Similar CD4/CD8 Ratio Recovery After Initiation of Dolutegravir Plus Lamivudine Versus Dolutegravir or Bictegravir-Based Three-Drug Regimens in Naive Adults With HIV

Evaluation of cytokine levels in HIV-infected individuals on therapy with tenofovir, lamivudine, and dolutegravir

Antiretroviral therapy (ART) is essential to reduce viral load and restore CD4+ T cell levels in people living with HIV/AIDS (PLWHA). However, different treatment protocols influence the levels of cytokines, important mediators of the immune response. This study aimed to evaluate cytokine levels in PLWHA on therapy with tenofovir (TDF), lamivudine (3TC), and dolutegravir (DTG). The results showed that PLWHA on treatment had a significant increase in CD4+ T lymphocyte levels and a reduction in CD8+ T lymphocyte levels compared to naive (untreated) individuals. Furthermore, PLWHA treated with TDF/3TC/DTG had a significant reduction in interleukin (IL)-4 and IL-10 levels (P<0.02; P=0.047) compared to other ART regimens. Naive individuals had higher levels of IL-2 and interferon (IFN)-γ, while their levels of tumor necrosis factor (TNF), IL-4, and IL-10 were lower. These findings suggested that TDF/3TC/DTG treatment modulated cytokines, reducing chronic inflammation and improving the immune response in PLWHA. The decrease in anti-inflammatory cytokines, such as IL-4 and IL-10, may be associated with better regulation of the immune system, resulting in greater control of infection and a balanced inflammatory response.

Efficacy and Safety of Dolutegravir/Lamivudine in Antiretroviral Therapy-Naive People Living With HIV-1 and With High-Level Viremia

BACKGROUND

Dual regimen dolutegravir/lamivudine (DOL/3TC) showed potent efficacy and favorable safety in both antiretroviral therapy-naive and therapy-experienced patients, but data from real life about naive people with high-level viremia are still lacking.

METHODS

We performed a retrospective cohort study of people living with HIV who were naive to antiretroviral therapy, had baseline HIV-1 RNA ranging from 100,000 to 500,000 copies/mL, and initiated DOL/3TC. Virologic efficacy and changes in immunologic parameters after 12 months of treatment were evaluated and compared with highly viremic people living with HIV who started a triple antiretroviral combination.

RESULTS

Inclusion criteria were met by 58 patients with median age of 43.4 years. At baseline, mean HIV RNA was 5.4 log 10 and mean CD4 T lymphocyte count was 488 cells/mm 3 . HIV RNA <50 copies/mL was obtained in 45 patients (77.6% in the intention-to-treat analysis) after 6 months and in 53 patients (91.4%) after 12 months. Reasons for treatment failure were virologic failure in 2 cases and adverse events in 3 cases. No significant changes in median value of lipids were reported, while there was a not significant increase in body weight (+1.18 kg). Virologic and immunologic response at month 12 in patients on DOL/3TC was comparable with that observed in 50 naive patients with high-level viremia and starting a triple antiretroviral therapy.

CONCLUSIONS

In this real-life cohort of naive patients with high-level viremia, DOL/3TC was associated with high virologic efficacy and good tolerability after 12 months, supporting use of this dual regimen also in persons with high initial viremia.

The clinical indexes and immunological status of HIV/AIDS patients undergoing different highly active antiretroviral treatments

Objective

This study aims to investigate the differences of clinical indices in HIV patients between three different first-line antiretroviral treatment strategies in Yunnan Province, China. Furthermore, the hematologic system, liver function, kidney function, blood lipid levels of HIV patients and its association with CD4+ count, CD8+ count, CD4/CD8 ratio and antiretroviral treatment were also assessed.

Methods

This retrospective cohort study included 81 participants who underwent highly active antiretroviral treatment from September 2009 to September 2019. Baseline sociodemographic and clinical characteristics were collected from each study participant. Routine blood tests, liver and renal function, lipid levels as well as lymphocyte subset counts were measured and recorded for evaluation before and 3, 6, 9, and 12 months after the treatment. Paired t-test was used to compare clinical indices changes after antiretroviral treatment. Univariate linear regression was performed to determine the association between clinical indices and CD4+ count, CD8+ count, CD4/CD8 ratio and antiretroviral treatment.

Result

There were no statistical differences in baseline demographic and clinical characteristics in either treatment group. Compared with the initiation of HARRT treatment, the CD4+ count(p < 0.001), CD4/CD8 ratio(p < 0.001) and PLT(p < 0.001) were increased in the three treatment groups. The TC(p < 0.01) and TG(p < 0.05) were increased in 3TC+AZT+EFV group after treatment. The ALT(p < 0.05), AST(p < 0.01) were decreased in 3TC+EFV+TDF group after treatment. The study indicated statistical differences in CD4+ count (p < 0.001), CD8+ count (p < 0.001), and CD4/CD8 ratio (p < 0.001) in the three treatment cohorts. Furthermore, a strong positive correlation was observed between WBC (p < 0.001), platelet (p < 0.001), Hb (p < 0.001), and CD4+ count in the three treatment cohorts. Moreover, ALT and AST were negatively associated with CD4+ count in the 3TC + AZT + EFV group. Whereas WBC were positively correlated with CD8+ count in the three treatment methods. In addition, platelet and TG were positively correlated with CD8+ count in the 3TC + EFV + TDF. The study also indicated that TC was positively associated with CD8+ count in the 3TC + AZT + NVP group. Furthermore, WBC was negatively related to CD4/CD8 ratio in the 3TC + EFV + TDF group. The platelet level analysis revealed a positive, while TG indicated a negative association with CD4/CD8 ratio in the 3TC + AZT + NVP group. Moreover, ALT and AST were negatively correlated with the CD4/CD8 ratio in the 3TC + AZT + EFV and 3TC + AZT + NVP groups.

Conclusion

The results showed that HIV/AIDS patients treated with different first-line antiretroviral treatment strategies had different hematopoietic, liver, renal and immune system functions. Furthermore, some clinical indicators such as WBC, PLT, TC, TG, and ALT could predict the CD4+ count, CD8+ count, CD4/CD8 ratio levels and recuperation of HIV/AIDS patients, therefore, should be monitored by clinicians.

Comparison of dolutegravir+Lamivudine and bictegravir/emtricitabine/tenofovir alafenamide in antiretroviral therapy-naïve patients infected with HIV: preliminary results from clinical practice

BACKGROUND

The efficacy and safety of dolutegravir+lamivudine (DTG +3TC) and bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) have been demonstrated in clinical trials of treatment-naïve therapy. However, real-life data are lacking. We investigated and compared the virological outcomes and safety of DTG + 3TC with BIC/FTC/TAF in an adult cohort of people living with HIV (PLWH).

RESEARCH DESIGN AND METHODS

We performed a retrospective cohort analysis of PLWH who were naïve to antiretroviral therapy and initiated the antiretroviral regimen of DTG + 3TC or BIC/FTC/TAF from January 2020 to March 2022. Treatment effectiveness, defined as the capability of treatment to achieve viral suppression (viral load < 50 copies/mL), was analyzed. Changes in immunology, metabolism, liver and renal function after 48 weeks of treatment were evaluated.

RESULTS

At 48 weeks, both groups showed high viral suppression, with 82.4% (108/131) and 89% (129/145) of the patients in the BIC/FTC/TAF and DTG + 3TC groups, respectively, having viral suppression (OR = 0.58, 95% CI: 0.29-1.15, P = 0.3). No differences existed in immunology, metabolism, liver and renal function; however, BIC/FTC/TAF led to greater weight gain.

CONCLUSIONS

Both optimization strategies showed high tolerability in antiretroviral therapy-naïve patients, with no differences in virological efficacy; however, BIC/FTC/TAF may be related to the risk of weight gain risk. Further research is required to evaluate this problem.

Pharmacological and Behavioral Interventions to Mitigate Premature Aging in Patients with HIV

PURPOSE OF REVIEW

We sought to review pharmacological and behavioral interventions that have been publicly presented, published, or are currently ongoing to prevent or mitigate the effect of premature HIV-associated comorbidities.

RECENT FINDINGS

Multiple studies have been conducted in hopes of finding an effective intervention. While the choice of antiretroviral regimen influences recovery of immune function, several drugs used as adjunct treatments have proven effective to mitigate premature aging. Additionally, few behavioral interventions have exhibited some efficacy. Statins, angiotensin-receptor blockers, and anti-hyperglycemic agents as well as optimal adherence, exercise, and intermittent fasting among others have had beneficial impact on markers of immune activation and levels of inflammatory biomarkers. However, several investigations had inconclusive outcomes so further studies with larger sample sizes are warranted.

Efficacy and safety profiles of dolutegravir plus lamivudine vs . bictegravir/emtricitabine/tenofovir alafenamide in therapy-naïve adults with HIV-1

BACKGROUND

Dual regimen dolutegravir (DTG) plus lamivudine (3TC) has demonstrated non-inferior efficacy compared to DTG-based three-drug regimens (3DRs), yet directly comparative data regarding the efficacy and safety of DTG + 3TC and bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) for therapy-naïve people with human immunodeficiency virus (HIV)-1 (PWH) are still limited. We aimed to assess the antiviral potency and safety profiles of DTG + 3TC vs. B/F/TAF based on antiretroviral therapy (ART)-naïve PWH in China.

METHODS

This retrospective multicenter study enrolled PWH initiating ART with DTG + 3TC or B/F/TAF from 2020 to 2022 in Guangdong and Guangxi. We analyzed response rates based on target not detected (TND) status using intention-to-treat (ITT) analysis. Subgroups were formed based on baseline viral load (VL) (<100,000 vs . ≥100,000 copies/mL) and CD4 + cell count (<200 vs . ≥200 cell/µL). Median time to TND VL was assessed by Kaplan-Meier method. We also measured changes from baseline in CD4 + cell counts, CD4/CD8 ratio, lipid parameters, weight, creatinine (Cr), estimated glomerular filtration rate (eGFR), and drug-related adverse effects (DRAEs).

RESULTS

We enrolled 280 participants, including 137 (48.9%) on DTG + 3TC and 143 (51.1%) on B/F/TAF. At week 48, 96.4% (132/137) on DTG+3TC and 100% (143/143) on B/F/TAF achieved TND ( P = 0.064). At week 12, TND responses were higher with B/F/TAF (78.3% [112/143]) than DTG+3TC (30.7% [42/137]) ( P <0.001). This trend held across subgroups. B/F/TAF achieved TND faster (12 weeks) than DTG+3TC (24 weeks) ( P <0.001). No differences were seen in CD4 + cell count and CD4/CD8 ratio, except in the high-VL subgroup, where B/F/TAF showed better recovery. DRAEs were significantly lower with B/F/TAF (4.9% [7/143]) than with DTG + 3TC (13.1% [18/137]) ( P = 0.016). Lipid parameters, body weight, and Cr increased in both groups over 48 weeks, with DTG+3TC showing a more favorable effect on triglycerides, high-density lipoprotein (HDL) cholesterol, and weight gain.

CONCLUSIONS

In this real-life study, B/F/TAF led to a faster viral decline and fewer DRAEs compared to DTG+3TC. No significant difference was observed in the TND rate at week 48, regardless of baseline VL and CD4 + cell count. CD4 + recovery was superior for B/F/TAF in participants with high VL. The DTG + 3TC regimen had less impact on metabolic changes than B/F/TAF.

Real-Life Experience With Bictegravir/Emtricitabine/Tenofovir Alafenamide in Turkey

INTRODUCTION

Single-tablet regimens (STRs) can increase treatment success and even improve the quality of life of human immunodeficiency virus (HIV) patients. In this study, we aim to analyze the real-life efficacy and tolerability data of people living with HIV (PLWH) initiated on or switched to bictegravir/emtricitabine/tenofovir alafenamide fumarate (BIC/FTC/TAF) as first-line treatment.

MATERIALS AND METHODS

This retrospective analysis was performed in HIV-1-positive patients who were initiated BIC/FTC/TAF in the HIV clinic between June 2020 and June 2022. Patients who received BIC/FTC/TAF for at least 12 months were included in this study. Virological suppression, laboratory parameters, side effects, and immunological response were analyzed at one, three, six, nine, and 12 months.

RESULTS

A total of 116 patients, 66 (56.9%) treatment-experienced and 50 (43.1%) naive, were evaluated within the scope of the study. In the naive patient group, baseline HIV-RNA, CD4+ and CD8+ T cell counts, CD4/CD8 ratio, and estimated glomerular filtration rate (eGFR) values were significantly different in different follow-up months. The number of patients with HIV-1 RNA levels below 50 copies/mL was 55.9% in the first month, 73.7% in the third month, 90.2% in the sixth month, and 100% in the ninth and 12th months.

CONCLUSION

In our real-life observational study, BIC/FTC/TAF treatment achieved rapid viral suppression, maintained viral suppression in virally suppressed patients, and was effective for immunological recovery in both treatment-experienced and naive HIV patients. No serious side effects were observed. Our study has proved the potential of BIC/FTC/TAF as an important option in the treatment of HIV patients.

Reporting of Observational Studies Explicitly Aiming to Emulate Randomized Trials: A Systematic Review

Importance

Observational (nonexperimental) studies that aim to emulate a randomized trial (ie, the target trial) are increasingly informing medical and policy decision-making, but it is unclear how these studies are reported in the literature. Consistent reporting is essential for quality appraisal, evidence synthesis, and translation of evidence to policy and practice.

Objective

To assess the reporting of observational studies that explicitly aimed to emulate a target trial.

Evidence Review

We searched Medline, Embase, PsycINFO, and Web of Science for observational studies published between March 2012 and October 2022 that explicitly aimed to emulate a target trial of a health or medical intervention. Two reviewers double-screened and -extracted data on study characteristics, key predefined components of the target trial protocol and its emulation (eligibility criteria, treatment strategies, treatment assignment, outcome[s], follow-up, causal contrast[s], and analysis plan), and other items related to the target trial emulation.

Findings

A total of 200 studies that explicitly aimed to emulate a target trial were included. These studies included 26 subfields of medicine, and 168 (84%) were published from January 2020 to October 2022. The aim to emulate a target trial was explicit in 70 study titles (35%). Forty-three studies (22%) reported use of a published reporting guideline (eg, Strengthening the Reporting of Observational Studies in Epidemiology). Eighty-five studies (43%) did not describe all key items of how the target trial was emulated and 113 (57%) did not describe the protocol of the target trial and its emulation.

Conclusion and Relevance

In this systematic review of 200 studies that explicitly aimed to emulate a target trial, reporting of how the target trial was emulated was inconsistent. A reporting guideline for studies explicitly aiming to emulate a target trial may improve the reporting of the target trial protocols and other aspects of these emulation attempts.