWH. Although scarce, mutations causing resistance to nucleosides and integrase can emerge.
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Affiliation(s)
- E Palmier
- Hospital Universitario La Paz, IdiPaz, Madrid, Spain
| | - R De Miguel
- Hospital Universitario La Paz, IdiPaz, Madrid, Spain
- CIBER Infectious Diseases (CIBERINFEC), Madrid, Spain
| | - R Montejano
- Hospital Universitario La Paz, IdiPaz, Madrid, Spain
- CIBER Infectious Diseases (CIBERINFEC), Madrid, Spain
| | - C Busca
- Hospital Universitario La Paz, IdiPaz, Madrid, Spain
- CIBER Infectious Diseases (CIBERINFEC), Madrid, Spain
| | - R Micán
- Hospital Universitario La Paz, IdiPaz, Madrid, Spain
- CIBER Infectious Diseases (CIBERINFEC), Madrid, Spain
| | - L Ramos
- Hospital Universitario La Paz, IdiPaz, Madrid, Spain
| | - J Cadiñanos
- Hospital Universitario La Paz, IdiPaz, Madrid, Spain
| | - L Serrano
- Hospital Universitario La Paz, IdiPaz, Madrid, Spain
| | - J I Bernardino
- Hospital Universitario La Paz, IdiPaz, Madrid, Spain
- CIBER Infectious Diseases (CIBERINFEC), Madrid, Spain
| | | | - E Valencia
- Hospital Universitario La Paz, IdiPaz, Madrid, Spain
| | - J R Arribas
- Hospital Universitario La Paz, IdiPaz, Madrid, Spain
- CIBER Infectious Diseases (CIBERINFEC), Madrid, Spain
| | - M L Montes
- Hospital Universitario La Paz, IdiPaz, Madrid, Spain
- CIBER Infectious Diseases (CIBERINFEC), Madrid, Spain
| | - J González-García
- Hospital Universitario La Paz, IdiPaz, Madrid, Spain
- CIBER Infectious Diseases (CIBERINFEC), Madrid, Spain
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Abdullahi A, Kida IM, Maina UA, Ibrahim AH, Mshelia J, Wisso H, Adamu A, Onyemata JE, Edun M, Yusuph H, Aliyu SH, Charurat M, Abimiku A, Abeler-Dorner L, Fraser C, Bonsall D, Kemp SA, Gupta RK. Limited emergence of resistance to integrase strand transfer inhibitors (INSTIs) in ART-experienced participants failing dolutegravir-based antiretroviral therapy: a cross-sectional analysis of a Northeast Nigerian cohort. J Antimicrob Chemother 2023; 78:2000-2007. [PMID: 37367727 PMCID: PMC10393879 DOI: 10.1093/jac/dkad195] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 05/30/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Due to the high prevalence of resistance to NNRTI-based ART since 2018, consolidated recommendations from the WHO have indicated dolutegravir as the preferred drug of choice for HIV treatment globally. There is a paucity of resistance outcome data from HIV-1 non-B subtypes circulating across West Africa. AIMS We characterized the mutational profiles of persons living with HIV from a cross-sectional cohort in North-East Nigeria failing a dolutegravir-based ART regimen. METHODS WGS of plasma samples collected from 61 HIV-1-infected participants following virological failure of dolutegravir-based ART were sequenced using the Illumina platform. Sequencing was successfully completed for samples from 55 participants. Following quality control, 33 full genomes were analysed from participants with a median age of 40 years and median time on ART of 9 years. HIV-1 subtyping was performed using SNAPPy. RESULTS Most participants had mutational profiles reflective of exposure to previous first- and second-line ART regimens comprised NRTIs and NNRTIs. More than half of participants had one or more drug resistance-associated mutations (DRMs) affecting susceptibility to NRTIs (17/33; 52%) and NNRTIs (24/33; 73%). Almost a quarter of participants (8/33; 24.4%) had one or more DRMs affecting tenofovir susceptibility. Only one participant, infected with HIV-1 subtype G, had evidence of DRMs affecting dolutegravir susceptibility-this was characterized by the T66A, G118R, E138K and R263K mutations. CONCLUSIONS This study found a low prevalence of resistance to dolutegravir; the data are therefore supportive of the continual rollout of dolutegravir as the primary first-line regimen for ART-naive participants and the preferred switch to second-line ART across the region. However, population-level, longer-term data collection on dolutegravir outcomes are required to further guide implementation and policy action across the region.
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Affiliation(s)
- Adam Abdullahi
- Department of Medicine, Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), Cambridge, UK
- Department of Medicine, University of Cambridge, Cambridge, UK
- Institute of Human Virology Nigeria, Abuja, Nigeria
| | - Ibrahim Musa Kida
- Department of Infectious Disease and Clinical Immunology, University of Maiduguri, Borno, Nigeria
| | - Umar Abdullahi Maina
- Department of Veterinary Pharmacology and Toxicology, Faculty of Veterinary Medicine, University of Maiduguri, Borno, Nigeria
| | | | - James Mshelia
- Department of Infectious Disease and Clinical Immunology, University of Maiduguri, Borno, Nigeria
| | - Haruna Wisso
- Institute of Human Virology Nigeria, Abuja, Nigeria
| | - Abdullahi Adamu
- Department of Veterinary Pharmacology and Toxicology, Faculty of Veterinary Medicine, University of Maiduguri, Borno, Nigeria
| | | | - Martin Edun
- Institute of Human Virology Nigeria, Abuja, Nigeria
| | - Haruna Yusuph
- Department of Infectious Disease and Clinical Immunology, University of Maiduguri, Borno, Nigeria
| | - Sani H Aliyu
- Department of Microbiology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Man Charurat
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, USA
| | | | - Lucie Abeler-Dorner
- Nuffield Department of Medicine, Big Data Institute, University of Oxford, Oxford, UK
| | - Christophe Fraser
- Nuffield Department of Medicine, Big Data Institute, University of Oxford, Oxford, UK
| | - David Bonsall
- Nuffield Department of Medicine, Big Data Institute, University of Oxford, Oxford, UK
| | - Steven A Kemp
- Department of Medicine, Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), Cambridge, UK
- Department of Medicine, University of Cambridge, Cambridge, UK
- Nuffield Department of Medicine, Big Data Institute, University of Oxford, Oxford, UK
| | - Ravindra K Gupta
- Department of Medicine, Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), Cambridge, UK
- Department of Medicine, University of Cambridge, Cambridge, UK
- Africa Health Research Institute, Durban, South Africa
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9
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Priest J, Germain G, Laliberté F, Duh MS, Mahendran M, Fakih I, Oglesby A. Comparing Real-World Healthcare Costs Associated with Single-Tablet Regimens for HIV-1: The 2-Drug Regimen Dolutegravir/Lamivudine vs. Standard 3- or 4-Drug Regimens. Infect Dis Ther 2023; 12:2117-2133. [PMID: 37552426 PMCID: PMC10505118 DOI: 10.1007/s40121-023-00848-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 07/14/2023] [Indexed: 08/09/2023] Open
Abstract
INTRODUCTION Dolutegravir/lamivudine (DTG/3TC) is a 2-drug regimen for HIV-1 treatment with long-term efficacy and good tolerability comparable to 3- or 4-drug regimens. This study evaluated DTG/3TC cost versus other standard single-tablet regimens during its first year of approval. METHODS This retrospective study analyzed US claims data from adults with HIV-1. Eligibility criteria included ≥ 1 dispensing of DTG/3TC, DTG/abacavir (ABC)/3TC, bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF), elvitegravir (EVG)/cobicistat (COBI)/FTC/TAF, and darunavir (DRV)/COBI/FTC/TAF (index date was first dispensing) and ≥ 6 months of continuous eligibility before index date (baseline period). All-cause and HIV-related healthcare costs were evaluated during the observation period (index date until earliest of end of continuous eligibility or data availability). Adjusted cost differences and adjusted cost ratios were estimated using multivariable regression models controlling for differences in baseline characteristics between cohorts. RESULTS Overall, 22,061 individuals with HIV-1 and dispensed treatment with DTG/3TC (n = 590), DTG/ABC/3TC (n = 4355), BIC/FTC/TAF (n = 9068), EVG/COBI/FTC/TAF (n = 7081), or DRV/COBI/FTC/TAF (n = 967) were included. Most claims data were from men (mean age ~ 46 years). Mean unadjusted all-cause total healthcare costs per patient per month were significantly lower for DTG/3TC versus BIC/FTC/TAF and DRV/COBI/FTC/TAF, and mean unadjusted HIV-related healthcare costs per patient per month were significantly lower for DTG/3TC versus DRV/COBI/FTC/TAF. Cost differences were primarily driven by significantly lower pharmacy costs for DTG/3TC versus other regimens (P < 0.001), while medical costs were similar across cohorts. Results were similar among treatment-naive and treatment-experienced individuals. After adjusting for baseline covariates, significant adjusted cost differences were generally consistent with unadjusted findings. Adjusted cost ratios generally favored DTG/3TC for all-cause healthcare and HIV-related costs, with all pharmacy cost ratios favoring DTG/3TC (P < 0.001). CONCLUSION Dolutegravir/lamivudine had the lowest healthcare costs of BIC/FTC/TAF, EVG/COBI/FTC/TAF, and DRV/COBI/FTC/TAF, and the lowest pharmacy costs of all regimens, in unadjusted and adjusted analyses and by treatment experience, supporting the economic benefits of DTG/3TC as an initial or switch regimen for HIV-1.
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Affiliation(s)
- Julie Priest
- Global Health Outcomes, ViiV Healthcare, 406 Blackwell Street, Suite 300, Durham, NC, 27701, USA.
| | - Guillaume Germain
- Groupe d'analyse Ltée, 1190 avenue des Canadiens-de-Montréal, Tour Deloitte, Suite 1500, Montréal, QC, H3B 0G7, Canada
| | - François Laliberté
- Groupe d'analyse Ltée, 1190 avenue des Canadiens-de-Montréal, Tour Deloitte, Suite 1500, Montréal, QC, H3B 0G7, Canada
| | - Mei Sheng Duh
- Analysis Group Inc, 111 Huntington Avenue, 14th Floor, Boston, MA, 02199, USA
| | - Malena Mahendran
- Groupe d'analyse Ltée, 1190 avenue des Canadiens-de-Montréal, Tour Deloitte, Suite 1500, Montréal, QC, H3B 0G7, Canada
| | - Iman Fakih
- Groupe d'analyse Ltée, 1190 avenue des Canadiens-de-Montréal, Tour Deloitte, Suite 1500, Montréal, QC, H3B 0G7, Canada
| | - Alan Oglesby
- Global Health Outcomes, ViiV Healthcare, 406 Blackwell Street, Suite 300, Durham, NC, 27701, USA
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Martínez-Serra A, De Lazzari E, Berrocal L, Foncillas A, De La Mora L, Inciarte A, Chivite I, González-Cordón A, Martínez-Rebollar M, Torres B, Laguno M, Blanco JL, Martínez E, Mallolas J, Ambrosioni J. Clinical use and effectiveness of dolutegravir and lamivudine: a long-term, real-world, retrospective study. J Antimicrob Chemother 2023:dkad189. [PMID: 37311224 DOI: 10.1093/jac/dkad189] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 05/30/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND The use of dolutegravir/lamivudine is based on solid clinical trials; however, real-world data remain limited. OBJECTIVES To provide data on the clinical use and effectiveness of dolutegravir/lamivudine in persons with HIV in a real-world scenario. PATIENTS AND METHODS Retrospective, single-centre and observational study. We included all adults starting dolutegravir/lamivudine since November 2014. We reported all demographic, virological and immunological variables at baseline and assessed effectiveness [on treatment (OT), modified ITT (mITT) and ITT in those persons who reached 6 and 12 month follow-ups (M6 and M12). RESULTS Of the 1058 persons, 9 were treatment-naive; the final analysis included 1049 treatment-experienced people with HIV. Median (IQR) follow-up was 1 (0.3-1.6) years, with 81% and 63% persons reaching M6 and M12, respectively. The longest use of dolutegravir/lamivudine was 7.4 years. Per OT, mITT and ITT, HIV-RNA < 50 copies/mL was 97%, 92% and 81% (M6) and 98%, 90% and 80% (M12), respectively. Females [adjusted risk ratio, aRR (95% CI): 1.69 (1.19-2.40)]; immediate, previous PI-based regimen [aRR (95% CI): 1.67 (1.09-2.56)]; and viral load (VL) ≥ 50 copies/mL at dolutegravir/lamivudine initiation [aRR (95% CI): 3.36 (2.32-4.88)] were independently associated with lack of effectiveness at M12; other demographic, immunological and virological variables like previous M184V/I substitutions or virological failure, were unrelated. Of the total, 944 (90%) continued dolutegravir/lamivudine. The most frequent known reason for discontinuation was toxicity [48 (46%) cases]. CONCLUSIONS In our real-world experience, virological suppression rates were high for treatment-experienced persons on dolutegravir/lamivudine; however, we identified subgroups with a higher risk of lack of effectiveness at M12, who may benefit from closer follow-ups.
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Affiliation(s)
- Adrián Martínez-Serra
- Infectious Disease Department, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Elisa De Lazzari
- Infectious Disease Department, School of Medicine, University of Barcelona, Barcelona, Spain
- HIV Unit, Infectious Diseases Service, Hospital Clinic, Villarroel 170, 08036, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - Leire Berrocal
- HIV Unit, Infectious Diseases Service, Hospital Clinic, Villarroel 170, 08036, Barcelona, Spain
| | - Alberto Foncillas
- Infectious Disease Department, School of Medicine, University of Barcelona, Barcelona, Spain
- HIV Unit, Infectious Diseases Service, Hospital Clinic, Villarroel 170, 08036, Barcelona, Spain
| | - Lorena De La Mora
- Infectious Disease Department, School of Medicine, University of Barcelona, Barcelona, Spain
- HIV Unit, Infectious Diseases Service, Hospital Clinic, Villarroel 170, 08036, Barcelona, Spain
| | - Alexy Inciarte
- Infectious Disease Department, School of Medicine, University of Barcelona, Barcelona, Spain
- HIV Unit, Infectious Diseases Service, Hospital Clinic, Villarroel 170, 08036, Barcelona, Spain
| | - Iván Chivite
- Infectious Disease Department, School of Medicine, University of Barcelona, Barcelona, Spain
- HIV Unit, Infectious Diseases Service, Hospital Clinic, Villarroel 170, 08036, Barcelona, Spain
| | - Ana González-Cordón
- Infectious Disease Department, School of Medicine, University of Barcelona, Barcelona, Spain
- HIV Unit, Infectious Diseases Service, Hospital Clinic, Villarroel 170, 08036, Barcelona, Spain
| | - María Martínez-Rebollar
- Infectious Disease Department, School of Medicine, University of Barcelona, Barcelona, Spain
- HIV Unit, Infectious Diseases Service, Hospital Clinic, Villarroel 170, 08036, Barcelona, Spain
| | - Berta Torres
- Infectious Disease Department, School of Medicine, University of Barcelona, Barcelona, Spain
- HIV Unit, Infectious Diseases Service, Hospital Clinic, Villarroel 170, 08036, Barcelona, Spain
| | - Montserrat Laguno
- Infectious Disease Department, School of Medicine, University of Barcelona, Barcelona, Spain
- HIV Unit, Infectious Diseases Service, Hospital Clinic, Villarroel 170, 08036, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - José Luis Blanco
- Infectious Disease Department, School of Medicine, University of Barcelona, Barcelona, Spain
- HIV Unit, Infectious Diseases Service, Hospital Clinic, Villarroel 170, 08036, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - Esteban Martínez
- Infectious Disease Department, School of Medicine, University of Barcelona, Barcelona, Spain
- HIV Unit, Infectious Diseases Service, Hospital Clinic, Villarroel 170, 08036, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - Josep Mallolas
- Infectious Disease Department, School of Medicine, University of Barcelona, Barcelona, Spain
- HIV Unit, Infectious Diseases Service, Hospital Clinic, Villarroel 170, 08036, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - Juan Ambrosioni
- Infectious Disease Department, School of Medicine, University of Barcelona, Barcelona, Spain
- HIV Unit, Infectious Diseases Service, Hospital Clinic, Villarroel 170, 08036, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
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Dueñas-Gutiérrez C, Buzón L, Pedrero-Tomé R, Iribarren JA, De Los Santos I, De la Fuente S, Pousada G, Moran MA, Moreno E, Ferreira E, Gómez J, Troya J. Efficacy and Safety of Two-Drug Regimens with Dolutegravir plus Rilpivirine or Lamivudine in HIV-1 Virologically Suppressed People Living with HIV. Viruses 2023; 15:v15040936. [PMID: 37112915 PMCID: PMC10145987 DOI: 10.3390/v15040936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 04/05/2023] [Accepted: 04/08/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND The high effectiveness and safety of the two-drug (2DRs) strategy using dolutegravir (DTG) plus lamivudine (3TC) have led to international guidelines recommending their use for treatment-naive HIV patients. In virologically suppressed patients, de-escalating from 3DRs to DTG plus either rilpivirine (RPV) or 3TC has shown high rates of virological suppression. OBJECTIVES This study aimed to compare the real-life data of two multicenter Spanish cohorts of PLWHIV treated with DTG plus 3TC (SPADE-3) or RPV (DORIPEX) as a switch strategy, not only in terms of virological suppression, safety, and durability but also in terms of immune restoration. The primary endpoint was the percentage of patients with virological suppression on DTG plus 3TC and DTG plus RPV at weeks 24 and 48. The secondary outcomes included the proportion of patients who experienced the protocol-defined loss of virological control by week 48; changes in immune status in terms of CD4+ and CD8+ T lymphocyte counts and the CD4+/CD8+ ratio; the rate, incidence, and reasons for discontinuation of treatment over the 48-week study period; and safety profiles at weeks 24 and 48. METHODS We conducted a retrospective, observational, multicenter study of 638 and 943 virologically suppressed HIV-1-infected patients in two cohorts who switched to 2DRs with DTG plus RPV or DTG plus 3TC. RESULTS The most frequent reasons for starting DTG-based 2DRs were treatment simplification/pill burden or drug decrease. The virological suppression rates were 96.9%, 97.4%, and 99.1% at weeks 24, 48, and 96, respectively. The proportion of patients with virological failure over the 48-week study period was 0.01%. Adverse drug reactions were uncommon. Patients treated with DTG+3TC increased CD4, CD8, and CD4/CD8 parameters at 24 and 48 weeks. CONCLUSIONS We conclude that DTG-based 2DRs (combined with 3TC or RPV) in clinical practice were effective and safe as a switching strategy, with a low VF and high viral suppression rates. Both regimens were well tolerated, and ADR rates were low, including neurotoxicity and induced treatment discontinuations.
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Affiliation(s)
- Carlos Dueñas-Gutiérrez
- Infectious Diseases Division, Hospital Universitario Clínico de Valladolid, 47003 Valladolid, Spain
| | - Luis Buzón
- Infectious Diseases Division, Hospital Universitario de Burgos, 09006 Burgos, Spain
| | - Roberto Pedrero-Tomé
- Infanta Leonor University Hospital Research and Innovation Foundation, 28031 Madrid, Spain
| | - José A Iribarren
- Infectious Diseases Department, Hospital Universitario de Donostia, 20014 San Sebastián, Spain
| | - Ignacio De Los Santos
- Infectious Diseases Division, Hospital Universitario de La Princesa, 28006 Madrid, Spain
| | - Sara De la Fuente
- Infectious Diseases Division, Hospital Universitario Puerta de Hierro, 28222 Madrid, Spain
| | - Guillermo Pousada
- Infectious Diseases Division, Hospital Universitario de Txagorritxu, 01009 Vitoria, Spain
| | - Miguel Angel Moran
- Infectious Diseases Division, HospitalÁlvaro Cunqueiro, 36312 Vigo, Spain
| | - Estela Moreno
- Infectious Diseases Division, Complejo Hospitalario de Navarra, 31008 Pamplona, Spain
| | - Eva Ferreira
- Infectious Diseases Division, Hospital de Segovia, 47002 Segovia, Spain
| | - Julia Gómez
- Infectious Diseases Division, Hospital Universitario de Salamanca, 37007 Salamanca, Spain
| | - Jesús Troya
- Internal Medicine Department, Hospital Universitario Infanta Leonor, 28031 Madrid, Spain
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12
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Nasreddine R, Yombi JC, Darcis G, Florence E, Allard SD, De Scheerder MA, Henrard S, Demeester R, Messiaen P, Ausselet N, Loeckx M, Delforge M, De Wit S. Efficacy, durability, and tolerability of dolutegravir/lamivudine and dolutegravir/rilpivirine for the treatment of HIV in a real-world setting in Belgium. HIV Med 2023; 24:267-278. [PMID: 35938381 DOI: 10.1111/hiv.13373] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 07/14/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES A paradigm shift from three-drug regimens to two-drug regimens (2DRs) is currently taking place in real-world clinical practice. This study aimed to describe the efficacy, durability, and tolerability of dolutegravir (DTG)/lamivudine (3TC) and DTG/rilpivirine (RPV) in a real-world setting. METHODS This was a retrospective, observational, multicentre (ten centres in Belgium) study involving adult treatment-naïve and treatment-experienced people living with HIV on DTG/3TC or DTG/RPV between 1 January 2019 and 30 September 2020. The primary endpoint was rate of virological suppression (VS; plasma HIV-1 viral load [VL] <50 copies/ml) using an on-treatment analysis. Main secondary endpoints included the proportion of people that experienced loss of VS (LVS; defined as two consecutive HIV-1 VLs of >200 copies/ml after initially achieving VS) and a resistance analysis at the time of LVS; rate, incidence, and reasons for discontinuation of treatment (stopping treatment or changing any component of the 2DR); and change in weight, along with the proportion of people reporting a >10% weight gain. Ordinal logistic regression analysis examined associations between baseline variables and >10% on-treatment weight gain. RESULTS Overall, 948 people were included, of whom 734 (77%) were on DTG/3TC and 214 (23%) were on DTG/RPV. Baseline characteristics included 54% aged ≥50 years, 31% female, 31% Black sub-Saharan African, 95% treatment-experienced, and 8% with HIV-1 VL ≥50 copies/ml. Through 48 weeks, the rate of VS for the overall cohort was 98.3% (99.1% with 3TC; 96.2% with RPV). LVS was observed in 0.5% (n = 5) of the overall population (n = 1 [3TC group], n = 4 [RPV group]). There were 40 treatment discontinuations (4.2%, n = 27 [3TC group]; n = 13 [RPV group]), corresponding to an incidence of 4.7 per 100 patient-years. The most common reason for discontinuation was an adverse event (1.4%), with neurotoxicity the most frequent (0.5%). Median on-treatment weight gain at week 48 was 1 kg (interquartile range [IQR] -1-3) overall, 1 kg (IQR -1-3) in the 3TC group, and 2 kg (IQR 0-4) in the RPV group. A >10% weight increase was observed in 6.3% of people. Regression analysis showed that being on a tenofovir disoproxil fumarate-based regimen prior to 2DR initiation was the only variable associated with a >10% increase in weight from baseline (odds ratio 3.48; 95% confidence interval 1.13-10.68; p = 0.038). CONCLUSION In this real-world analysis, the 2DRs analysed were effective, durable, and safe for those who were treatment-naive and treatment-experienced. A slight increase in weight was associated with these regimens.
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Affiliation(s)
| | | | | | | | | | | | - Sophie Henrard
- University Clinics of Brussels - Erasme Hospital, Brussels, Belgium
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13
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Dolutegravir Plus 3TC in Virologically Suppressed PLWHIV: Immunological Outcomes in a Multicenter Retrospective Cohort in Spain during the COVID-19 Pandemic. Viruses 2023; 15:v15020322. [PMID: 36851536 PMCID: PMC9963008 DOI: 10.3390/v15020322] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/18/2023] [Accepted: 01/19/2023] [Indexed: 01/26/2023] Open
Abstract
Dolutegravir (DTG) based dual therapies for treating PLWHIV are a standard of care nowadays. Switching to DTG and lamivudine (3TC) safety and efficacy were proven in TANGO randomized clinical trial. This multicenter retrospective study included 1032 HIV virologically suppressed patients switching to DTG+3TC from 13 Spanish hospitals. DTG+3TC provided high rates of undetectable viral load over 96%, corresponding to 96.6% (889/921) at 24 weeks, 97.5% (743/763) at 48 weeks, and 98.3% (417/425) at 96 weeks. No significant differences are evident when comparing the total population according to sex, presence of comorbidity, or presence of AIDS. The analysis for paired data showed an increase in CD4+ cell count. A statistically significant increase in CD4+ lymphocyte count was found in those without comorbidities in the three-time series analyzed [average increase at 24 weeks: 48.7 (SD: 215.3) vs. 25.8 (SD: 215.5), p-value = 0.050; a mean increase at 48 weeks: 75.1 (SD: 232.9) vs. 42.3 (SD: 255.6), p-value = 0.003; a mean increase at 96 weeks: 120.1 (SD: 205.0) vs. 63.8 (SD:275.3), p-value = 0.003]. In conclusion, our cohort demonstrates that DTG+3TC is an effective treatment strategy for virologically-suppressed PLWHIV independent of age, sex, and HIV stage, as well as a safe and durable strategy.
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Grau S, Miró JM, Olalla J, Alcalá JC, Castro A, Rubio-Rodríguez D, Rubio-Terrés C. Comparison of the design and methodology of Phase 3 clinical trials of bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) and dolutegravir-based dual therapy (DTG) in HIV: a systematic review of the literature. Expert Rev Anti Infect Ther 2023; 21:65-76. [PMID: 36399521 DOI: 10.1080/14787210.2023.2149490] [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: 11/19/2022]
Abstract
INTRODUCTION Current recommended antiretroviral regimens include a combination of two (dual; DT) or three (triple; TT) antiretroviral drugs. This study aims to determine whether the quality of evidence from clinical trials of dolutegravir (dolutegravir/lamivudine [DTG/3TC] or dolutegravir/rilpivirine [DTG/RPV]) is methodologically comparable to that of clinical trials conducted with bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF). AREAS COVERED A systematic review of the medical literature was carried out in PubMed without date or language restrictions, following the PRISMA guidelines. All aspects of the methodological design of phase 3 randomized clinical trials (RCTs) of DT and TT, evaluated by the European Medicines Agency (registration trials), were reviewed. The quality of clinical trials was assessed using the Jadad scale. EXPERT OPINION The search identified 5, 3 and 2 phase 3 RCTs with BIC/FTC/TAF, DTG/3TC and DTG/RPV, respectively, that met the inclusion criteria. The designs would not be comparable due to differences in pre-randomization losses, blinding, patient recruitment, as well as differences in methodological quality, with the average score of the RCTs conducted with BIC/FTC/TAF, DTG/3TC and DTG/RPV being 4.2 (high quality), 3.0 (medium quality) and 3.0 (medium quality), respectively. Due to methodological differences between the BIC/FTC/TAF, DTG/3TC and DTG/RPV RCTs, the results of these are not comparable.
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Affiliation(s)
- Santiago Grau
- Pharmacy Department, Hospital Del Mar, Barcelona, Spain
| | - Jose Maria Miró
- Department of Infectious Diseases, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.,CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Julian Olalla
- Internal Medicine Department, Hospital Costa Del Sol, Marbella, Spain
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Gibas KM, Kelly SG, Arribas JR, Cahn P, Orkin C, Daar ES, Sax PE, Taiwo BO. Two-drug regimens for HIV treatment. Lancet HIV 2022; 9:e868-e883. [PMID: 36309038 PMCID: PMC10015554 DOI: 10.1016/s2352-3018(22)00249-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 08/16/2022] [Accepted: 08/22/2022] [Indexed: 12/05/2022]
Abstract
Combination therapy with three antiretroviral agents has been integral to successful HIV-1 treatment since 1996. Although the efficacy, adverse effects, and toxicities of contemporary three-drug regimens have improved, even the newest therapies have potential adverse effects. The use of two-drug regimens is one way to reduce lifetime exposure to antiretroviral drugs while maintaining the benefits of viral suppression. Multiple large, randomised trials have shown the virological non-inferiority of certain two-drug regimens versus three-drug comparators, including adverse effect differences that reflect known profiles of the antiretroviral drugs in the respective regimens. Two-drug combinations are now recommended in treatment guidelines and include the first long-acting antiretroviral regimen for the treatment of HIV-1. Recommended two-drug regimens differ in their risks for, and factors associated with, virological failure and emergent resistance. The tolerability, safety, metabolic profiles, and drug interactions of two-drug regimens also vary by the constituent drugs. No current two-drug regimen is recommended for people with chronic hepatitis B virus as none include tenofovir. Two-drug regimens have increased options for individualised care.
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Affiliation(s)
- Kevin M Gibas
- Division of Infectious Diseases, Vanderbilt University Medical Center, Vanderbilt University, Nashville, TN, USA
| | - Sean G Kelly
- Division of Infectious Diseases, Vanderbilt University Medical Center, Vanderbilt University, Nashville, TN, USA
| | - Jose R Arribas
- Infectious Diseases Unit, La Paz University Hospital, Hospital La Paz Institute for Health Research, Madrid, Spain; School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
| | - Pedro Cahn
- Fundación Huésped, Buenos Aires, Argentina
| | - Chloe Orkin
- Department of Immunobiology, Queen Mary University of London, London, UK
| | - Eric S Daar
- The Lundquist Institute, Harbor University of California, Los Angeles, Torrence, CA, USA
| | - Paul E Sax
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA
| | - Babafemi O Taiwo
- Division of Infectious Diseases, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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Rildo: Real-World Multicenter Study on the Effectiveness and Safety of Single-Tablet Regimen of Dolutegravir plus Rilpivirine in Treatment-Experienced People Living with HIV. Viruses 2022; 14:v14122626. [PMID: 36560630 PMCID: PMC9780933 DOI: 10.3390/v14122626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/19/2022] [Accepted: 11/24/2022] [Indexed: 11/26/2022] Open
Abstract
Two-drug regimens (2DRs) are emerging in clinical practice guidelines as treatment option for both naive and treatment-experienced people living with HIV (PLHIV). Objectives: To determine the real-life effectiveness of 2DR with 25 mg RPV plus 50 mg DTG in a single-tablet regimen (RPV/DTGSTR) and its impact on viral and immune status, lipid profile, and inflammatory markers. Methods: This observational study included 291 treatment-experienced PLHIV, starting 2DR with RPV/DTGSTR between 29 January 2019 and 2 February 2022, who were followed up for at least six months. Participants gave verbal informed consent for the switch in antiretroviral therapy (ART) to RPV/DTGSTR. Results: The mean age of the 291 participants was 51.3 years; 77.7% were male; and 42.9% were in the AIDS stage with a CD4 nadir of 283.5 ± 204.6 cells/uL. The median time since HIV diagnosis was 19.7 years (IQR: 10.6-27). Before 2DR, patients received a median of five ART lines (IQR: 3-7) for 22.2 years (IQR: 14-26), with 34.4% (n = 100) receiving a three-drug regimen (3DR), 31.3% (n = 91) receiving monotherapy, and 34.4% (n = 100) receiving 2DR. The median time on RPV/DTGSTR was 14 months (IQR: 9.5-21); 1.4% were lost to the follow-up. Effectiveness was 96.2% by intention-to-treat (ITT) analysis, 97.5% by modified ITT, and 99.3% by per-protocol analysis. Virological failure was observed in 0.69%, blips in 3.5%, and switch to another ART in 1.4%. The mean lipid profile improved, with reductions in TC/HDLc ratio (3.9 ± 0.9 vs. 3.6 ± 0.9; p = 0.0001), LDLc (118.3 ± 32.2 mg/dL vs. 106.2 ± 29.8 mg/dL, p = 0.0001), TG (130.9 ± 73.9 mg/dL vs. 115.9 ± 68.5 mg/dL, p = 0.0001), and CD4/CD8 ratio increase (0.99 ± 0.58 vs. 1.01 ± 0.54; p = 0.0001). The cost-effectiveness of 2DR with RPV/DTGSTR was similar to that of DTG/3TC and superior to those of BIC/TAF/FTC and DRV/c/TAF/FTC, with higher virological suppression and lower annual costs. Conclusions: The switch to RPV plus DTG in STR is a cost-effective, long-lasting, and robust strategy for PLHIV, with a very long experience of treatment, which improves the lipid profile without affecting inflammatory markers.
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Yang X, Fu Y, Xie X, Gan L, Song C, Song Y, Li J, Long H. Real-world implementation of dolutegravir plus lamivudine in people living with HIV in Southwest China. Expert Rev Anti Infect Ther 2022; 20:1501-1508. [PMID: 36168914 DOI: 10.1080/14787210.2022.2128766] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Long-term outcome data from real-world studies on the implementation of a two-drug dolutegravir plus lamivudine (DTG+3TC) regimen for the treatment of human immunodeficiency virus (HIV) infection remain limited. This study evaluated the real-world effectiveness and safety of DTG+3TC in people living with HIV (PLHIV) in Southwestern China. METHODS This was an observational, single-center, retrospective study that enrolled antiretroviral therapy (ART)-naïve (n = 36) and ART-experienced patients with HIV (n = 86) between January 2019 and April 2021. The virological response to therapy and adverse events were documented. The primary endpoint was an HIV viral load (VL) <50 copies/mL at week 48. RESULTS The proportion of treatment-naïve and ART-experienced PLHIV with a VL <50 copies/mL at 48 weeks was 97.2% and 97.7%, respectively. The CD4 count increased significantly by 80.2 cells/μL (P = 0.012) and 79.0 cells/μL (P = 0.021) in the ART-naïve and ART-experienced patients, respectively. No patients discontinued DTG+3TC by week 48 due to adverse events. CONCLUSION Virologic suppression may be achieved with DTG+3TC, in ART-naïve patients with a high VL, and in ART-experienced patients with residual viremia. This study also demonstrated a low prevalence of drug-related side effects.
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Affiliation(s)
- Xiaoyan Yang
- School of Public Health, the Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, Guizhou, China
| | - Yanhua Fu
- Department of Infection, Guiyang Public Health Clinical Center, Guiyang, Guizhou, China
| | - Xiaoxin Xie
- Department of Infection, Guiyang Public Health Clinical Center, Guiyang, Guizhou, China
| | - Lin Gan
- Department of Infection, Guiyang Public Health Clinical Center, Guiyang, Guizhou, China
| | - Chunli Song
- Department of Infection, Guiyang Public Health Clinical Center, Guiyang, Guizhou, China
| | - Yebing Song
- Department of Infection, Guiyang Public Health Clinical Center, Guiyang, Guizhou, China
| | - Jun Li
- School of Public Health, the Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, Guizhou, China
| | - Hai Long
- Department of Infection, Guiyang Public Health Clinical Center, Guiyang, Guizhou, China
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Efficacy and Safety of a Simplified Lamivudine Plus Dolutegravir Dual Therapy in HIV-1-Infected Patients: A Multicenter Cohort Study in China. J Acquir Immune Defic Syndr 2022; 91:S42-S50. [PMID: 36094514 DOI: 10.1097/qai.0000000000003047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/11/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Results from both clinical trials and real-world observational studies suggest that lamivudine plus dolutegravir (3TC + DTG) dual therapy has excellent virological efficacy and safety in HIV-1-infected patients. However, there is still no relevant study related to this dual therapy reported in China. METHODS In this multicenter, retrospective, observational study that included HIV-1-infected patients in China, baseline and follow-up data were collected to analyze the virological suppression rate, immune restoration, and adverse events during follow-up in HIV-1-infected patients who switched to the 3TC + DTG dual therapy. RESULTS This study recruited 112 HIV-1-infected patients, including 101 men (90.2%), with a median age of 44.0 years (IQR: 33.00-57.75) and median CD4+ T-cell count of 432.13 cells/μL (IQR: 237.75-578.50). The overall virological suppression rate was 94.5% at the 24-week follow-up. However, the virological suppression rates of men who have sex with men patients and patients with CD4+ T-cell count of <350 cells/μL were higher than the baseline value (P < 0.05) at week 24. The results of Cox regression analysis showed that the baseline CD4+ T-cell count was an independent determinant of immune restoration in patients, and patients with baseline CD4+ T-cell count of 350-500 cells/μL outperformed patients with baseline CD4+ T-cell count of <350 cells/μL in immune restoration (hazard ratio: 4.469, 95% confidence interval: 1.801 to 11.091, P = 0.001). Adverse events were reported in 5 patients (incidence rate of 4.5%); among them, 3 patients developed neuropsychiatric symptoms. Results from the laboratory data analysis showed that patients with grade 1 and 2 adverse events had elevated levels of low-density lipoprotein cholesterol and total bilirubin. Furthermore, grade 3 and 4 adverse events were associated with the elevation of blood glucose level in 4 patients. CONCLUSIONS Thus, the 3TC + DTG dual therapy displayed an excellent virological efficacy against HIV-1 infections and had an acceptable safety profile, with predominantly mild adverse events in HIV-1-infected patients in China.
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Ergen P, Bektas B, Aydın Ö, Keskin H, Üçışık AC, Karadağ FY, Cağ Y. Evaluation of treatment efficacy after switching to dolutegravir-lamivudine dual therapy in people living with HIV. Afr Health Sci 2022; 22:426-435. [PMID: 36910407 PMCID: PMC9993276 DOI: 10.4314/ahs.v22i3.46] [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: 11/16/2022] Open
Abstract
Background People living with HIV need to use antiretroviral therapy throughout their lives. Objectives Studies on the efficacy and safety of dual therapy are limited in Turkey. We sought to evaluate the treatment efficacy and side effects among patients who were given a combination of dolutegravir (DTG) and lamivudine (3TC) as a maintenance therapy. Methods This retrospective, single-centre study included individuals with viral suppression who were older than 18 years of age, living with HIV, switched from a combination antiretroviral therapy regimen to DTG-3TC dual therapy, and followed up for at least 6 months. Results The study included 63 patients living with HIV. The median age was 42 years (interquartile range (IQR): 36-51 years). The median follow-up under the DTG-3TC regimen was 10.4 months (7.1-16.0 months). In the course of dual therapy, no patients developed any serious adverse effects that would necessitate a therapy switch, but virological blips were seen in two patients. Two patients lost their lives, with one dying from suicide and one dying from respiratory failure associated with the underlying chronic obstructive pulmonary disease. Conclusion The DTG-3TC dual-therapy regimen is a promising and effective therapy that can be used as a treatment of choice for eligible patients.
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Affiliation(s)
- Pınar Ergen
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medeniyet University Göztepe Training and Research Hospital, Istanbul, Turkey
| | - Begüm Bektas
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medeniyet University Göztepe Training and Research Hospital, Istanbul, Turkey
| | - Özlem Aydın
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medeniyet University Göztepe Training and Research Hospital, Istanbul, Turkey
| | - Havva Keskin
- Department of Internal Medicine, Istanbul Medeniyet University Göztepe Training and Research Hospital, Istanbul, Turkey
| | - Ayşe Canan Üçışık
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medeniyet University Göztepe Training and Research Hospital, Istanbul, Turkey
| | - Fatma Yılmaz Karadağ
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medeniyet University Göztepe Training and Research Hospital, Istanbul, Turkey
| | - Yasemin Cağ
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medeniyet University Faculty of Medicine, Istanbul, Turkey
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Pérez-Cordón L, Sánchez A, Marin S, Force L, Serra-Prat M, Palomera E, Campins L. Real-world effectiveness and durability of dual antiretroviral therapy in HIV-infected patients. Eur J Hosp Pharm 2022; 31:ejhpharm-2022-003277. [PMID: 35882532 PMCID: PMC10895179 DOI: 10.1136/ejhpharm-2022-003277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 07/11/2022] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND AND OBJECTIVES While randomised controlled trials in HIV-infected patients have shown that certain dual antiretroviral therapy (DAT) regimens are non-inferior in terms of efficacy compared with classical triple-drug regimens, few real clinical experiences have been described. The aim of the study was to investigate, in real clinical practice, DAT effectiveness, durability, and risk factors for treatment discontinuation. METHODS This was a prospective cohort study that included HIV-infected patients treated with DAT (2015-2020). DAT was considered effective when patients achieved or maintained virological suppression and was assessed at 24 and 48 weeks. DAT durability was evaluated using the Kaplan-Meier method. Adherence and treatment cost were compared with patients' previous antiretroviral regimens. RESULTS 51 patients were included, 27.5% with HIV-1 RNA ≥50 copies/mL at baseline, treated with a wide range of dual combinations. At 48 weeks follow-up, 83.8% and 50.0% of patients who started DAT with HIV-1 RNA <50 copies/mL and ≥50 copies/mL, respectively, were suppressed. 39 out of 51 patients (76.5%) maintained DAT for a mean treatment duration of 40.5±14.8 weeks. Full adherence was observed in 78.4% of patients compared with 70.2% in the previous regimen. Mean daily cost was €18.6±4.3 compared with €16.1±7.9 in the previous regimen (p=0.008). CONCLUSION DAT effectiveness and durability were higher in patients who were virologically suppressed at baseline. DAT is a possible alternative for virologically non-suppressed patients who cannot be treated with a triple-drug regimen.
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Affiliation(s)
| | | | - Sergio Marin
- Pharmacy Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Lluis Force
- Department of Internal Medicine, Hospital de Mataró, Mataró, Spain
| | | | | | - Lluis Campins
- Pharmacy Department, Hospital de Mataró, Mataró, Spain
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21
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Magnasco L, Pincino R, Pasculli G, Bouba Y, Saladini F, Bavaro DF, De Vito A, Lattanzio R, Corsini R, Zazzi M, Incardona F, Rossetti B, Bezenchek A, Borghi V, Di Biagio A. Predictors of Virological Failure Among People Living with HIV Switching from an Effective First-Line Antiretroviral Regimen. AIDS Res Hum Retroviruses 2022; 38:463-471. [PMID: 34969260 DOI: 10.1089/aid.2021.0016] [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] [Indexed: 11/12/2022] Open
Abstract
Aim of this study was to assess the predictors of virological failure (VF) among patients living with HIV (PLWHIV) switching from an effective first-line antiretroviral therapy (ART) regimen, and to evaluate the emergence of resistance-associated mutations. All adult patients enrolled in the Antiviral Response Cohort Analysis cohort who started ART after 2010, with at least 6 months of virological suppression (VS) before ART switch and with an available genotypic resistance test (GRT) at baseline were included. Thirty-two patients out of the 607 PLWHIV included (5.3%) experienced VF after a median of 11 months from ART switch. Younger age (adjusted Hazard Ratio [aHR] 0.96, 95% confidence interval [CI] 0.92-0.99, p = .023), being male who have sex with male (aHR 0.15, 95% CI 0.03-0.69, p = .014), and longer time from VS to ART switch (aHR 0.97, 95% CI 0.95-1.00, p = .021) resulted protective toward VF, while receiving a first-line regimen containing a backbone other than ABC/3TC or TXF/FTC (aHR 3.61, 95% CI 1.00-13.1, p = .050) and a boosted protease inhibitor as anchor drug (aHR 3.34, 95% CI 1.20-9.28, p = .021) were associated with higher risk of VF. GRT at the moment of VF was available only for 13 patients (40.6%). ART switch in patients with stable control of HIV infection is a safe practice, even if particular attention should be paid in certain cases of patients switching from regimens containing low-performance backbones or protease inhibitors.
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Affiliation(s)
- Laura Magnasco
- Infectious Diseases Unit, Ospedale Policlinico San Martino - IRCCS per l'Oncologia, Genoa, Italy
| | - Rachele Pincino
- Infectious Diseases Unit, Ospedale Policlinico San Martino - IRCCS per l'Oncologia, Genoa, Italy
- Department of Health's Sciences, University of Genoa, Genoa, Italy
| | - Giuseppe Pasculli
- Department of Computer, Control, and Management Engineering Antonio Ruberti (DIAG), La Sapienza University, Rome, Italy
| | - Yagai Bouba
- Department of Experimental Medicine, University of Rome "Tor Vergata," Rome, Italy
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaoundé, Cameroon
| | - Francesco Saladini
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Davide Fiore Bavaro
- Department of Biomedical Sciences and Human Oncology, Clinic of Infectious Diseases, University of Bari "Aldo Moro," Bari, Italy
| | - Andrea De Vito
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Rossana Lattanzio
- Department of Biomedical Sciences and Human Oncology, Clinic of Infectious Diseases, University of Bari "Aldo Moro," Bari, Italy
| | - Romina Corsini
- Infectious Diseases Unit, AUSL - IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Maurizio Zazzi
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | | | - Barbara Rossetti
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | | | - Vanni Borghi
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Antonio Di Biagio
- Infectious Diseases Unit, Ospedale Policlinico San Martino - IRCCS per l'Oncologia, Genoa, Italy
- Department of Health's Sciences, University of Genoa, Genoa, Italy
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22
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Hidalgo-Tenorio C, Pasquau J, Vinuesa D, Ferra S, Terrón A, SanJoaquín I, Payeras A, Martínez OJ, López-Ruz MÁ, Omar M, de la Torre-Lima J, López-Lirola A, Palomares J, Blanco JR, Montero M, García-Vallecillos C. DOLAVI Real-Life Study of Dolutegravir Plus Lamivudine in Naive HIV-1 Patients (48 Weeks). Viruses 2022; 14:v14030524. [PMID: 35336931 PMCID: PMC8951045 DOI: 10.3390/v14030524] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/28/2022] [Accepted: 03/02/2022] [Indexed: 12/28/2022] Open
Abstract
Brief: Real-world data in naïve HIV-1 patients demonstrate that dolutegravir plus lamivudine in a multiple tablet regimen is effective, safe, and satisfactory; it causes moderately increasing weight and abdominal circumference and is administrable on a test-and-treat strategy. Background: Our objectives were to determine the real-life effectiveness and safety of DT with dolutegravir (50 mg/QD) plus lamivudine (300 mg/QD) in a multiple-tablet regimen (MTR) in naïve PLHIV followed up for 48 weeks and to evaluate the compliance and satisfaction of patients. Material and methods: An open, single-arm, multicenter, non-randomized clinical trial from May 2019 through September 2020 with a 48-week follow-up. Results: The study included 88 PLHIV patients (87.5% male) with a mean age of 35.9 years; 76.1% were MSM patients. The mean baseline CD4 was 516.4 cells/uL, with a viral load (VL) of 4.49 log10, and 11.4% were in the AIDS stage. DT started within 7 days of first specialist consultation in all patients and the same day in 84.1%; 3.4% had baseline resistance mutations (K103N, V106I + E138A, and V108I); 12.5% were lost to follow-up. At week 48, 86.3% had VL < 50 cop/uL by intention-to-treat analysis and 98.7% by per-protocol (PP) analysis. Virological failure (VF) was recorded in 1.1%, with no resistance mutation. One blip was detected in 5.2% without VF. Three reported anxiety, dizziness, and cephalgia, respectively, at week 4 and one reported insomnia at week 24; none reported adverse events at week 48. The mean weight was 4 kg higher at 48 weeks (p = 0.0001) and abdominal circumference 3 cm larger at 24 weeks (p = 0.022). No forgetfulness occurred in 98.7% of patients. Patient satisfaction was 90/100 at 4, 24, and 48 weeks. Conclusion: Real-world data demonstrate that dolutegravir plus lamivudine in MTR is effective, safe, and satisfactory, moderately increasing weight and abdominal circumference and administrable on a test-and-treat strategy.
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Affiliation(s)
- Carmen Hidalgo-Tenorio
- Unit of Infectious Diseases, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (J.P.); (M.Á.L.-R.); (C.G.-V.)
- Correspondence:
| | - Juan Pasquau
- Unit of Infectious Diseases, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (J.P.); (M.Á.L.-R.); (C.G.-V.)
| | - David Vinuesa
- Unit of Infectious Diseases, University Hospital San Cecilio, 18016 Granada, Spain;
| | - Sergio Ferra
- Unit of Infectious Diseases, Torrecárdenas University Hospital, 04009 Almería, Spain;
| | - Alberto Terrón
- Unit of Infectious Diseases, Hospital de Jerez, 11407 Jerez de la Frontera, Spain;
| | - Isabel SanJoaquín
- Unit of Infectious Diseases, Hospital Lozano Blesa, 50009 Zaragoza, Spain;
| | - Antoni Payeras
- Internal Medicine Service, Hospital Son Llatzer, 07198 Palma, Spain;
| | | | - Miguel Ángel López-Ruz
- Unit of Infectious Diseases, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (J.P.); (M.Á.L.-R.); (C.G.-V.)
| | - Mohamed Omar
- Unit of Infectious Diseases, Hospital Complex of Jaén, 23007 Jaén, Spain;
| | | | - Ana López-Lirola
- Unit of Infectious Diseases, University Hospital Canarias, 38320 San Cristóbal de La Laguna, Spain;
| | - Jesús Palomares
- Internal Medicine Service, Hospital Santa Ana, 18600 Motril, Spain;
| | - José Ramón Blanco
- Unit of Infectious Diseases, Hospital San Pedro, 26006 Logroño, Spain;
| | - Marta Montero
- Service of Infectious Diseases, Hospital de La Fe, 46026 València, Spain;
| | - Coral García-Vallecillos
- Unit of Infectious Diseases, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (J.P.); (M.Á.L.-R.); (C.G.-V.)
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23
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Llibre JM, Cahn PE, Lo J, Barber TJ, Mussini C, van Welzen BJ, Hernandez B, Donovan C, Kisare M, Sithamparanathan M, van Wyk J. Changes in Inflammatory and Atherogenesis Biomarkers With the 2-Drug Regimen Dolutegravir Plus Lamivudine in Antiretroviral Therapy–Experienced, Virologically Suppressed People With HIV-1: A Systematic Literature Review. Open Forum Infect Dis 2022; 9:ofac068. [PMID: 35265729 PMCID: PMC8900931 DOI: 10.1093/ofid/ofac068] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 02/08/2022] [Indexed: 11/23/2022] Open
Abstract
Background The 2-drug regimen dolutegravir plus lamivudine has demonstrated long-term noninferior efficacy vs 3-/4-drug regimens (3/4DRs) in phase 3 trials. This systematic literature review summarizes clinical trial and real-world evidence evaluating impact of dolutegravir plus lamivudine on inflammatory and atherogenesis biomarkers in people with human immunodeficiency virus type 1 (PWH). Methods Using Ovid MEDLINE, Embase, PubMed, and Cochrane library databases and conference proceedings, we searched for studies published from 1 January 2013 to 14 July 2021, reporting changes in inflammatory and atherogenesis biomarkers with dolutegravir plus lamivudine in antiretroviral therapy–experienced, virologically suppressed PWH aged ≥18 years. Results Four records representing 2 randomized controlled trials (RCTs) and 6 records of real-world evidence met eligibility criteria. All real-world studies evaluated CD4+/CD8+ ratio, while only 1 assessed inflammatory biomarkers. Across both RCTs, no consistent pattern of change in biomarkers was observed between dolutegravir/lamivudine and 3/4DR comparators. There were significant changes in soluble CD14 favoring dolutegravir/lamivudine in TANGO at weeks 48 and 144 and SALSA at week 48, and in interleukin-6 favoring the control group in TANGO at weeks 48 and 144. In the real-world study evaluating inflammatory biomarkers, median soluble CD14 significantly decreased 48 weeks postswitch to dolutegravir plus lamivudine (P < .001), while other biomarkers remained stable. In all 6 real-world studies, increases in CD4+/CD8+ ratio were reported after switch to dolutegravir plus lamivudine (follow-up, 12–60 months). Conclusions Results show that dolutegravir plus lamivudine has a comparable impact on inflammatory and atherogenesis biomarkers vs 3/4DRs, with no consistent pattern of change after switch in virologically suppressed PWH.
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Affiliation(s)
- Josep M Llibre
- Infectious Diseases, Fundació Lluita contra la Sida, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | | | - Janet Lo
- Metabolism Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Tristan J Barber
- Ian Charleson Day Centre, Royal Free London NHS Foundation Trust, London, UK
- Institute for Global Health, University College London, London, UK
| | - Cristina Mussini
- Clinic of Infectious Diseases, AOU Policlinico, and University of Modena and Reggio Emilia, Modena, Italy
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24
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Patel R, Evitt L, Mariolis I, Di Giambenedetto S, d'Arminio Monforte A, Casado J, Cabello Úbeda A, Hocqueloux L, Allavena C, Barber T, Jha D, Kumar R, Kamath RD, Vincent T, van Wyk J, Koteff J. HIV Treatment with the Two-Drug Regimen Dolutegravir Plus Lamivudine in Real-world Clinical Practice: A Systematic Literature Review. Infect Dis Ther 2021; 10:2051-2070. [PMID: 34426899 PMCID: PMC8572911 DOI: 10.1007/s40121-021-00522-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/04/2021] [Indexed: 12/15/2022] Open
Abstract
The two-drug regimen dolutegravir plus lamivudine demonstrated durable efficacy for up to 3 years in phase III studies and a high barrier to resistance in treatment-naive and virologically suppressed people with HIV (PWH). This systematic literature review summarizes real-world evidence evaluating effectiveness and safety of dolutegravir plus lamivudine. We searched Ovid MEDLINE®, Embase®, PubMed, Cochrane library, and relevant international conference proceedings from 2013 to 2020. Qualitative synthesis of virologic suppression at Week 48, treatment-emergent resistance, discontinuation rates, and comorbidities was undertaken, with no statistical analyses conducted. Linked publications and potential for duplication in reporting of outcomes for cohorts and populations were identified, and the publication reporting the highest number of PWH receiving dolutegravir plus lamivudine was included in the analysis. Thirty-four studies reporting on cohorts of PWH not suspected to be linked or to include duplicate data receiving dolutegravir plus lamivudine were identified (N = 5017). Of 3744 virologically suppressed PWH who switched to dolutegravir plus lamivudine, 603 (16%) reported history of virologic failure. Nineteen studies included effectiveness data (n = 3558), four of which included data from treatment-naive PWH (n = 69). In studies with > 100 PWH, high rates of virologic suppression (Week 48, 97-100%) were maintained with dolutegravir plus lamivudine, with low rates of virologic failure (0-3.3 per 100 person-years of follow-up); one instance of emergent integrase strand transfer inhibitor resistance was reported in a complex treatment-experienced individual. Rates of discontinuation due to adverse events were low and consistent with previously observed trial data. Dolutegravir plus lamivudine minimally impacted renal function and had minimal impact on or improved lipid profiles and bone mineral density. This systematic review demonstrates that effectiveness and safety of dolutegravir plus lamivudine in clinical practice support data from randomized controlled trials with regard to high rates of virologic response, low rates of discontinuation, and a high barrier to resistance.
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Affiliation(s)
- Rickesh Patel
- ViiV Healthcare, 980 Great West Road, Brentford, TW8 9GS, Middlesex, UK.
| | - Lee Evitt
- ViiV Healthcare, 980 Great West Road, Brentford, TW8 9GS, Middlesex, UK
| | | | - Simona Di Giambenedetto
- UOC Malattie Infettive, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dipartimento di Sicurezza e Bioetica, Sezione di Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonella d'Arminio Monforte
- Department of Health Sciences, Clinic of Infectious Diseases, 'San Paolo' Hospital, University of Milan, Milan, Italy
| | - José Casado
- Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Alfonso Cabello Úbeda
- Infectious Diseases Division, Fundación Jimenez Diaz University Hospital, Madrid, Spain
| | - Laurent Hocqueloux
- Infectious Diseases Department, Centre Hospitalier Régional d'Orléans, Orléans, France
| | | | | | - Diwakar Jha
- GlaxoSmithKline Knowledge Centre, Gurgaon, Haryana, India
| | - Rahul Kumar
- GlaxoSmithKline Knowledge Centre, Gurgaon, Haryana, India
| | | | - Tia Vincent
- ViiV Healthcare, 980 Great West Road, Brentford, TW8 9GS, Middlesex, UK
| | - Jean van Wyk
- ViiV Healthcare, 980 Great West Road, Brentford, TW8 9GS, Middlesex, UK
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25
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Ciccullo A, Borghi V, Giacomelli A, Cossu MV, Sterrantino G, Latini A, Giacometti A, De Vito A, Gennari W, Madeddu G, Capetti A, d'Ettorre G, Mussini C, Rusconi S, Di Giambenedetto S, Baldin G. Five Years With Dolutegravir Plus Lamivudine as a Switch Strategy: Much More Than a Positive Finding. J Acquir Immune Defic Syndr 2021; 88:234-237. [PMID: 34446677 DOI: 10.1097/qai.0000000000002787] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 08/12/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Results from clinical trials and observational studies suggest that dolutegravir plus lamivudine could be an effective and well-tolerated option for simplification in HIV-1-positive patients. We aimed to assess long-time efficacy and safety in our multicenter cohort. METHODS This was a retrospective study enrolling HIV-1-infected, virologically suppressed patients switching to dolutegravir + lamivudine. We performed survival analysis to evaluate time to virological failure (VF, defined by a single HIV-RNA ≥1000 copies/mL or by 2 consecutive HIV-RNA ≥ 50 copies/mL) and treatment discontinuation (defined as the interruption of either 3TC or dolutegravir), assessing predictors via Cox regression analyses. RESULTS Seven-hundred eighty-five patients were considered for the analysis: 554 were men (70.6%), with a median age of 52 years (interquartile range 45-58 years). Estimated probabilities of maintaining virological suppression at weeks 96, 144, and 240 were 97.7% (SD ±0.6), 96.9% (SD ±0.8), and 96.4% (SD ±0.9), respectively. A non-B HIV subtype (P = 0.014) and a previous VF (P = 0.037) resulted predictors of VF. We did not observe differences in probability of VF in people living with HIV with an M184V resistance mutation (P = 0.689); however, in a deeper analysis, M184V mutation was a predictor of VF (P = 0.038) in patients with time of virological suppression <88 months. Estimated probabilities of remaining on study regimen at 96, 144, and 240 weeks were 82.9% (SD ±1.4), 79.7% (SD ±1.6) and 74.3% (SD ±2.2), respectively. CONCLUSIONS Our findings show the long-term efficacy and tolerability of dolutegravir plus lamivudine in virologically suppressed patients.
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Affiliation(s)
- Arturo Ciccullo
- UOC Malattie Infettive, P.O. San Salvatore, L'Aquila, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Vanni Borghi
- Azienda Ospedaliero Universitaria di Modena, Clinica Malattie Infettive e Tropicali, Modena, Italy
| | - Andrea Giacomelli
- Infectious Diseases Unit, DIBIC Luigi Sacco, University of Milan, Milan, Italy
| | - Maria Vittoria Cossu
- Division of Infectious Diseases, Department of Infectious Diseases, Luigi Sacco University Hospital, Milan, Italy
| | - Gaetana Sterrantino
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Alessandra Latini
- Infectious Dermatology and Allergology Unit, IFO S. Gallicano Institute (IRCCS), Rome, Italy
| | - Andrea Giacometti
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Public Health, Polytechnic University of Marche, Ancona. Italy
| | - Andrea De Vito
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - William Gennari
- Azienda Ospedaliero Universitaria di Modena Laboratorio di Microbiologia e Virologia, Modena, Italy
| | - Giordano Madeddu
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Amedeo Capetti
- Division of Infectious Diseases, Department of Infectious Diseases, Luigi Sacco University Hospital, Milan, Italy
| | - Gabriella d'Ettorre
- Department of Public Health and Infectious Diseases, Azienda Policlinico Umberto I, Rome, Italy
| | - Cristina Mussini
- Azienda Ospedaliero Universitaria di Modena, Clinica Malattie Infettive e Tropicali, Modena, Italy
| | - Stefano Rusconi
- Infectious Diseases Unit, DIBIC Luigi Sacco, University of Milan, Milan, Italy
| | - Simona Di Giambenedetto
- Catholic University of the Sacred Heart, Rome, Italy
- UOC Malattie Infettive, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy ; and
| | - Gianmaria Baldin
- UOC Malattie Infettive, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy ; and
- Mater Olbia Hospital, Olbia, Italy
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26
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Deschanvres C, Reynes J, Lamaury I, Rey D, Palich R, Bani-Sadr F, Robineau O, Duvivier C, Hocqueloux L, Cuzin L, Joly V, Raffi F, Cabie A, Allavena C. Dolutegravir-based dual maintenance regimens combined with lamivudine/emtricitabine or rilpivirine: risk of virological failure in a real-life setting. J Antimicrob Chemother 2021; 77:196-204. [PMID: 34651192 DOI: 10.1093/jac/dkab367] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 09/02/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Maintenance ART with dolutegravir-based dual regimens have proved their efficacy among HIV-1-infected subjects in randomized trials. However, real-life data are scarce, with limited populations and follow-up. OBJECTIVES We assessed virological failure (VF) and resistance-associated mutations (RAMs) on dolutegravir maintenance regimens in combination with rilpivirine or with lamivudine or emtricitabine (xTC) and analysed the factors associated with VF. METHODS Between 2014 and 2018, all HIV-1-infected adults included in the Dat'AIDS cohort and starting dolutegravir/rilpivirine or dolutegravir/xTC as a maintenance dolutegravir-based dual regimen were selected. VF was defined as two consecutive HIV RNA values >50 copies/mL or a single value >400 copies/mL. We compared cumulative genotypes before initiation of a maintenance dolutegravir-based dual regimen with genotype at VF. RESULTS We analysed 1374 subjects (799 on dolutegravir/rilpivirine and 575 on dolutegravir/xTC) with a median follow-up of 20 months (IQR = 11-31) and 19 months (IQR = 11-31), respectively. VF occurred in 3.8% (n = 30) of dolutegravir/rilpivirine subjects and 2.6% (n = 15) of dolutegravir/xTC subjects. Among subjects receiving dolutegravir/rilpivirine, two genotypes harboured emerging RAMs at VF: E138K on NNRTI (n = 1); and E138K+K101E on NNRTI and N155H on INSTI (n = 1). Among subjects receiving dolutegravir/xTC, no new RAM was detected. The only predictive factor of VF on dolutegravir/rilpivirine was the history of failure on an NNRTI-based regimen (adjusted HR = 2.97, 95% CI = 1.28-6.93). No factor was associated with VF on dolutegravir/xTC. CONCLUSIONS In this large real-life cohort, dolutegravir/rilpivirine and dolutegravir/xTC sustained virological suppression and were associated with a low rate of VF and RAM emergence. Careful virological screening is essential before switching to dolutegravir/rilpivirine in virologically suppressed patients with a history of NNRTI therapy.
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Affiliation(s)
- Colin Deschanvres
- Infectious Diseases Department, Nantes University Hospital, Nantes, France
| | - Jacques Reynes
- Infectious and Tropical Diseases Department, Montpellier University Hospital, Montpellier, France.,UMI 233, Inserm U1175, Montpellier University Hospital, Montpellier, France
| | - Isabelle Lamaury
- Department of Infectious and Tropical Diseases, Dermatology, Internal Medicine, University Hospital of Guadeloupe, Pointe-à-Pitre, France
| | - David Rey
- Human Immunodeficiency Virus Care Center, Strasbourg University Hospitals, Strasbourg, France
| | - Romain Palich
- Infectious Diseases Department, Pitié-Salpêtrière Hospital, Paris, France
| | - Firouzé Bani-Sadr
- Department of Internal Medicine, Clinical Immunology and Infectious Diseases, Reims University Hospital, Reims, France
| | - Olivier Robineau
- Infectious Diseases Department, Gustave Dron Hospital, Tourcoing, France
| | - Claudine Duvivier
- Infectious and Tropical Diseases Department, Institut Pasteur, Paris, France
| | - Laurent Hocqueloux
- Department of Infectious and Tropical Diseases, Regional Hospital Center, Orléans, France
| | - Lise Cuzin
- CERPOP, Inserm UMR1295, Toulouse University, Toulouse, France.,Infectious Diseases Department, Martinique University Hospital, Fort-de-France, France
| | - Veronique Joly
- Infectious and Tropical Diseases Department, Bichat-Claude Bernard University Hospital, Paris, France
| | - Francois Raffi
- Infectious Diseases Department, Nantes University Hospital, Nantes, France
| | - André Cabie
- Infectious Diseases Department, Martinique University Hospital, Fort-de-France, France
| | - Clotilde Allavena
- Infectious Diseases Department, Nantes University Hospital, Nantes, France
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27
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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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28
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Mendoza I, Lázaro A, Torralba M. Effectiveness, Durability, and Safety of Dolutegravir and Lamivudine Versus Dolutegravir, Lamivudine, and Abacavir in a Real-Life Cohort of HIV-Infected Adults. Ann Pharmacother 2021; 56:412-421. [PMID: 34293960 DOI: 10.1177/10600280211034176] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Dolutegravir (DTG) plus lamivudine (2-DR) is suggested as an initial and switch option in HIV-1 treatment. OBJECTIVE To analyze the effectiveness, durability, and safety of 2-DR compared with DTG plus abacavir/lamivudine (3-DR). METHODS This was an observational, ambispective study that included all treatment-naïve (TN) and treatment-experienced (TE) patients who started 2-DR or 3-DR between July 1, 2018, and November 30, 2020. The primary end point was noninferiority, at 24 and 48 weeks, of 2-DR versus 3-DR regarding the percentage of patients with viral load (VL)≥50 and 200 copies/mL in TN (4% margin) and VL<50 and 200 copies/mL in TE (margin 12%). Durability of response, and safety were also measured. RESULTS 242 patients were included (53 TN and 189 TE). Two TN patients on 2-DR had VL≥50 copies/mL and 1 had VL≥200 copies/mL at week 24. In TE patients on 2-DR, 90.2% achieved VL<200 copies/mL at week 24 (difference: 3.8%; 95% CI = -6.3% to 14%) and 91.8% at week 48 (difference: 0.06%; 95% CI = -9% to 10%), meeting noninferiority criteria. Among the 53 TN patients, only 1 VF was observed in 2-DR. In TN patients, the risk of treatment discontinuation was similar between groups (hazard ratio [HR] = 0.37; P = 0.15); similar rates were also found in TE patients (HR = 0.94; P = 0.85). TE patients on 2-DR showed a better safety profile compared with 3-DR patients (P<0.001). CONCLUSION AND RELEVANCE Our results did not show noninferiority in terms of virological effectiveness. Nevertheless, all effectiveness measures support the use of 2-DR in a real-life cohort of TN and TE. Additionally, durability and safety of 2-DR were confirmed to be similar to that of 3-DR.
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Affiliation(s)
- Inés Mendoza
- Pharmacy Department, Hospital Universitario de Guadalajara, Guadalajara, Spain.,Alcalá University, Alcalá de Henares, Spain
| | - Alicia Lázaro
- Pharmacy Department, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - Miguel Torralba
- Alcalá University, Alcalá de Henares, Spain.,Internal Medicine Department, Research Unit. Hospital Universitario de Guadalajara, Guadalajara, Spain
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29
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Pujari S, Patel A, Gaikwad S, Patel K, Dabhade D, Chitalikar A, Joshi K, Bele V. Effectiveness of dolutegravir-based antiretroviral treatment for HIV-2 infection: retrospective observational study from Western India. J Antimicrob Chemother 2021; 75:1950-1954. [PMID: 32277827 DOI: 10.1093/jac/dkaa112] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 02/23/2020] [Accepted: 03/03/2020] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Data on the use of dolutegravir for treatment of HIV-2 infection are limited. OBJECTIVES To assess the effectiveness of dolutegravir in people living with HIV-2 (PLHIV-2). METHODS A retrospective chart review was performed in two clinics in Western India. PLHIV-2 initiated on dolutegravir-based regimens were included. Response to treatment in both treatment-naive (TN) and treatment-experienced (TE; substitution and not in the context of failure) was assessed by CD4 counts and HIV-2 viral load (VL) in a proportion of individuals. The primary objective was to assess immunological effectiveness (absence of a drop in absolute CD4 counts by more than 30% of baseline). Change in absolute CD4 counts was assessed by fitting a mixed-effects model. RESULTS Sixty-two PLHIV-2 treated with dolutegravir were included. The immunological effectiveness rates (95% CI) were 91.9% (82.4%-96.5%), 92% (81.1%-96.8%) and 91.6% (64.6%-98.5%) amongst all, TE and TN individuals, respectively. Median change in absolute CD4 counts at 6, 12 and 18 months were +29 cells/mm3, +101 cells/mm3 and +72 cells/mm3, respectively. The virological effectiveness rates (HIV-2 VL <100 copies/mL) (95% CI) for all, TE and TN individuals were 88.8% (74.6%-95%), 89.6% (73.6%-96.4%) and 85.7% (48.6%-97.4%), respectively. Three clinical events were documented: spinal tuberculosis, relapsed non-Hodgkin's lymphoma and herpes simplex virus retinitis. One individual reported self-limiting somnolence. CONCLUSIONS Dolutegravir was well tolerated and associated with immunological, virological and clinical effectiveness in both TN and TE PLHIV-2 in a large cohort from Western India. Dolutegravir-based ART is an excellent option for treatment of individuals with HIV-2 infection.
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Affiliation(s)
| | - Atul Patel
- Infectious Diseases Clinic, Ahmedabad, India
| | | | - Ketan Patel
- Infectious Diseases Clinic, Ahmedabad, India
| | | | | | - Kedar Joshi
- Institute of Infectious Diseases, Pune, India
| | - Vivek Bele
- Institute of Infectious Diseases, Pune, India
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30
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Calza L, Colangeli V, Borderi M, Testi D, Granozzi B, Bon I, Re MC, Viale P. Simplification to dual therapy containing lamivudine and raltegravir or dolutegravir in HIV-infected patients on virologically suppressive antiretroviral therapy. J Antimicrob Chemother 2021; 75:3327-3333. [PMID: 32728708 DOI: 10.1093/jac/dkaa319] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 06/25/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Antiretroviral dual regimens including lamivudine and one boosted PI or dolutegravir are warranted in order to optimize combination ART (cART), prevent long-term toxicity and reduce the cost of treatments. OBJECTIVES We hypothesized that a maintenance dual regimen of lamivudine plus raltegravir would be effective and as well tolerated as the dual maintenance combination of lamivudine plus dolutegravir. METHODS We performed an observational, retrospective study of HIV-infected patients on suppressive ART who switched to a dual regimen containing lamivudine 300 mg once daily plus raltegravir 1200 mg once daily or dolutegravir 50 mg once daily. RESULTS In total, 109 patients (79 men; mean age 46.4 years; mean CD4+ T lymphocyte count 605 cells/mm3) were enrolled. Overall, 50 subjects switched to lamivudine plus raltegravir (Group A) and 59 to lamivudine plus dolutegravir (Group B). After 12 months, 45 patients (90%) in Group A and 52 (88.1%) in Group B had HIV RNA <20 copies/mL. No patients had severe adverse effects in either group, and the percentages of patients with mild adverse effects were comparable, except for a higher incidence of headache and sleeping disturbances in Group B than in Group A (30.5% versus 14%, P < 0.001). A comparable and non-significant weight increase was reported in both groups (+1.91 kg in Group A and +2.28 kg in Group B). CONCLUSIONS In our study, dual therapies containing lamivudine plus raltegravir or dolutegravir in virologically suppressed patients showed high and comparable efficacy, as well as good tolerability.
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Affiliation(s)
- Leonardo Calza
- Clinic of Infectious Diseases, 'Alma Mater Studiorum' University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Vincenzo Colangeli
- Clinic of Infectious Diseases, 'Alma Mater Studiorum' University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Marco Borderi
- Clinic of Infectious Diseases, 'Alma Mater Studiorum' University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Diletta Testi
- Clinic of Infectious Diseases, 'Alma Mater Studiorum' University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Bianca Granozzi
- Clinic of Infectious Diseases, 'Alma Mater Studiorum' University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Isabella Bon
- Unit of Microbiology, 'Alma Mater Studiorum' University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Maria Carla Re
- Unit of Microbiology, 'Alma Mater Studiorum' University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Pierluigi Viale
- Clinic of Infectious Diseases, 'Alma Mater Studiorum' University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
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Baldin G, Ciccullo A, Lombardi F, D'Angelillo A, Dusina A, Emiliozzi A, Farinacci D, Moschese D, Picarelli C, Borghetti A, Di Giambenedetto S. Short Communication: Comparing Lamivudine+Dolutegravir and Bictegravir/Emtricitabine/Tenofovir Alafenamide as Switch Strategies: Preliminary Results from Clinical Practice. AIDS Res Hum Retroviruses 2021; 37:429-432. [PMID: 33280486 DOI: 10.1089/aid.2020.0219] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
We tried to investigate and compare the safety of a dual therapy (DT) with dolutegravir+lamivudine (DTG +3TC) versus bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF). We performed a retrospective analysis in a cohort of virologically suppressed HIV+ pts switching to DT or BIC in our center. Primary endpoint was to evaluate time to treatment discontinuation (TD) for any cause. Survival analysis was employed to determine time to TD and its predictors were analyzed by Cox regression. Moreover, we collected viro-immunological parameters as well as markers of renal function and lipid profile at baseline and after 24 weeks and assessed changes through nonparametric tests. We analyzed 476 patients: 350 starting a DT and 126 starting BIC. Overall, we registered 21 TD: 15 in the DT group during 170 patient-years of follow-up (PYFU) (a rate of 8.8 per 100 PYFU) and 6 in the BIC one during 48 PYFU (12.5 per 100 PYFU). Estimated probabilities of maintaining study regimen after 24 weeks were 95.5% [standard deviation (SD) ±1.1] in the DT group and 94.9% (SD ±2.0) in the BIC group, with no significant differences between them (log-rank p = .639). Concerning metabolic profile, in the DT group, after 24 weeks, triglycerides decreased significantly (median change -14 mg/dL, p < .001), whereas high-density lipoprotein cholesterol increased (+3 mg/dL, p = .031). In the BIC group, meanwhile, we observed a significant decrease in low-density lipoprotein cholesterol after 24 weeks (-13 mg/dL, p = .026). Both optimization strategies showed high tolerability in the short term in experienced pts, with few differences between them. Further studies are needed to properly assess the matter.
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Affiliation(s)
- Gianmaria Baldin
- Mater Olbia Hospital, Olbia, Italy
- Fondazione Policlinico Agostino Gemelli IRCCS, UOC Malattie Infettive, Roma, Italy
| | - Arturo Ciccullo
- Fondazione Policlinico Agostino Gemelli IRCCS, UOC Malattie Infettive, Roma, Italy
- Gemelli Molise Hospital, Campobasso, Italy
| | - Francesca Lombardi
- Dipartimento di Sicurezza e Bioetica, Sezione di Malattie Infettive, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Anna D'Angelillo
- Dipartimento di Sicurezza e Bioetica, Sezione di Malattie Infettive, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Alex Dusina
- Fondazione Policlinico Agostino Gemelli IRCCS, UOC Malattie Infettive, Roma, Italy
| | - Arianna Emiliozzi
- Dipartimento di Sicurezza e Bioetica, Sezione di Malattie Infettive, Università Cattolica del Sacro Cuore, Roma, Italy
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Damiano Farinacci
- Dipartimento di Sicurezza e Bioetica, Sezione di Malattie Infettive, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Davide Moschese
- Fondazione Policlinico Agostino Gemelli IRCCS, UOC Malattie Infettive, Roma, Italy
| | - Chiara Picarelli
- Fondazione Policlinico Agostino Gemelli IRCCS, UOC Malattie Infettive, Roma, Italy
| | - Alberto Borghetti
- Fondazione Policlinico Agostino Gemelli IRCCS, UOC Malattie Infettive, Roma, Italy
| | - Simona Di Giambenedetto
- Fondazione Policlinico Agostino Gemelli IRCCS, UOC Malattie Infettive, Roma, Italy
- Dipartimento di Sicurezza e Bioetica, Sezione di Malattie Infettive, Università Cattolica del Sacro Cuore, Roma, Italy
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32
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Dolutegravir Plus Lamivudine Two-Drug Regimen: Safety, Efficacy and Diagnostic Considerations for Its Use in Real-Life Clinical Practice-A Refined Approach in the COVID-19 Era. Diagnostics (Basel) 2021; 11:diagnostics11050809. [PMID: 33947009 PMCID: PMC8145545 DOI: 10.3390/diagnostics11050809] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 11/17/2022] Open
Abstract
The diagnostic and therapeutic management of the Coronavirus Disease 2019 (COVID-19) pandemic in the HIV population brought some known criticalities (and opportunities) to the forefront, for both those who are facing their first therapeutic line today, and for those already well viro-suppressed. The clinical, socioeconomic, and psychological impact of the COVID-19 pandemic should not affect the long-term care of people living with HIV, which creates an urgent need to optimize the diagnostic and treatment approach to the first-line or switch regimens. The use of dolutegravir plus a lamivudine two-drug regimen is one of the most promising solutions to ease the management of HIV treatment in this difficult period. In this review, we report the most salient features related to the use of this regimen from real-life cohorts, meta-analyses, randomized clinical trials, and studies presented at international conferences up to March 2021. We focused on the diagnostic and clinical-management implications of its use in real life, and how these comply with the contingent historical situation. The issue of the timing and type of diagnostic procedures and the relevance of classical diagnostic tests (such as genotype for resistance detection) is also discussed. According to the currently available results, dolutegravir plus a lamivudine two-drug regimen represents an outstanding tool, whose expected advantages fulfill the current requirements for optimal daily care of our HIV patients.
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33
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Borghetti A, Ciccullo A, Baldin G, Rusconi S, Capetti A, Sterrantino G, Gennari W, Mussini C, Borghi V, Di Giambenedetto S. Shall We Dance? Extending TANGO's Results to Clinical Practice. Clin Infect Dis 2021; 71:e200-e201. [PMID: 32198516 PMCID: PMC7583402 DOI: 10.1093/cid/ciaa313] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Alberto Borghetti
- Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Unità Operativa Complessa Malattie Infettive, Rome, Italy
| | - Arturo Ciccullo
- Dipartimento di Sicurezza e Bioetica Sezione Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Stefano Rusconi
- Infectious Diseases Unit, Dipartimento di Scienze Biomediche e Cliniche Luigi Sacco, University of Milan, Milan, Italy
| | - Amedeo Capetti
- Division of Infectious Diseases, Department of Infectious Diseases, Luigi Sacco University Hospital, Milan, Italy
| | - Gaetana Sterrantino
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - William Gennari
- Laboratorio di Microbiologia e Virologia, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Cristina Mussini
- Clinica Malattie Infettive e Tropicali, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Vanni Borghi
- Clinica Malattie Infettive e Tropicali, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Simona Di Giambenedetto
- Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Unità Operativa Complessa Malattie Infettive, Rome, Italy.,Dipartimento di Sicurezza e Bioetica Sezione Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy
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34
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Punekar YS, Parks D, Joshi M, Kaur S, Evitt L, Chounta V, Radford M, Jha D, Ferrante S, Sharma S, Van Wyk J, de Ruiter A. Effectiveness and safety of dolutegravir two-drug regimens in virologically suppressed people living with HIV: a systematic literature review and meta-analysis of real-world evidence. HIV Med 2021; 22:423-433. [PMID: 33529489 PMCID: PMC8248313 DOI: 10.1111/hiv.13050] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2020] [Indexed: 01/21/2023]
Abstract
Objectives Dolutegravir (DTG) is widely recommended within three‐drug regimens. However, similar efficacy and tolerability have also been achieved with DTG within two‐drug regimens in clinical trials. This study evaluated the real‐world effectiveness and discontinuations in people living with HIV‐1 (PLHIV) switching to DTG with lamivudine (3TC) or rilpivirine (RPV). Methods This was a one‐arm meta‐analysis utilizing data from a systematic literature review. Data from real‐world evidence studies of DTG + RPV and DTG + 3TC were extracted, pooled and analysed. The primary outcome was the proportion of patients with viral failure (VF; ≥ 50 copies/mL in two consecutive measurements and/or ≥ 1000 copies/mL in a single measurement) at week 48 (W48) and week 96 (W96). Other outcomes included virological suppression (VS; < 50 copies/mL) and discontinuations (W48 and W96). Estimates were calculated for VF, VS as per snapshot (VSS) and on treatment analysis (VSOT), and discontinuations. Results Pooled mean estimates of VF for DTG + 3TC and DTG + RPV were 0.8% [95% confidence interval (CI): 0.4–1.3] and 0.6% (95% CI: 0.0–1.6), respectively, at W48. VSS rate at W48 was 85.0% (95% CI: 82.3–87.5) for DTG + 3TC regimen and 92.4% (95% CI: 85.0–97.7) in the DTG + RPV regimen. The DTG + 3TC and DTG + RPV regimens led to discontinuations in 13.6% (95% CI: 11.1–16.2) and 7.2% (95% CI: 2.1–14.4) of patients, respectively, at W48. Similar results were observed at W96. Conclusions Treatment with DTG + 3TC or DTG + RPV in clinical practice provides a low rate of VF and a high rate of VS when initiated in virologically suppressed PLHIV with diverse backgrounds.
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Affiliation(s)
| | - D Parks
- GlaxoSmithKline, Collegeville, PA, USA
| | - M Joshi
- GlaxoSmithKline Knowledge Centre, Gurgaon, India
| | - S Kaur
- Parexel India, Chandigarh, India
| | - L Evitt
- ViiV Healthcare, Brentford, UK
| | | | | | - D Jha
- GlaxoSmithKline Knowledge Centre, Gurgaon, India
| | | | - S Sharma
- Parexel India, Chandigarh, India
| | | | - A de Ruiter
- ViiV Healthcare, Brentford, UK.,Guy's and St Thomas' NHS Foundation Trust, London, UK
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35
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Tsutsumi T, Sato H, Kikuchi T, Ikeuchi K, Lim LA, Adachi E, Koga M, Okushin K, Kawahara T, Koibuchi T, Yotsuyanagi H. Factors associated with clearance of hepatitis B virus surface antigen in patients infected with human immunodeficiency virus. Medicine (Baltimore) 2020; 99:e21271. [PMID: 32702915 PMCID: PMC7373618 DOI: 10.1097/md.0000000000021271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Owing to similar routes of transmission, hepatitis B virus (HBV) and human immunodeficiency virus (HIV) coinfection commonly occurs. Compared with patients infected with only HBV, coinfected patients develop persistent HBV infection followed by advanced liver diseases. However, the characteristics of HIV-infected patients who can achieve the clearance of HBV surface antigen (HBsAg) have not been clarified. In this study, we retrospectively examined patients coinfected with HBV and HIV and determined the host factors associated with HBsAg clearance.Among HIV-infected patients who visited our hospital between 1994 and 2017, we examined medical records of those who were seropositive for HBsAg at least once. Among them, patients who cleared HBsAg afterward were regarded as "cured," while those who remained HBsAg-seropositive until 2017 were "chronic."HBsAg seropositivity was found in 57 patients, and among them, 27 male patients were cured whereas 18 were chronic. The cured patients were significantly younger and had higher CD4 cell and platelet counts than the chronic patients. In addition, the cured patients had higher levels of transaminases after the detection of HBsAg. Multivariate analysis revealed age as an independent factor. Analyses of the patients infected with genotype A also showed that the cured patients had significantly higher CD4 cell counts.Considering that the CD4 cell and platelet counts were higher in the cured patients, immunological and liver functions were closely associated with HBsAg clearance. Higher levels of transaminases in the cured patients may also reflect the immunological function leading to HBsAg clearance.
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Affiliation(s)
- Takeya Tsutsumi
- Division of Infectious Diseases, Advanced Clinical Research Center, Institute of Medical Science, The University of Tokyo
| | - Hidenori Sato
- Department of Infectious Diseases and Applied Immunology, IMSUT Hospital of The Institute of Medical Science, The University of Tokyo
| | - Tadashi Kikuchi
- Department of Infectious Diseases and Applied Immunology, IMSUT Hospital of The Institute of Medical Science, The University of Tokyo
| | - Kazuhiko Ikeuchi
- Division of Infectious Diseases, Advanced Clinical Research Center, Institute of Medical Science, The University of Tokyo
| | - Lay Ahyoung Lim
- Department of Infectious Diseases and Applied Immunology, IMSUT Hospital of The Institute of Medical Science, The University of Tokyo
| | - Eisuke Adachi
- Department of Infectious Diseases and Applied Immunology, IMSUT Hospital of The Institute of Medical Science, The University of Tokyo
| | - Michiko Koga
- Division of Infectious Diseases, Advanced Clinical Research Center, Institute of Medical Science, The University of Tokyo
| | - Kazuya Okushin
- Department of Infection Control and Prevention, Graduate School of Medicine, The University of Tokyo
| | - Takuya Kawahara
- Central Coordinating Unit, Clinical Research Support Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Tomohiko Koibuchi
- Department of Infectious Diseases and Applied Immunology, IMSUT Hospital of The Institute of Medical Science, The University of Tokyo
| | - Hiroshi Yotsuyanagi
- Division of Infectious Diseases, Advanced Clinical Research Center, Institute of Medical Science, The University of Tokyo
- Department of Infectious Diseases and Applied Immunology, IMSUT Hospital of The Institute of Medical Science, The University of Tokyo
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Abstract
The oral once-daily, fixed-dose single-tablet regimen (STR) of dolutegravir/lamivudine (Dovato®), combining a second generation integrase single-strand transfer inhibitor (INSTI) and a nucleoside reverse transcriptase inhibitor (NRTI), is indicated as a complete regimen for the treatment of HIV-1 infection in adults and adolescents (> 12 years of age weighing at least 40 kg) with no known or suspected resistance to the INSTI class or lamivudine. In GEMINI trials in antiretroviral therapy (ART)-naïve HIV-1-infected adults, treatment with dolutegravir plus lamivudine provided rapid and sustained virological suppression and was noninferior to dolutegravir plus tenofovir disoproxil fumarate/emtricitabine at 48 weeks, irrespective of baseline patient or disease characteristics. Virological suppression was sustained at 96 weeks in these ongoing trials. In patients with HIV-1 with sustained virological suppression on their current tenofovir alafenamide (AF)-based ART regimen (≥ 3 drugs), switching to treatment with dolutegravir/lamivudine was noninferior to continuing on a tenofovir AF-based regimen at 48 weeks in the ongoing TANGO trial. No resistance mutations to dolutegravir or lamivudine were detected in patients who met criteria for confirmed virological withdrawal in GEMINI and TANGO trials. Hence, the dolutegravir/lamivudine STR is an effective, generally well tolerated and convenient initial and subsequent ART option for adolescents and adults with HIV-1 infection with no known or suspected resistance to the INSTI class or lamivudine.
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Affiliation(s)
- Lesley J Scott
- Springer Nature, Private Bag 65901, Mairangi Bay, Auckland, 0754, New Zealand.
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37
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Ciccullo A, Baldin G, Borghetti A, Di Giambenedetto S. Dolutegravir plus lamivudine for the treatment of HIV-1 infection. Expert Rev Anti Infect Ther 2020; 18:279-292. [PMID: 32067525 DOI: 10.1080/14787210.2020.1729742] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Introduction: Recent data on the 2-drug regimen (2DR) with dolutegravir (DTG) plus lamivudine (3TC) have shown high efficacy and tolerability both in treatment-naïve and experienced HIV-positive patients. Current guidelines recommend DTG+3TC as an alternative to triple antiretroviral therapy (ART) in selected patients to reduce long-term toxicity and costs.Areas covered: This review is intended to provide insight about the efficacy, safety, and tolerability of a 2DR with DTG+3TC in naïve and treatment-experienced patients.Expert opinion: Data from clinical trials and from real-life show that DTG+3TC is an effective and safe switch option for the treatment of experienced patients. In treatment-naïve patients, DTG+3TC has shown non-inferiority compared to standard 3-drug regimens but is less effective in severely immunocompromised naïve patients (i.e. with a CD4+ cell count below 200 cell/mm3); furthermore, current guidelines have upgraded this dual regimen to recommended first-line strategy, but indicate that it should not be used without genotypic resistance results. Moreover, this regimen is not feasible for HBV-coinfected individuals and should not be used during pregnancy. Currently, out of 2-drug regimens, DTG+3TC is one of clinicians' preferred option as it requires no pharmacokinetic booster, has a low risk of drug interaction, and does not require food intake.
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Affiliation(s)
- Arturo Ciccullo
- Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
| | - Gianmaria Baldin
- Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy.,Mater Olbia Hospital, Olbia, Italy
| | - Alberto Borghetti
- UOC Malattie Infettive, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Simona Di Giambenedetto
- Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy.,UOC Malattie Infettive, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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38
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Colafigli M, Ciccullo A, Borghetti A, Fanti I, Melis F, Modica S, Uccella I, Bonadies A, Ferraresi V, Anzalone E, Pennica A, Migliano E, Rossetti B, Madeddu G, Cauda R, Cristaudo A, Di Giambenedetto S, Latini A. Impact of Antiretroviral Therapy on the Risk of Recurrence in HIV-1 Infected Patients with Kaposi Sarcoma: A Multicenter Cohort Experience. J Clin Med 2019; 8:jcm8122062. [PMID: 31771172 PMCID: PMC6947508 DOI: 10.3390/jcm8122062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 11/19/2019] [Accepted: 11/21/2019] [Indexed: 12/17/2022] Open
Abstract
Kaposi sarcoma (KS) remains a relevant malignancy in human immunodeficiency virus (HIV)-infected patients with a non-standardized management; despite past suggestions that ritonavir-boosted protease inhibitor (bPI)-based regimens could be preferable, no combination antiretroviral therapy (cART) regimen was demonstrated to outperform the others and the impact of new drugs, drug classes or paradigms was never investigated nor proven better than previous therapeutic regimes. In order to do this, we retrospectively collected data regarding HIV-infected patients with a diagnosis of KS last seen in six Italian centers after 1 January 2013. A total of 104 KS cases in 99 patients was analyzed for 945.34 patient-year follow-up (PYFU). Twenty-six patients had visceral localizations. Thirty-three patients were treated with chemotherapy, four with electrochemotherapy, and 12 with α-interferon (α-IFN). At censor, 22% received a bPI-based, 14% a non-nucleoside reverse transcriptase inhibitor (NNRTI)-based, and 28% an integrase inhibitor (INI)-based standard cART, 24% a less drug regimen and 12% a mega-cART. Twelve recurrence episodes were observed in seven patients for an incidence of 1.27 per 100 PYFU. Two patients with no evidence of recurrence episodes died for other reasons. In our experience, KS recurrence episodes were infrequent. Despite the increasing use of new antiretroviral drug classes and new treatment paradigms, no excess of recurrence episodes was observed in patients receiving such cART regimens.
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Affiliation(s)
- Manuela Colafigli
- Infectious Dermatology and Allergology, San Gallicano Dermatological Institute IRCCS, 00144 Rome, Italy
- Correspondence ; Tel.: +39-0652662808
| | - Arturo Ciccullo
- Clinical Infectious Diseases, Catholic University of S. Heart, 00168 Rome, Italy
| | - Alberto Borghetti
- Clinical Infectious Diseases, Catholic University of S. Heart, 00168 Rome, Italy
| | - Iuri Fanti
- Clinical Infectious Diseases, Catholic University of S. Heart, 00168 Rome, Italy
| | - Federico Melis
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari Italy
| | - Sara Modica
- Department of Medical Biotechnologies, Azienda Ospedaliera Universitaria Senese, 53100 Siena, Italy
- Infectious Diseases Unit, Azienda Ospedaliera Universitaria Senese, 53100 Siena, Italy
| | | | - Antonio Bonadies
- Plastic Surgery, San Gallicano Dermatological Institute IRCCS, 00144 Rome, Italy
| | - Virginia Ferraresi
- First Division of Medical Oncology, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | | | | | - Emilia Migliano
- Plastic Surgery, San Gallicano Dermatological Institute IRCCS, 00144 Rome, Italy
| | - Barbara Rossetti
- Infectious Diseases Unit, Azienda Ospedaliera Universitaria Senese, 53100 Siena, Italy
| | - Giordano Madeddu
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari Italy
| | - Roberto Cauda
- Clinical Infectious Diseases, Catholic University of S. Heart, 00168 Rome, Italy
| | - Antonio Cristaudo
- Infectious Dermatology and Allergology, San Gallicano Dermatological Institute IRCCS, 00144 Rome, Italy
| | | | - Alessandra Latini
- Infectious Dermatology and Allergology, San Gallicano Dermatological Institute IRCCS, 00144 Rome, Italy
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