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Lowenthal ED, Chapman J, Ohrenschall R, Calabrese K, Baltrusaitis K, Heckman B, Yin DE, Agwu AL, Harrington C, Van Solingen-Ristea RM, McCoig CC, Adeyeye A, Kneebone J, Chounta V, Smith-Anderson C, Camacho-Gonzalez A, D'Angelo J, Bearden A, Crauwels H, Huang J, Buisson S, Milligan R, Ward S, Bolton-Moore C, Gaur AH. Acceptability and tolerability of long-acting injectable cabotegravir or rilpivirine in the first cohort of virologically suppressed adolescents living with HIV (IMPAACT 2017/MOCHA): a secondary analysis of a phase 1/2, multicentre, open-label, non-comparative dose-finding study. Lancet HIV 2024; 11:e222-e232. [PMID: 38538161 DOI: 10.1016/s2352-3018(23)00301-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 10/06/2023] [Accepted: 11/13/2023] [Indexed: 04/16/2024]
Abstract
BACKGROUND Long-acting injectable cabotegravir and rilpivirine have demonstrated safety, acceptability, and efficacy in adults living with HIV-1. The IMPAACT 2017 study (MOCHA study) was the first to use these injectable formulations in adolescents (aged 12-17 years) living with HIV-1. Herein, we report acceptability and tolerability outcomes in cohort 1 of the study. METHODS In this a secondary analysis of a phase 1/2, multicentre, open-label, non-comparative dose-finding study, with continuation of pre-study oral combination antiretroviral treatment (ART), 55 adolescents living with HIV-1 were enrolled to receive sequential doses of either long-acting cabotegravir or rilpivirine and 52 received at least two injections. Participants had a body weight greater than 35 kg and BMI less than 31·5 kg/m2 and had been on stable ART for at least 90 consecutive days with an HIV-1 viral load of less than 50 copies per mL at a participating IMPAACT study site. Participants had to be willing to continue their pre-study ART during cohort 1. The primary objectives of the study were to confirm doses for oral and injectable cabotegravir and for injectable rilpivirine in adolescents living with HIV. This analysis of participant-reported outcomes included a face scale assessment of pain at each injection and a Pediatric Quality of Life Inventory (PedsQL) at baseline and week 16 for participants in the USA, South Africa, Botswana, and Thailand. A subset of 11 adolescents and 11 parents or caregivers in the USA underwent in-depth interviews after receipt of one or two injections. This trial is registered at ClinicalTrials.gov, NCT03497676. FINDINGS Between March 19, 2019, and Nov 25, 2021, 55 participants were enrolled into cohort 1. Using the six-point face scale, 43 (83%) of participants at week 4 and 38 (73%) at week 8 reported that the injection caused "no hurt" or "hurts little bit", while only a single (2%) participant for each week rated the pain as one of the two highest pain levels. Quality of life was not diminished by the addition of one injectable antiretroviral. In-depth interviews revealed that parents and caregivers in the USA frequently had more hesitancy than adolescents about use of long-acting formulations, but parental acceptance was higher after their children received injections. INTERPRETATION High acceptability and tolerability of long-acting cabotegravir or rilpivirine injections suggests that these are likely to be favoured treatment options for some adolescents living with HIV. FUNDING National Institutes of Health and ViiV Healthcare.
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Affiliation(s)
- Elizabeth D Lowenthal
- The Children's Hospital of Philadelphia, Division of General Pediatrics and Global Health Center, Philadelphia, PA, USA; University of Pennsylvania Perelman School of Medicine, Departments of Pediatrics and Biostatistics, Epidemiology and Informatics, Philadelphia, PA, USA.
| | - Jennifer Chapman
- The Children's Hospital of Philadelphia, Division of General Pediatrics and Global Health Center, Philadelphia, PA, USA
| | | | | | - Kristin Baltrusaitis
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Dwight E Yin
- National Institute of Allergy and Infectious Diseases (NIAID) Division of AIDS, National Institutes of Health (NIH), Rockville, MD, USA
| | - Allison L Agwu
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | | | - Adeola Adeyeye
- National Institute of Allergy and Infectious Diseases (NIAID) Division of AIDS, National Institutes of Health (NIH), Rockville, MD, USA
| | | | | | | | | | - Jessica D'Angelo
- Northwestern University and Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Allison Bearden
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | | | - Jenny Huang
- ViiV Healthcare, Research Triangle Park, NC, USA
| | | | | | - Shawn Ward
- Frontier Science Foundation, Amherst, NY, USA
| | - Carolyn Bolton-Moore
- Centre for Infectious Disease Research in Zambia/University of Alabama Birmingham, Lusaka, Zambia
| | - Aditya H Gaur
- St Jude Children's Research Hospital, Memphis, TN, USA
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Han K, Gevorkyan H, Sadik Shaik J, Crauwels H, Leemereise C, Bontempo G, Win B, Chounta V, Seal C, DeMoor R, D'Amico R, Spreen WR, Ford SL. Pharmacokinetics and tolerability of cabotegravir and rilpivirine long-acting intramuscular injections to the vastus lateralis (lateral thigh) muscles of healthy adult participants. Antimicrob Agents Chemother 2024; 68:e0078123. [PMID: 38038460 PMCID: PMC10777827 DOI: 10.1128/aac.00781-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/04/2023] [Indexed: 12/02/2023] Open
Abstract
Cabotegravir + rilpivirine administered via intramuscular gluteal injections is the first complete long-acting (LA) regimen approved for maintaining HIV-1 virologic suppression. The vastus lateralis (lateral) thigh muscle could be a potential alternative site of administration in circumstances such as injection site fatigue, intolerability, or contraindication for gluteal administration. Cabotegravir and rilpivirine pharmacokinetics and participant tolerability were evaluated following single intramuscular injections to the lateral thigh. Healthy adult participants received 4 weeks of daily oral cabotegravir (30 mg) and rilpivirine (25 mg), followed by a 10- to 14-day washout and single 3 mL intramuscular injections of cabotegravir LA 600 mg and rilpivirine LA 900 mg to the lateral thigh. Safety, tolerability, and pharmacokinetics were evaluated through 52 weeks post injection. Pharmacokinetic parameters were estimated using non-compartmental analysis. Fifteen participants (female at birth, n = 6) enrolled. Median age was 33 years. Median weight was 93.6 kg. Median body mass index was 31.4 kg/m2. One participant withdrew due to pregnancy after oral dosing before receiving an injection. Plasma concentrations at Weeks 4 and 8 were 15.4- and 5.3-fold above the protein-adjusted 90% inhibitory concentration for cabotegravir and 4.7- and 2.4-fold for rilpivirine, respectively. The most common injection site reactions were pain [28/28 (100%)], induration [15/28 (54%)], and swelling [12/28 (42%)]; 94% were Grade 1 or 2. Cabotegravir and rilpivirine plasma pharmacokinetic profiles observed in this study support further evaluation of thigh administration in target populations of people living with HIV-1. Tolerability of cabotegravir + rilpivirine LA intramuscular lateral thigh injections was similar to gluteal administration.
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Affiliation(s)
- Kelong Han
- Department of Clinical Pharmacology, Modeling & Simulation, GSK, Collegeville, Pennsylvania, USA
| | - Hakop Gevorkyan
- California Clinical Trials Medical Group in affiliation with PAREXEL, Glendale, California, USA
| | - Jafar Sadik Shaik
- Department of Clinical Pharmacology & Pharmacometrics, Janssen Research & Development, Spring House, Pennsylvania, USA
| | - Herta Crauwels
- Department of Clinical Pharmacology, Janssen Research & Development, Beerse, Belgium
| | | | | | | | | | | | | | | | | | - Susan L. Ford
- Department of Clinical Pharmacology, Modeling & Simulation, GSK, Durham, North Carolina, USA
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Chounta V, Byrnes HF, Henry-Szatkowski M, Browning D, Donatti C, Lambert J. Psychometric Validation of the Perception of Injection (PIN) Questionnaire Using Data From Two Phase III, Open-Label, Active-Controlled, Non-Inferiority Studies in People Living With HIV. Adv Ther 2023; 40:5300-5314. [PMID: 37776478 PMCID: PMC10611592 DOI: 10.1007/s12325-023-02656-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/17/2023] [Indexed: 10/02/2023]
Abstract
INTRODUCTION Currently, there are no patient-reported outcome tools specifically validated for use in people living with human immunodeficiency virus (PLHIV) to measure treatment injection acceptance and experience. The Perception of Injection (PIN) questionnaire was modified with consent from the Vaccinees' Perception of Injection (VAPI), a validated instrument developed by Sanofi Pasteur. The objective of developing the PIN was to provide information on participant experience with injectable therapies, including acceptance of pain, injection-site reactions, and tolerability following injections in PLHIV. METHODS This post hoc analysis used data from participants who received the long-acting intramuscular cabotegravir plus rilpivirine combination treatment every 4 weeks, as part of the ATLAS (NCT02951052) and FLAIR (NCT02938520) studies, to evaluate the psychometric properties of the PIN questionnaire. RESULTS These findings support the reliability, validity, and responsiveness to change for the PIN questionnaire in PLHIV. CONCLUSION As a clinical trial endpoint, the PIN questionnaire could provide valuable evidence around the acceptance and experience of injections in PLHIV which could have implications for treatment adherence in this population. TRIAL REGISTRATION ATLAS (NCT02951052); 1 November, 2016. FLAIR (NCT02938520); 19 October, 2016.
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Affiliation(s)
- Vasiliki Chounta
- ViiV Healthcare Ltd, Global Health Outcomes, 980 Great West Road, Brentford, Middlesex, TW8 9GS, UK
| | | | | | - Dominy Browning
- ViiV Healthcare Ltd, Global Health Outcomes, 980 Great West Road, Brentford, Middlesex, TW8 9GS, UK
| | - Christina Donatti
- ViiV Healthcare Ltd, Global Health Outcomes, 980 Great West Road, Brentford, Middlesex, TW8 9GS, UK.
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Angel JB, Freilich J, Arthurs E, Ban JK, Lachaine J, Chounta V, Harris M. Adherence to oral antiretroviral therapy in Canada, 2010-2020. AIDS 2023; 37:2031-2040. [PMID: 37418513 PMCID: PMC10552836 DOI: 10.1097/qad.0000000000003648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 06/23/2023] [Accepted: 06/30/2023] [Indexed: 07/09/2023]
Abstract
OBJECTIVE To assess antiretroviral therapy (ART) adherence among people with HIV (PWH) in Canada and identify baseline characteristics associated with suboptimal adherence (<95%). DESIGN Retrospective observational study using data from the National Prescription Drug Utilization Information System and Régie de l'assurance maladie Quebec (RAMQ) Public Prescription Drug Insurance Plan. METHODS This analysis included PWH aged 18 years or older who initiated an ART regimen and were followed for at least 12 months (2010-2020). Patient characteristics were summarized using medical/pharmacy claims data from seven provinces (Alberta, Manitoba, New Brunswick, Newfoundland and Labrador, Ontario, Saskatchewan, and Quebec). ART regimen at index date (first dispensing of a regimen including a core agent) was defined as a single-tablet or multitablet regimen (MTR). Adherence was calculated using a Proportion of Days Covered approach, based on ART dispensing, recorded between April 2010 and the last available date. Multivariate linear regression analysis was used to determine correlations between suboptimal adherence and baseline characteristics. RESULTS We identified 19 322 eligible PWH, 44.7% of whom had suboptimal adherence (<95%). Among 12 594 PWH with evaluable baseline data, 10 673 (84.8%) were ART-naive, 74.2% were men, mean age was 42.9 years, and 54.1% received a MTR as their ART. Based on multivariate regression analysis, suboptimal adherence was significantly associated with multitablet ART ( P < 0.001) and younger age ( P < 0.001) but not sex. CONCLUSION Almost half of adult PWH in Canada had suboptimal adherence to ART. Better understanding of factors influencing adherence may help address gaps in current care practices that may impact adherence.
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Affiliation(s)
- Jonathan B. Angel
- Division of Infectious Diseases, Ottawa Hospital-General Campus, Ottawa, Ontario, Canada
| | - Jonatan Freilich
- Department of Public Health and Clinical Medicine, Dermatology, Umeå University, Umeå
- Parexel International, Stockholm, Sweden
| | - Erin Arthurs
- Health Economics and Outcomes Research, GSK, Mississauga, Ontario
| | - Joann K. Ban
- Health Economics and Outcomes Research, GSK, Mississauga, Ontario
| | - Jean Lachaine
- Faculty of Pharmacy, Université de Montréal, Québec, Canada
| | - Vasiliki Chounta
- Global Health Outcomes, ViiV Healthcare Ltd, Brentford, Middlesex, UK
| | - Marianne Harris
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Ramgopal MN, Castagna A, Cazanave C, Diaz-Brito V, Dretler R, Oka S, Osiyemi O, Walmsley S, Sims J, Di Perri G, Sutton K, Sutherland-Phillips D, Berni A, Latham CL, Zhang F, D'Amico R, Pascual Bernáldez M, Van Solingen-Ristea R, Van Eygen V, Patel P, Chounta V, Spreen WR, Garges HP, Smith K, van Wyk J. Efficacy, safety, and tolerability of switching to long-acting cabotegravir plus rilpivirine versus continuing fixed-dose bictegravir, emtricitabine, and tenofovir alafenamide in virologically suppressed adults with HIV, 12-month results (SOLAR): a randomised, open-label, phase 3b, non-inferiority trial. Lancet HIV 2023; 10:e566-e577. [PMID: 37567205 DOI: 10.1016/s2352-3018(23)00136-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 05/05/2023] [Accepted: 05/31/2023] [Indexed: 08/13/2023]
Abstract
BACKGROUND Cabotegravir plus rilpivirine is the only approved complete long-acting regimen for the maintenance of HIV-1 virological suppression dosed every 2 months. The SOLAR study aimed to compare long-acting cabotegravir plus rilpivirine every 2 months with continued once-daily bictegravir, emtricitabine, and tenofovir alafenamide for the maintenance of HIV-1 virological suppression in adults living with HIV. METHODS SOLAR is a randomised, open-label, multicentre, phase 3b, non-inferiority study. The study was done in 118 centres across 14 countries. Participants with HIV-1 RNA less than 50 copies per mL were randomly assigned (2:1), stratified by sex at birth and BMI, to either long-acting cabotegravir (600 mg) plus rilpivirine (900 mg) dosed intramuscularly every 2 months or to continue daily oral bictegravir (50 mg), emtricitabine (200 mg), and tenofovir alafenamide (25 mg). Participants randomly assigned to long-acting therapy had a choice to receive cabotegravir (30 mg) plus rilpivirine (25 mg) once daily as an optional oral lead-in for approximately 1 month. The primary efficacy endpoint was the proportion of participants with virological non-response (HIV-1 RNA ≥50 copies per mL; the US Food and Drug Administration snapshot algorithm, 4% non-inferiority margin; modified intention-to-treat exposed population) at month 11 (long-acting start with injections group) and month 12 (long-acting with oral lead-in group and bictegravir, emtricitabine, and tenofovir alafenamide group). The study is registered with ClinicalTrials.gov, NCT04542070, and is ongoing. FINDINGS 837 participants were screened between Nov 9, 2020, and May 31, 2021, and 687 were randomly assigned to switch treatment or continue existing treatment. Of 670 participants (modified intention-to-treat exposed population), 447 (67%) switched to long-acting therapy (274 [61%] of 447 start with injections; 173 [39%] of 447 with oral lead-in) and 223 (33%) continued bictegravir, emtricitabine, and tenofovir alafenamide. Baseline characteristics were similar; median age was 37 years (range 18-74), 118 (18%) of 670 were female sex at birth, 207 (31%) of 670 were non-White, and median BMI was 25·9 kg/m2 (IQR 23·3-29·5). At month 11-12, long-acting cabotegravir plus rilpivirine showed non-inferior efficacy versus bictegravir, emtricitabine, and tenofovir alafenamide (HIV-1 RNA ≥50 copies per mL, five [1%] of 447 vs one [<1%] of 223), with an adjusted treatment difference of 0·7 (95% CI -0·7 to 2·0). Excluding injection site reactions, adverse events and serious adverse events were similar between groups. No treatment-related deaths occurred. More long-acting group participants had adverse events leading to withdrawal (25 [6%] of 454 vs two [1%] of 227). Injection site reactions were reported by 316 (70%) of 454 long-acting participants; most (98%) were grade 1 or 2. INTERPRETATION These data support the use of long-acting cabotegravir plus rilpivirine dosed every 2 months as a complete antiretroviral regimen that has similar efficacy to a commonly used integrase strand transfer inhibitor-based first-line regimen, while addressing unmet psychosocial issues associated with daily oral treatment. FUNDING ViiV Healthcare.
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Affiliation(s)
| | | | - Charles Cazanave
- Department of Infectious Diseases, Pellegrin Hospital, University Hospital of Bordeaux, Bordeaux, France
| | - Vicens Diaz-Brito
- Department of Infectious Diseases, Parc Sanitari Sant Joan de Deu, Sant Boi de Llobregat, Spain
| | - Robin Dretler
- Infectious Disease Specialists of Atlanta, Decatur, GA, USA
| | - Shinichi Oka
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
| | | | | | | | - Giovanni Di Perri
- Department of Medical Sciences, Unit of Infectious Diseases, University of Turin, Turin, Italy
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Matza LS, Howell TA, Chounta V, van de Velde N. Patient preferences and health state utilities associated with the treatment process of antiretroviral therapy for people living with HIV. Qual Life Res 2023; 32:531-541. [PMID: 36512302 PMCID: PMC9746581 DOI: 10.1007/s11136-022-03290-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE People living with HIV (PLHIV) have reported challenges associated with daily oral antiretroviral therapy (ART), including missed doses, negative psychological impact, and difficulty remaining discreet while at home or traveling. Recently approved long-acting injectable (LAI) ART may help eliminate these concerns. The purpose of this study was to examine patient preferences and estimate health state utilities associated with oral and LAI treatment for ART. METHODS Four health state vignettes were developed based on published literature, clinician interviews, and a pilot study. All vignettes included the same description of HIV, but differed in treatment regimens: (A) single daily oral tablet, (B) two daily oral tablets, (C) injections once monthly, and (D) injections every two months. PLHIV in the UK reported their preferences and valued the health states in time trade-off utility interviews. RESULTS The sample included 201 PLHIV (83.1% male; mean age = 44.9y). The health states frequently selected as most preferable were D (n = 119; 59.2%) and A (n = 75; 37.3%). Utility differences among health states were relatively small, which is typical for treatment process utilities (mean utilities: A, 0.908; B, 0.905; C, 0.900; D, 0.910). Statistically significant differences in utility were found for one vs. two tablets and injections every month vs. every two months (p < 0.001). Participants' quotations highlight the wide range of reasons for treatment process preferences. CONCLUSIONS Current results indicate that many PLHIV would prefer LAI ART. The reported utilities may be useful in economic modeling comparing oral vs. LAI ART.
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Affiliation(s)
- Louis S Matza
- Patient-Centered Research, Evidera, Bethesda, MD, USA.
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Swindells S, Lutz T, Van Zyl L, Porteiro N, Stoll M, Mitha E, Shon A, Benn P, Huang JO, Harrington CM, Hove K, Ford SL, Talarico CL, Chounta V, Crauwels H, Van Solingen-Ristea R, Vanveggel S, Margolis DA, Smith KY, Vandermeulen K, Spreen WR. Week 96 extension results of a Phase 3 study evaluating long-acting cabotegravir with rilpivirine for HIV-1 treatment. AIDS 2022; 36:185-194. [PMID: 34261093 PMCID: PMC8711605 DOI: 10.1097/qad.0000000000003025] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 06/11/2021] [Accepted: 06/19/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND ATLAS (NCT02951052), a phase 3, multicenter, open-label study, demonstrated that switching to injectable cabotegravir (CAB) with rilpivirine (RPV) long-acting dosed every 4 weeks was noninferior at week (W) 48 to continuing three-drug daily oral current antiretroviral therapy (CAR). Results from the W 96 analysis are presented. METHODS AND DESIGN Participants completing W 52 of ATLAS were given the option to withdraw, transition to ATLAS-2M (NCT03299049), or enter an Extension Phase to continue long-acting therapy (Long-acting arm) or switch from CAR to long-acting therapy (Switch arm). Endpoints assessed at W 96 included proportion of participants with plasma HIV-1 RNA less than 50 copies/ml, incidence of confirmed virologic failure (CVF; two consecutive HIV-1 RNA ≥200 copies/ml), safety and tolerability, pharmacokinetics, and patient-reported outcomes. RESULTS Most participants completing the Maintenance Phase transitioned to ATLAS-2M (88%, n = 502/572). Overall, 52 participants were included in the W 96 analysis of ATLAS; of these, 100% (n = 23/23) and 97% (n = 28/29) in the Long-acting and Switch arms had plasma HIV-1 RNA less than 50 copies/ml at W 96, respectively. One participant had plasma HIV-1 RNA 50 copies/ml or higher in the Switch arm (173 copies/ml). No participants met the CVF criterion during the Extension Phase. No new safety signals were identified. All Switch arm participants surveyed preferred long-acting therapy to their previous daily oral regimen (100%, n = 27/27). CONCLUSION In this subgroup of ATLAS, 98% (n = 51/52) of participants at the Extension Phase W 96 analysis maintained virologic suppression with long-acting therapy. Safety, efficacy, and participant preference results support the therapeutic potential of long-acting CAB+RPV treatment for virologically suppressed people living with HIV-1.
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Affiliation(s)
| | | | | | | | | | - Essack Mitha
- Newtown Clinical Research Centre, Johannesburg, South Africa
| | - Alyssa Shon
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | | | | | | | | | - Susan L. Ford
- GlaxoSmithKline, Research Triangle Park, North Carolina, USA
| | | | | | | | | | | | - David A. Margolis
- ViiV Healthcare, Research Triangle Park, North Carolina, USA
- Brii Biosciences, Durham, North Carolina, USA
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Overton ET, Richmond G, Rizzardini G, Jaeger H, Orrell C, Nagimova F, Bredeek F, García Deltoro M, Swindells S, Andrade-Villanueva JF, Wong A, Khuong-Josses MA, Van Solingen-Ristea R, van Eygen V, Crauwels H, Ford S, Talarico C, Benn P, Wang Y, Hudson KJ, Chounta V, Cutrell A, Patel P, Shaefer M, Margolis DA, Smith KY, Vanveggel S, Spreen W. Long-acting cabotegravir and rilpivirine dosed every 2 months in adults with HIV-1 infection (ATLAS-2M), 48-week results: a randomised, multicentre, open-label, phase 3b, non-inferiority study. Lancet 2021; 396:1994-2005. [PMID: 33308425 DOI: 10.1016/s0140-6736(20)32666-0] [Citation(s) in RCA: 141] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/28/2020] [Accepted: 10/07/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Phase 3 clinical studies showed non-inferiority of long-acting intramuscular cabotegravir and rilpivirine dosed every 4 weeks to oral antiretroviral therapy. Important phase 2 results of every 8 weeks dosing, and supportive modelling, underpin further evaluation of every 8 weeks dosing in this trial, which has the potential to offer greater convenience. Our objective was to compare the week 48 antiviral efficacy of cabotegravir plus rilpivirine long-acting dosed every 8 weeks with that of every 4 weeks dosing. METHODS ATLAS-2M is an ongoing, randomised, multicentre (13 countries; Australia, Argentina, Canada, France, Germany, Italy, Mexico, Russia, South Africa, South Korea, Spain, Sweden, and the USA), open-label, phase 3b, non-inferiority study of cabotegravir plus rilpivirine long-acting maintenance therapy administered intramuscularly every 8 weeks (cabotegravir 600 mg plus rilpivirine 900 mg) or every 4 weeks (cabotegravir 400 mg plus rilpivirine 600 mg) to treatment-experienced adults living with HIV-1. Eligible newly recruited individuals must have received an uninterrupted first or second oral standard-of-care regimen for at least 6 months without virological failure and be aged 18 years or older. Eligible participants from the ATLAS trial, from both the oral standard-of-care and long-acting groups, must have completed the 52-week comparative phase with an ATLAS-2M screening plasma HIV-1 RNA less than 50 copies per mL. Participants were randomly assigned 1:1 to receive cabotegravir plus rilpivirine long-acting every 8 weeks or every 4 weeks. The randomisation schedule was generated by means of the GlaxoSmithKline validated randomisation software RANDALL NG. The primary endpoint at week 48 was HIV-1 RNA ≥50 copies per mL (Snapshot, intention-to-treat exposed), with a non-inferiority margin of 4%. The trial is registered at ClinicalTrials.gov, NCT03299049 and is ongoing. FINDINGS Screening occurred between Oct 27, 2017, and May 31, 2018. Of 1149 individuals screened, 1045 participants were randomised to the every 8 weeks (n=522) or every 4 weeks (n=523) groups; 37% (n=391) transitioned from every 4 weeks cabotegravir plus rilpivirine long-acting in ATLAS. Median participant age was 42 years (IQR 34-50); 27% (n=280) female at birth; 73% (n=763) white race. Cabotegravir plus rilpivirine long-acting every 8 weeks was non-inferior to dosing every 4 weeks (HIV-1 RNA ≥50 copies per mL; 2% vs 1%) with an adjusted treatment difference of 0·8 (95% CI -0·6-2·2). There were eight (2%, every 8 weeks group) and two (<1%, every 4 weeks group) confirmed virological failures (two sequential measures ≥200 copies per mL). For the every 8 weeks group, five (63%) of eight had archived non-nucleoside reverse transcriptase inhibitor resistance-associated mutations to rilpivirine at baseline. The safety profile was similar between dosing groups, with 844 (81%) of 1045 participants having adverse events (excluding injection site reactions); no treatment-related deaths occurred. INTERPRETATION The efficacy and safety profiles of dosing every 8 weeks and dosing every 4 weeks were similar. These results support the use of cabotegravir plus rilpivirine long-acting administered every 2 months as a therapeutic option for people living with HIV-1. FUNDING ViiV Healthcare and Janssen.
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Affiliation(s)
| | | | - Giuliano Rizzardini
- Fatebenefratelli Sacco Hospital, Milan, Italy; School of Clinical Medicine, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Hans Jaeger
- MVZ Karlsplatz, HIV Research and Clinical Care Centre, Munich, Germany
| | - Catherine Orrell
- Desmond Tutu HIV Foundation, University of Cape Town Medical School, Cape Town, South Africa
| | - Firaya Nagimova
- Republic Center for the Prevention and Control of AIDS and Infectious Diseases, Russia
| | | | | | | | | | - Alexander Wong
- Department of Medicine, University of Saskatchewan, Regina, Saskatchewan, Canada
| | | | | | - Veerle van Eygen
- Janssen Research and Development, Janssen Pharmaceutica NV, Beerse, Belgium
| | - Herta Crauwels
- Janssen Research and Development, Janssen Pharmaceutica NV, Beerse, Belgium
| | - Susan Ford
- GlaxoSmithKline, Research Triangle Park, NC, USA
| | | | | | | | | | | | - Amy Cutrell
- ViiV Healthcare, Research Triangle Park, NC, USA
| | - Parul Patel
- ViiV Healthcare, Research Triangle Park, NC, USA
| | - Mark Shaefer
- ViiV Healthcare, Research Triangle Park, NC, USA
| | | | | | - Simon Vanveggel
- Janssen Research and Development, Janssen Pharmaceutica NV, Beerse, Belgium
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9
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Akinwunmi B, Buchenberger D, Scherzer J, Bode M, Rizzini P, Vecchio F, Roustand L, Nachbaur G, Finkielsztejn L, Chounta V, Van de Velde N. Dose-related and contextual aspects of suboptimal adherence to antiretroviral therapy among persons living with HIV in Western Europe. Eur J Public Health 2021; 31:567-575. [PMID: 33462616 PMCID: PMC8277220 DOI: 10.1093/eurpub/ckaa229] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND The daily oral dosing requirement for antiretroviral therapy (ART) may be challenging for some people living with HIV (PLWHIV) with comorbid conditions, confidentiality concerns or pill fatigue. We investigated suboptimal adherence from the perspective of PLWHIV and HIV physicians. METHODS PLWHIV on ART (n = 688) and HIV physicians (n = 120) were surveyed during 2019 in France, Germany, Italy and the UK. Suboptimal adherence was a report the participant missed taking their dose as prescribed 'Sometimes'/'Often'/'Very often'. Physicians' interest in offering a hypothetical long-acting HIV regimen for suboptimally adherent patients was assessed. Descriptive and multivariable analyses were performed (P < 0.05). RESULTS Of PLWHIV, 23.8% (164/688) reported suboptimal adherence vs. providers' estimated prevalence of 33.6% (SD = 28.8). PLWHIV-reported prevalence of specific suboptimal adherence behaviors were: mistimed dose [16.1% (111/688)]; missed a dose [15.7% (108/688)]; dosed under wrong conditions [e.g. food restrictions, 10.5% (72/688)] and overdosed [3.3% (23/688)]. Odds of suboptimal adherence were higher among those with vs. without a report of the following: dysphagia (AOR = 3.61, 95% CI = 2.28-5.74), stress/anxiety because of their daily dosing schedule (AOR = 3.09, 95% CI = 1.97-4.85), gastrointestinal side effects (AOR = 2.09, 95% CI = 1.39-3.15), neurocognitive/mental health conditions (AOR = 1.88, 95% CI = 1.30-2.72) or hiding their HIV medication (AOR = 1.51, 95% CI = 1.04-2.19). Of providers, 84.2% indicated they Definitely/Probably will offer a hypothetical long-acting HIV regimen 'for patients who have suboptimal levels of adherence to daily oral therapy (50-90%) for non-medical reasons'. CONCLUSIONS Dysphagia, stressful daily oral dosing schedule, gastrointestinal side effects, neurocognitive/mental health conditions and confidentiality concerns were associated with suboptimal adherence in our study. Adherence support and alternative regimens, such as long-acting antiretroviral therapies, could help address these challenges.
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Affiliation(s)
- Babatunde Akinwunmi
- Zatum LLC, Department of Epidemiology and Real-World Evidence Grand Blanc, MI, USA
| | | | | | | | | | | | | | - Gaelle Nachbaur
- GlaxoSmithKline Pharmaceuticals, Saint Amant les Eaux, France
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10
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Chounta V, Overton ET, Mills A, Swindells S, Benn PD, Vanveggel S, van Solingen-Ristea R, Wang Y, Hudson KJ, Shaefer MS, Margolis DA, Smith KY, Spreen WR. Patient-Reported Outcomes Through 1 Year of an HIV-1 Clinical Trial Evaluating Long-Acting Cabotegravir and Rilpivirine Administered Every 4 or 8 Weeks (ATLAS-2M). Patient 2021; 14:849-862. [PMID: 34056699 PMCID: PMC8563641 DOI: 10.1007/s40271-021-00524-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/28/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Advances in HIV-1 therapeutics have led to the development of a range of daily oral treatment regimens, which share similar high efficacy rates. Consequently, more emphasis is being placed upon the individual's experience of treatment and impact on quality of life. The first long-acting injectable antiretroviral therapy for HIV-1 (long-acting cabotegravir + rilpivirine [CAB + RPV LA]) may address challenges associated with oral treatment for HIV-1, such as stigma, pill burden/fatigue, drug-food interactions, and adherence. Patient-reported outcomes (PROs) collected in an HIV-1 clinical trial (ATLAS-2M; NCT03299049) comparing participants' experience with two dosing regimens (every 4 weeks [Q4W] vs. every 8 weeks [Q8W]) of CAB + RPV LA are presented herein. METHODS PRO endpoints evaluated through 48 weeks of therapy included treatment satisfaction (HIV Treatment Satisfaction Questionnaire [HIVTSQ]), treatment acceptance ("General Acceptance" domain of the Chronic Treatment Acceptance [ACCEPT®] questionnaire), acceptability of injections (Perception of Injection [PIN] questionnaire), treatment preference (questionnaire), and reasons for switching to/continuing long-acting therapy (exploratory endpoint; questionnaire). Participants were randomized 1:1 to receive CAB + RPV LA Q8W or Q4W. Results were stratified by prior CAB + RPV exposure in either preplanned or post hoc analyses. RESULTS Overall, 1045 participants were randomized to the Q8W (n = 522) and Q4W (n = 523) regimens; 37% (n = 391/1045) had previously received CAB + RPV in ATLAS. For participants without prior CAB + RPV exposure, large increases from baseline were reported in treatment satisfaction in both long-acting arms (HIVTSQ status version), with Q8W dosing statistically significantly favored at Weeks 24 (p = 0.036) and 48 (p = 0.004). Additionally, improvements from baseline were also observed in the "General Acceptance" domain of the ACCEPT questionnaire in both long-acting arms for participants without prior CAB + RPV exposure; however, no statistically significant difference was observed between arms at either timepoint (Week 24, p = 0.379; Week 48, p = 0.525). Significant improvements (p < 0.001) in the "Acceptance of Injection Site Reactions" domain of the PIN questionnaire were observed from Week 8 to Weeks 24 and 48 in both arms for participants without prior CAB + RPV exposure. Participants with prior CAB + RPV exposure reported high treatment satisfaction (mean [HIVTSQ status version]: Q8W 62.2/66.0; Q4W 62.0/66.0), treatment acceptance (mean: Q8W 89.3/100; Q4W 91.2/100), and acceptance of injection site reactions (mean [5 = not at all acceptable; 1 = totally acceptable]: Q8W 1.72; Q4W 1.59) at baseline/Week 8 that were maintained over time. Participants without prior CAB + RPV exposure who received Q8W dosing preferred this regimen over oral CAB + RPV (98%, n = 300/306). Among those with prior Q4W exposure, 94% (n = 179/191) preferred Q8W dosing versus Q4W dosing (3%, n = 6/191) or oral CAB + RPV (2%, n = 4/191). CONCLUSIONS Both long-acting regimens provided high treatment satisfaction and acceptance, irrespective of prior CAB + RPV exposure, with most participants preferring Q8W dosing over both the Q4W regimen and their previous daily oral regimen. The PRO data collected at Week 48 support the therapeutic potential of CAB + RPV LA. FUNDING ViiV Healthcare and Janssen. TRIAL REGISTRATION ATLAS-2M: ClinicalTrials.gov NCT03299049, registered October 2, 2017.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Krischan J Hudson
- ViiV Healthcare, Research Triangle Park, NC, USA.,Horizon Therapeutics, Lake Forest, IL, USA
| | - Mark S Shaefer
- ViiV Healthcare, Research Triangle Park, NC, USA.,Hengrui USA, East Windsor, NJ, USA
| | - David A Margolis
- ViiV Healthcare, Research Triangle Park, NC, USA.,Brii Biosciences, Durham, NC, USA
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11
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Orkin C, Oka S, Philibert P, Brinson C, Bassa A, Gusev D, Degen O, García JG, Morell EB, Tan DHS, D'Amico R, Dorey D, Griffith S, Thiagarajah S, St Clair M, Van Solingen-Ristea R, Crauwels H, Ford SL, Patel P, Chounta V, Vanveggel S, Cutrell A, Van Eygen V, Vandermeulen K, Margolis DA, Smith KY, Spreen WR. Long-acting cabotegravir plus rilpivirine for treatment in adults with HIV-1 infection: 96-week results of the randomised, open-label, phase 3 FLAIR study. Lancet HIV 2021; 8:e185-e196. [PMID: 33794181 DOI: 10.1016/s2352-3018(20)30340-4] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/04/2020] [Accepted: 12/10/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND There is a need for more convenient, less frequent treatment to help address challenges associated with daily oral HIV treatment in people living with HIV, including stigma, pill burden, drug-food interactions, and adherence. The phase 3 ATLAS and FLAIR studies showed non-inferiority of long-acting cabotegravir and rilpivirine dosed every 4 weeks compared with standard oral therapy for the maintenance of virological suppression in adults with HIV-1 over 48 weeks. We present the 96-week findings. METHODS FLAIR is a randomised, phase 3, open-label, multicentre study done in 11 countries investigating whether switching to long-acting cabotegravir and rilpivirine is non-inferior to daily dolutegravir, abacavir, and lamivudine in virologically suppressed adults living with HIV-1. Antiretroviral therapy (ART)-naive participants received induction therapy with daily oral dolutegravir (50 mg), abacavir (600 mg), and lamivudine (300 mg) for 20 weeks. After 16 weeks, participants with less than 50 HIV-1 RNA copies per mL were randomly assigned (1:1) to continue the standard of care regimen (standard care group) or switch to receive daily oral cabotegravir 30 mg and rilpivirine 25 mg for at least 4 weeks followed by long-acting cabotegravir 400 mg and rilpivirine 600 mg, administered as two 2 mL intramuscular injections, every 4 weeks for at least 96 weeks (long-acting group). Randomisation was stratified by baseline (preinduction) HIV-1 RNA (<100 000 or ≥100 000 copies per mL) and sex at birth and used GlaxoSmithKline-verified randomisation software (RandAll NG, version 1.3.3) for treatment assignment. The primary endpoint was the proportion of participants with plasma HIV-1 RNA of 50 copies per mL or more assessed as per the US Food and Drug Administration (FDA) Snapshot algorithm at week 48, which has been reported previously. Here, we report the proportion of participants with 50 or more HIV-1 RNA copies per mL using the FDA Snapshot algorithm at week 96 (intention-to-treat population; non-inferiority margin 6%). The trial is registered with ClinicalTrials.gov, NCT02938520. FINDINGS Between Oct 27, 2016, and March 24, 2017, 809 participants were screened. 631 (78%) participants entered the induction phase and 566 (70%) were randomly assigned to either the standard care group (283 [50%] participants) or the long-acting group (283 [50%]). Median age was 34 years (IQR 29 to 43), 62 (11%) were 50 years or older, 127 (22%) were women (sex at birth), and 419 (74%) were white. At week 96, nine (3%) participants in each arm had 50 or more HIV-1 RNA copies per mL, with an adjusted difference of 0·0 (95% CI -2·9 to 2·9), consistent with non-inferiority established at week 48. Across both treatment groups, adverse events leading to withdrawal were infrequent (14 [5%] participants in the long-acting group and four [1%] in the standard care group). Injection site reactions were the most common adverse event, reported by 245 (88%) participants in the long-acting group; their frequency decreased over time. Median injection site reaction duration was 3 days (IQR 2 to 4), and 3082 (99%) of 3100 reactions were grade 1 or 2. No deaths occurred during the maintenance phase. INTERPRETATION The 96-week results reaffirm the 48-week results, showing long-acting cabotegravir and rilpivirine continued to be non-inferior compared with continuing a standard care regimen in adults with HIV-1 for the maintenance of viral suppression. These results support the durability of long-acting cabotegravir and rilpivirine, over an almost 2-year-long period, as a therapeutic option for virally suppressed adults with HIV-1. FUNDING ViiV Healthcare and Janssen Research and Development.
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Affiliation(s)
- Chloe Orkin
- Department of Immunobiology, Queen Mary University, London, UK.
| | - Shinichi Oka
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Patrick Philibert
- Department for Internal Medicine and Infectious Diseases, Hôpital Européen, Marseille, France
| | | | - Ayesha Bassa
- Mzansi Ethical Research Centre, Middelburg, South Africa
| | - Denis Gusev
- State Medical Center for the Prevention and Control of AIDS and Infectious Diseases, St Petersburg, Russia; St Petersburg State Budgetary Health Care Institution, St Petersburg, Russia
| | - Olaf Degen
- Infectious Diseases Unit, Outpatient Center, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Juan González García
- Department for Internal Medicine, Hospital La Paz Institute for Health Research, Hospital Universitario La Paz, Madrid, Spain
| | - Enrique Bernal Morell
- Sección de Enfermedades Infecciosas, Hospital General Universitario Reina Sofía, Murcia, Spain
| | - Darrell H S Tan
- Division of Infectious Diseases, Department of Medicine, St Michael's Hospital, Toronto, ON, Canada
| | - Ronald D'Amico
- Research and Development, ViiV Healthcare, Research Triangle Park, NC, USA
| | - David Dorey
- Biostatistics, GlaxoSmithKline, Mississauga, ON, Canada
| | - Sandy Griffith
- Research and Development, ViiV Healthcare, Research Triangle Park, NC, USA
| | | | - Marty St Clair
- Translational Medical Research, ViiV Healthcare, Research Triangle Park, NC, USA
| | | | - Herta Crauwels
- Infectious Diseases & Vaccines, Janssen Research & Development, Beerse, Belgium
| | - Susan L Ford
- Clinical Pharmacology, GlaxoSmithKline, Research Triangle Park, NC, USA
| | - Parul Patel
- Research and Development, ViiV Healthcare, Research Triangle Park, NC, USA
| | | | - Simon Vanveggel
- Global Development, Janssen Research & Development, Beerse, Belgium
| | - Amy Cutrell
- Research Statistics, ViiV Healthcare, Research Triangle Park, NC, USA
| | - Veerle Van Eygen
- Infectious Diseases & Vaccines, Janssen Research & Development, Beerse, Belgium
| | - Kati Vandermeulen
- Infectious Diseases & Vaccines, Janssen Research & Development, Beerse, Belgium
| | - David A Margolis
- Research and Development, ViiV Healthcare, Research Triangle Park, NC, USA
| | - Kimberly Y Smith
- Research and Development, ViiV Healthcare, Research Triangle Park, NC, USA
| | - William R Spreen
- Research and Development, ViiV Healthcare, Research Triangle Park, NC, USA
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12
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Akinwunmi B, Buchenberger D, Scherzer J, Bode M, Rizzini P, Vecchio F, Roustand L, Nachbaur G, Finkielsztejn L, Chounta V, Van de Velde N. Factors associated with interest in a long-acting HIV regimen: perspectives of people living with HIV and healthcare providers in four European countries. Sex Transm Infect 2021; 97:566-573. [PMID: 33632889 DOI: 10.1136/sextrans-2020-054648] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 01/17/2021] [Accepted: 01/22/2021] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES A novel long-acting regimen (LAR) of cabotegravir and rilpivirine for HIV treatment requires dosing every 2 months instead of daily. We assessed what proportion of people living with HIV and physicians would be interested in trying and offering LAR respectively and why. METHODS 688 people living with HIV on treatment, and 120 HIV physicians completed web-based surveys in Germany, Italy, the UK and France during 2019. Balanced description of a hypothetical LAR regarding efficacy, administration and possible side effects were provided. The hypothetical long-acting injections were assumed to be cost-neutral to current daily oral antiretrovirals. Interest of people living with HIV in trying ('very'/'highly') and physicians' willingness to offer ('definitely'/'probably') this LAR in different situations, with perceived benefits/concerns was measured. RESULTS Of people living with HIV, 65.8% were interested in trying LAR. The majority (~80%-90%) of those with unmet needs felt LAR would help, including those with strong medical needs (malabsorption and interfering gastrointestinal conditions), suboptimal adherence, confidentiality/privacy concerns and emotional burden of daily dosing. Of physicians, percentage willing to offer LAR varied situationally: strong medical need (dysphagia, 93.3%; malabsorption, 91.6%; interfering gastrointestinal issues, 90.0%; central nervous system disorders, 87.5%); suboptimal adherence (84.2%); confidentiality/privacy concerns (hiding medications, 86.6%) and convenience/lifestyle (84.2%). People living with HIV liked LAR for not having to carry pills when travelling (56.3%); physicians liked the increased patient contact (54.2%). Furthermore, 50.0% of people living with HIV perceived LAR would minimise transmission risk and improve their sexual health. The most disliked attribute was scheduling appointments (37.2%) and resource constraints (57.5%) for people living with HIV and physicians, respectively. Physicians estimated 25.7% of their patients would actually switch. CONCLUSION Providers and people living with HIV viewed the described LAR as addressing several unmet needs. Alternative treatment routes and especially LAR may improve adherence and quality of life.
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13
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Parker B, Ward T, Hayward O, Jacob I, Arthurs E, Becker D, Anderson SJ, Chounta V, Van de Velde N. Cost-effectiveness of the long-acting regimen cabotegravir plus rilpivirine for the treatment of HIV-1 and its potential impact on adherence and viral transmission: A modelling study. PLoS One 2021; 16:e0245955. [PMID: 33529201 PMCID: PMC7853524 DOI: 10.1371/journal.pone.0245955] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 01/11/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Combination antiretroviral therapy (cART) improves outcomes for people living with HIV (PLWH) but requires adherence to daily dosing. Suboptimal adherence results in reduced treatment effectiveness, increased costs, and greater risk of resistance and onwards transmission. Treatment with long-acting (LA), injection-based ART administered by healthcare professionals (directly observed therapy (DOT)) eliminates the need for adherence to daily dosing and may improve clinical outcomes. This study reports the cost-effectiveness of the cabotegravir plus rilpivirine LA regimen (CAB+RPV LA) and models the potential impact of LA DOT therapies. Methods Parameterisation was performed using pooled data from recent CAB+RPV LA Phase III trials. The analysis was conducted using a cohort-level hybrid decision-tree and state-transition model, with states defined by viral load and CD4 cell count. The efficacy of oral cART was adjusted to reflect adherence to daily regimens from published data. A Canadian health service perspective was adopted. Results CAB+RPV LA is predicted to be the dominant intervention when compared to oral cART, generating, per 1,000 patients treated, lifetime cost-savings of $1.5 million, QALY and life-year gains of 107 and 138 respectively with three new HIV cases averted. Conclusions Economic evaluations of LA DOTs need to account for the impact of adherence and HIV transmission. This study adds to the existing literature by incorporating transmission and using clinical data from the first LA DOT regimen. Providing PLWH and healthcare providers with novel modes of ART administration, enhancing individualisation of treatment, may facilitate the achievement of UNAIDS 95-95-95 objectives.
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Affiliation(s)
- Ben Parker
- Health Economics and Outcomes Research Ltd, Pontprennau, Cardiff, United Kingdom
| | - Tom Ward
- Health Economics and Outcomes Research Ltd, Pontprennau, Cardiff, United Kingdom
| | - Olivia Hayward
- Health Economics and Outcomes Research Ltd, Pontprennau, Cardiff, United Kingdom
| | - Ian Jacob
- Health Economics and Outcomes Research Ltd, Pontprennau, Cardiff, United Kingdom
- * E-mail: (IJ); (NVdV)
| | - Erin Arthurs
- Health Economics & Outcomes Research, GlaxoSmithKline, Toronto, Ontario, Canada
| | - Debbie Becker
- Quadrant Health Economics Inc, Cambridge, Ontario, Canada
| | - Sarah-Jane Anderson
- Value Evidence and Outcomes, GlaxoSmithKline, Brentford, Middlesex, United Kingdom
| | - Vasiliki Chounta
- Global Health Outcomes, ViiV Healthcare Ltd, Brentford, Middlesex, United Kingdom
| | - Nicolas Van de Velde
- Global Health Outcomes, ViiV Healthcare Ltd, Brentford, Middlesex, United Kingdom
- * E-mail: (IJ); (NVdV)
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14
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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15
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Chounta V, Bernal E, Lombaard J, Katner HP, Walmsley S, Dorey D, Spreen W, Griffith S, Margolis D. 1035. Patient-Reported Outcomes on Long-Acting Cabotegravir + Rilpivirine as Maintenance Therapy: FLAIR 96-Week Results. Open Forum Infect Dis 2020. [PMCID: PMC7776404 DOI: 10.1093/ofid/ofaa439.1221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background In the phase 3 FLAIR study, switching to monthly injectable long-acting (LA) cabotegravir (CAB) + rilpivirine (RPV) was noninferior to continued daily oral dolutegravir/abacavir/lamivudine (DTG/ABC/3TC) for the maintenance of virologic suppression over 96 weeks in adults with HIV-1. Key patient-reported outcomes (PROs) through Week 96 are presented. Methods In FLAIR, ART-naive adult participants received induction therapy with oral DTG/ABC/3TC for 20 weeks. Those with HIV-1 RNA < 50 c/mL at 16 weeks were randomized (1:1) to continue DTG/ABC/3TC or receive monthly CAB + RPV LA injections after a 4-week lead-in with daily oral CAB + RPV through Week 96. Treatment satisfaction (HIV Treatment Satisfaction Questionnaire status version [HIVTSQs]) and acceptability of injections (Perception of Injection [PIN] Questionnaire) up to Week 96 were secondary endpoints. Results A total of 566 participants were randomized (median age, 34 years; 22% female); baseline characteristics were similar between treatment groups. At Week 96, significantly greater improvement from baseline in total treatment satisfaction score was observed in the CAB + RPV LA vs DTG/ABC/3TC treatment group (adjusted mean difference, 2.3 [95% CI, 1.1-3.5]; P< 0.001), further increasing from Weeks 24 (2.1 [0.9-3.3]) and 44 (0.7 [−0.4, 1.9]). Key drivers for the difference in HIVTSQs between treatment groups were items assessing convenience, flexibility, and satisfaction to continue with LA therapy. In participants receiving CAB + RPV LA, mean score for the “Acceptability of ISRs” dimension of PIN (scale, 1-5) significantly decreased (improved) from Week 5 to Weeks 41, 48, and 96 (2.08 to 1.71, 1.66, and 1.71, respectively; P< 0.001 for all). In addition, 82% and 85% of LA participants, respectively, rated pain and local reactions due to injections as “totally” or “very acceptable” at Week 96. Conclusion At Week 96, FLAIR participants receiving LA therapy reported greater improvement in treatment satisfaction compared with participants continuing on daily oral medication as well as overall good acceptability of injections with improvement over time. Overall, these results support monthly CAB + RPV LA as an alternative to daily oral regimens for adults with HIV-1. Disclosures Vasiliki Chounta, MSc, GlaxoSmithKline (Shareholder)ViiV Healthcare (Employee) Sharon Walmsley, FRCPC, MD, MSC, GSK (Grant/Research Support)ViiV Healthcare (Grant/Research Support) David Dorey, MMATH, GlaxoSmithKline Inc. (Employee, Shareholder) William Spreen, PharmD, ViiV Healthcare (Employee, Shareholder) Sandy Griffith, PharmD, GlaxoSmithKline (Shareholder)ViiV Healthcare (Employee) David Margolis, MD, MPH, GlaxoSmithKline (Shareholder)ViiV Healthcare (Employee)
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Affiliation(s)
| | - Enrique Bernal
- Reina Sofía General University Hospital, Murcia, Murcia, Spain
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16
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Arthurs E, Parker B, Jacob I, Becker D, Lee A, Hayward O, Chounta V, Anderson SJ, Van de Velde N. 1018. Health Technology Assessment of New Long-Acting, Directly-Observed HIV Treatments in Canada: Impact of Real-World Adherence to Daily Oral Therapy on Treatment, Transmission and Cost-Effectiveness. Open Forum Infect Dis 2020. [PMCID: PMC7777051 DOI: 10.1093/ofid/ofaa439.1204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Current antiretroviral therapy (ART) has dramatically improved outcomes for people living with HIV (PLWHIV), however adherence to daily oral dosing remains a challenge for some. New, long-acting (LA) ARTs which are directly administered by physicians eliminate the need to adhere to daily oral dosing and may improve clinical outcomes. The study objective was to evaluate costs and QALYs associated with improved adherence achieved via a novel, directly-observed therapy (DOT) of a monthly LA injectable ART, compared to standard of care (SoC), daily oral therapy.
Methods
A published Markov cohort state-transition model was adapted to model the impact of treatment adherence and subsequent disease transmission. Without the need to adhere to daily dosing, the efficacy of the injectable was modelled independent of adherence whereas virologic suppression in the SoC arm was adjusted to reflect published data on adherence to daily dosing (8.12% below optimal levels observed in clinical trials).
Results
This evidence-based approach of accounting for adherence revealed an increase in lifetime costs for oral SOC of approximately $850, and QALY loss of 0.109 when compared to results without accounting for adherence. Disease transmission results yielded 3 cases averted of HIV per 1,000 patients with LA’s impact on adherence.
Conclusion
In the absence of comparative adherence estimates between a LA, injectable DOT and daily oral therapy in the real world, an evidence-based approach provides a method to address the uncertainty around the true impact on costs and QALYs of a novel mode of administration.
Disclosures
Erin Arthurs, MSc, GlaxoSmithKline (Employee) Ben Parker, MSc, HEOR Ltd. (Employee) Ian Jacob, MSc, HEOR Ltd (Employee) Debbie Becker, MSc, GSK (Consultant) Amy Lee, MSc, PhD, GSK (Consultant) Olivia Hayward, PhD, HEOR ltd. (Employee) Vasiliki Chounta, MSc, GlaxoSmithKline (Shareholder)ViiV Healthcare (Employee) Sarah-Jane Anderson, PhD, GlaxoSmithKline (Employee, Shareholder) Nicolas Van de Velde, PhD, GlaxoSmithKline (Shareholder)ViiV Healthcare (Employee)
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Affiliation(s)
| | - Ben Parker
- HEOR Ltd., Cardiff, England, United Kingdom
| | - Ian Jacob
- HEOR ltd., Cardiff, England, United Kingdom
| | - Debbie Becker
- Quadrant Health Economics Inc., Cambridge, Ontario, Canada
| | - Amy Lee
- Quadrant Health Economics, Cambridge, Ontario, Canada
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Clark L, Karki C, Noone J, Scherzer J, Bode M, Rizzini P, Vecchio F, Roustand L, Nachbaur G, Finkielsztejn L, Chounta V, Van de Velde N. Quantifying people living with HIV who would benefit from an alternative to daily oral therapy: Perspectives from HIV physicians and people living with HIV. Popul Med 2020. [DOI: 10.18332/popmed/126632] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Orkin C, Arasteh K, Górgolas Hernández-Mora M, Pokrovsky V, Overton ET, Girard PM, Oka S, Walmsley S, Bettacchi C, Brinson C, Philibert P, Lombaard J, St Clair M, Crauwels H, Ford SL, Patel P, Chounta V, D'Amico R, Vanveggel S, Dorey D, Cutrell A, Griffith S, Margolis DA, Williams PE, Parys W, Smith KY, Spreen WR. Long-Acting Cabotegravir and Rilpivirine after Oral Induction for HIV-1 Infection. N Engl J Med 2020; 382:1124-1135. [PMID: 32130806 DOI: 10.1056/nejmoa1909512] [Citation(s) in RCA: 202] [Impact Index Per Article: 50.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Long-acting injectable regimens may simplify therapy for patients with human immunodeficiency virus type 1 (HIV-1) infection. METHODS We conducted a phase 3, randomized, open-label trial in which adults with HIV-1 infection who had not previously received antiretroviral therapy were given 20 weeks of daily oral induction therapy with dolutegravir-abacavir-lamivudine. Participants who had an HIV-1 RNA level of less than 50 copies per milliliter after 16 weeks were randomly assigned (1:1) to continue the current oral therapy or switch to oral cabotegravir plus rilpivirine for 1 month followed by monthly injections of long-acting cabotegravir plus rilpivirine. The primary end point was the percentage of participants who had an HIV-1 RNA level of 50 copies per milliliter or higher at week 48 (Food and Drug Administration snapshot algorithm). RESULTS At week 48, an HIV-1 RNA level of 50 copies per milliliter or higher was found in 6 of 283 participants (2.1%) who received long-acting therapy and in 7 of 283 (2.5%) who received oral therapy (adjusted difference, -0.4 percentage points; 95% confidence interval [CI], -2.8 to 2.1), a result that met the criterion for noninferiority for the primary end point (margin, 6 percentage points). An HIV-1 RNA level of less than 50 copies per milliliter at week 48 was found in 93.6% who received long-acting therapy and in 93.3% who received oral therapy (adjusted difference, 0.4 percentage points; 95% CI, -3.7 to 4.5), a result that met the criterion for noninferiority for this end point (margin, -10 percentage points). Of the participants who received long-acting therapy, 86% reported injection-site reactions (median duration, 3 days; mild or moderate severity, 99% of cases); 4 participants withdrew from the trial for injection-related reasons. Grade 3 or higher adverse events and events that met liver-related stopping criteria occurred in 11% and 2%, respectively, who received long-acting therapy and in 4% and 1% who received oral therapy. Treatment satisfaction increased after participants switched to long-acting therapy; 91% preferred long-acting therapy at week 48. CONCLUSIONS Therapy with long-acting cabotegravir plus rilpivirine was noninferior to oral therapy with dolutegravir-abacavir-lamivudine with regard to maintaining HIV-1 suppression. Injection-site reactions were common. (Funded by ViiV Healthcare and Janssen; FLAIR ClinicalTrials.gov number, NCT02938520.).
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Affiliation(s)
- Chloe Orkin
- From Queen Mary University of London, London (C.O.), and ViiV Healthcare, Brentford (V.C.) - both in the United Kingdom; EPIMED, Berlin (K.A.); Fundación Jiménez Díaz, Madrid (M.G.H.-M.); Central Research Institute of Epidemiology, Moscow (V.P.); the University of Alabama at Birmingham, Birmingham (E.T.O.); Hôpital Saint Antoine, Paris (P.-M.G.), and Hôpital Européen, Marseille (P. Philibert) - both in France; the National Center for Global Health and Medicine, Tokyo (S.O.); the University Health Network, University of Toronto, Toronto (S.W.), and GlaxoSmithKline, Mississauga (S.L.F., D.D.) - both in Ontario, Canada; North Texas Infectious Disease Consultants, Dallas (C. Bettacchi), and Central Texas Clinical Research, Austin (C. Brinson); Josha Research, Bloemfontein, South Africa (J.L.); ViiV Healthcare, Research Triangle Park, NC (M.S.C., P. Patel, R.D., A.C., S.G., D.A.M., K.Y.S., W.R.S.); and Janssen Research and Development, Beerse, Belgium (H.C., S.V., P.E.W., W.P.)
| | - Keikawus Arasteh
- From Queen Mary University of London, London (C.O.), and ViiV Healthcare, Brentford (V.C.) - both in the United Kingdom; EPIMED, Berlin (K.A.); Fundación Jiménez Díaz, Madrid (M.G.H.-M.); Central Research Institute of Epidemiology, Moscow (V.P.); the University of Alabama at Birmingham, Birmingham (E.T.O.); Hôpital Saint Antoine, Paris (P.-M.G.), and Hôpital Européen, Marseille (P. Philibert) - both in France; the National Center for Global Health and Medicine, Tokyo (S.O.); the University Health Network, University of Toronto, Toronto (S.W.), and GlaxoSmithKline, Mississauga (S.L.F., D.D.) - both in Ontario, Canada; North Texas Infectious Disease Consultants, Dallas (C. Bettacchi), and Central Texas Clinical Research, Austin (C. Brinson); Josha Research, Bloemfontein, South Africa (J.L.); ViiV Healthcare, Research Triangle Park, NC (M.S.C., P. Patel, R.D., A.C., S.G., D.A.M., K.Y.S., W.R.S.); and Janssen Research and Development, Beerse, Belgium (H.C., S.V., P.E.W., W.P.)
| | - Miguel Górgolas Hernández-Mora
- From Queen Mary University of London, London (C.O.), and ViiV Healthcare, Brentford (V.C.) - both in the United Kingdom; EPIMED, Berlin (K.A.); Fundación Jiménez Díaz, Madrid (M.G.H.-M.); Central Research Institute of Epidemiology, Moscow (V.P.); the University of Alabama at Birmingham, Birmingham (E.T.O.); Hôpital Saint Antoine, Paris (P.-M.G.), and Hôpital Européen, Marseille (P. Philibert) - both in France; the National Center for Global Health and Medicine, Tokyo (S.O.); the University Health Network, University of Toronto, Toronto (S.W.), and GlaxoSmithKline, Mississauga (S.L.F., D.D.) - both in Ontario, Canada; North Texas Infectious Disease Consultants, Dallas (C. Bettacchi), and Central Texas Clinical Research, Austin (C. Brinson); Josha Research, Bloemfontein, South Africa (J.L.); ViiV Healthcare, Research Triangle Park, NC (M.S.C., P. Patel, R.D., A.C., S.G., D.A.M., K.Y.S., W.R.S.); and Janssen Research and Development, Beerse, Belgium (H.C., S.V., P.E.W., W.P.)
| | - Vadim Pokrovsky
- From Queen Mary University of London, London (C.O.), and ViiV Healthcare, Brentford (V.C.) - both in the United Kingdom; EPIMED, Berlin (K.A.); Fundación Jiménez Díaz, Madrid (M.G.H.-M.); Central Research Institute of Epidemiology, Moscow (V.P.); the University of Alabama at Birmingham, Birmingham (E.T.O.); Hôpital Saint Antoine, Paris (P.-M.G.), and Hôpital Européen, Marseille (P. Philibert) - both in France; the National Center for Global Health and Medicine, Tokyo (S.O.); the University Health Network, University of Toronto, Toronto (S.W.), and GlaxoSmithKline, Mississauga (S.L.F., D.D.) - both in Ontario, Canada; North Texas Infectious Disease Consultants, Dallas (C. Bettacchi), and Central Texas Clinical Research, Austin (C. Brinson); Josha Research, Bloemfontein, South Africa (J.L.); ViiV Healthcare, Research Triangle Park, NC (M.S.C., P. Patel, R.D., A.C., S.G., D.A.M., K.Y.S., W.R.S.); and Janssen Research and Development, Beerse, Belgium (H.C., S.V., P.E.W., W.P.)
| | - Edgar T Overton
- From Queen Mary University of London, London (C.O.), and ViiV Healthcare, Brentford (V.C.) - both in the United Kingdom; EPIMED, Berlin (K.A.); Fundación Jiménez Díaz, Madrid (M.G.H.-M.); Central Research Institute of Epidemiology, Moscow (V.P.); the University of Alabama at Birmingham, Birmingham (E.T.O.); Hôpital Saint Antoine, Paris (P.-M.G.), and Hôpital Européen, Marseille (P. Philibert) - both in France; the National Center for Global Health and Medicine, Tokyo (S.O.); the University Health Network, University of Toronto, Toronto (S.W.), and GlaxoSmithKline, Mississauga (S.L.F., D.D.) - both in Ontario, Canada; North Texas Infectious Disease Consultants, Dallas (C. Bettacchi), and Central Texas Clinical Research, Austin (C. Brinson); Josha Research, Bloemfontein, South Africa (J.L.); ViiV Healthcare, Research Triangle Park, NC (M.S.C., P. Patel, R.D., A.C., S.G., D.A.M., K.Y.S., W.R.S.); and Janssen Research and Development, Beerse, Belgium (H.C., S.V., P.E.W., W.P.)
| | - Pierre-Marie Girard
- From Queen Mary University of London, London (C.O.), and ViiV Healthcare, Brentford (V.C.) - both in the United Kingdom; EPIMED, Berlin (K.A.); Fundación Jiménez Díaz, Madrid (M.G.H.-M.); Central Research Institute of Epidemiology, Moscow (V.P.); the University of Alabama at Birmingham, Birmingham (E.T.O.); Hôpital Saint Antoine, Paris (P.-M.G.), and Hôpital Européen, Marseille (P. Philibert) - both in France; the National Center for Global Health and Medicine, Tokyo (S.O.); the University Health Network, University of Toronto, Toronto (S.W.), and GlaxoSmithKline, Mississauga (S.L.F., D.D.) - both in Ontario, Canada; North Texas Infectious Disease Consultants, Dallas (C. Bettacchi), and Central Texas Clinical Research, Austin (C. Brinson); Josha Research, Bloemfontein, South Africa (J.L.); ViiV Healthcare, Research Triangle Park, NC (M.S.C., P. Patel, R.D., A.C., S.G., D.A.M., K.Y.S., W.R.S.); and Janssen Research and Development, Beerse, Belgium (H.C., S.V., P.E.W., W.P.)
| | - Shinichi Oka
- From Queen Mary University of London, London (C.O.), and ViiV Healthcare, Brentford (V.C.) - both in the United Kingdom; EPIMED, Berlin (K.A.); Fundación Jiménez Díaz, Madrid (M.G.H.-M.); Central Research Institute of Epidemiology, Moscow (V.P.); the University of Alabama at Birmingham, Birmingham (E.T.O.); Hôpital Saint Antoine, Paris (P.-M.G.), and Hôpital Européen, Marseille (P. Philibert) - both in France; the National Center for Global Health and Medicine, Tokyo (S.O.); the University Health Network, University of Toronto, Toronto (S.W.), and GlaxoSmithKline, Mississauga (S.L.F., D.D.) - both in Ontario, Canada; North Texas Infectious Disease Consultants, Dallas (C. Bettacchi), and Central Texas Clinical Research, Austin (C. Brinson); Josha Research, Bloemfontein, South Africa (J.L.); ViiV Healthcare, Research Triangle Park, NC (M.S.C., P. Patel, R.D., A.C., S.G., D.A.M., K.Y.S., W.R.S.); and Janssen Research and Development, Beerse, Belgium (H.C., S.V., P.E.W., W.P.)
| | - Sharon Walmsley
- From Queen Mary University of London, London (C.O.), and ViiV Healthcare, Brentford (V.C.) - both in the United Kingdom; EPIMED, Berlin (K.A.); Fundación Jiménez Díaz, Madrid (M.G.H.-M.); Central Research Institute of Epidemiology, Moscow (V.P.); the University of Alabama at Birmingham, Birmingham (E.T.O.); Hôpital Saint Antoine, Paris (P.-M.G.), and Hôpital Européen, Marseille (P. Philibert) - both in France; the National Center for Global Health and Medicine, Tokyo (S.O.); the University Health Network, University of Toronto, Toronto (S.W.), and GlaxoSmithKline, Mississauga (S.L.F., D.D.) - both in Ontario, Canada; North Texas Infectious Disease Consultants, Dallas (C. Bettacchi), and Central Texas Clinical Research, Austin (C. Brinson); Josha Research, Bloemfontein, South Africa (J.L.); ViiV Healthcare, Research Triangle Park, NC (M.S.C., P. Patel, R.D., A.C., S.G., D.A.M., K.Y.S., W.R.S.); and Janssen Research and Development, Beerse, Belgium (H.C., S.V., P.E.W., W.P.)
| | - Chris Bettacchi
- From Queen Mary University of London, London (C.O.), and ViiV Healthcare, Brentford (V.C.) - both in the United Kingdom; EPIMED, Berlin (K.A.); Fundación Jiménez Díaz, Madrid (M.G.H.-M.); Central Research Institute of Epidemiology, Moscow (V.P.); the University of Alabama at Birmingham, Birmingham (E.T.O.); Hôpital Saint Antoine, Paris (P.-M.G.), and Hôpital Européen, Marseille (P. Philibert) - both in France; the National Center for Global Health and Medicine, Tokyo (S.O.); the University Health Network, University of Toronto, Toronto (S.W.), and GlaxoSmithKline, Mississauga (S.L.F., D.D.) - both in Ontario, Canada; North Texas Infectious Disease Consultants, Dallas (C. Bettacchi), and Central Texas Clinical Research, Austin (C. Brinson); Josha Research, Bloemfontein, South Africa (J.L.); ViiV Healthcare, Research Triangle Park, NC (M.S.C., P. Patel, R.D., A.C., S.G., D.A.M., K.Y.S., W.R.S.); and Janssen Research and Development, Beerse, Belgium (H.C., S.V., P.E.W., W.P.)
| | - Cynthia Brinson
- From Queen Mary University of London, London (C.O.), and ViiV Healthcare, Brentford (V.C.) - both in the United Kingdom; EPIMED, Berlin (K.A.); Fundación Jiménez Díaz, Madrid (M.G.H.-M.); Central Research Institute of Epidemiology, Moscow (V.P.); the University of Alabama at Birmingham, Birmingham (E.T.O.); Hôpital Saint Antoine, Paris (P.-M.G.), and Hôpital Européen, Marseille (P. Philibert) - both in France; the National Center for Global Health and Medicine, Tokyo (S.O.); the University Health Network, University of Toronto, Toronto (S.W.), and GlaxoSmithKline, Mississauga (S.L.F., D.D.) - both in Ontario, Canada; North Texas Infectious Disease Consultants, Dallas (C. Bettacchi), and Central Texas Clinical Research, Austin (C. Brinson); Josha Research, Bloemfontein, South Africa (J.L.); ViiV Healthcare, Research Triangle Park, NC (M.S.C., P. Patel, R.D., A.C., S.G., D.A.M., K.Y.S., W.R.S.); and Janssen Research and Development, Beerse, Belgium (H.C., S.V., P.E.W., W.P.)
| | - Patrick Philibert
- From Queen Mary University of London, London (C.O.), and ViiV Healthcare, Brentford (V.C.) - both in the United Kingdom; EPIMED, Berlin (K.A.); Fundación Jiménez Díaz, Madrid (M.G.H.-M.); Central Research Institute of Epidemiology, Moscow (V.P.); the University of Alabama at Birmingham, Birmingham (E.T.O.); Hôpital Saint Antoine, Paris (P.-M.G.), and Hôpital Européen, Marseille (P. Philibert) - both in France; the National Center for Global Health and Medicine, Tokyo (S.O.); the University Health Network, University of Toronto, Toronto (S.W.), and GlaxoSmithKline, Mississauga (S.L.F., D.D.) - both in Ontario, Canada; North Texas Infectious Disease Consultants, Dallas (C. Bettacchi), and Central Texas Clinical Research, Austin (C. Brinson); Josha Research, Bloemfontein, South Africa (J.L.); ViiV Healthcare, Research Triangle Park, NC (M.S.C., P. Patel, R.D., A.C., S.G., D.A.M., K.Y.S., W.R.S.); and Janssen Research and Development, Beerse, Belgium (H.C., S.V., P.E.W., W.P.)
| | - Johan Lombaard
- From Queen Mary University of London, London (C.O.), and ViiV Healthcare, Brentford (V.C.) - both in the United Kingdom; EPIMED, Berlin (K.A.); Fundación Jiménez Díaz, Madrid (M.G.H.-M.); Central Research Institute of Epidemiology, Moscow (V.P.); the University of Alabama at Birmingham, Birmingham (E.T.O.); Hôpital Saint Antoine, Paris (P.-M.G.), and Hôpital Européen, Marseille (P. Philibert) - both in France; the National Center for Global Health and Medicine, Tokyo (S.O.); the University Health Network, University of Toronto, Toronto (S.W.), and GlaxoSmithKline, Mississauga (S.L.F., D.D.) - both in Ontario, Canada; North Texas Infectious Disease Consultants, Dallas (C. Bettacchi), and Central Texas Clinical Research, Austin (C. Brinson); Josha Research, Bloemfontein, South Africa (J.L.); ViiV Healthcare, Research Triangle Park, NC (M.S.C., P. Patel, R.D., A.C., S.G., D.A.M., K.Y.S., W.R.S.); and Janssen Research and Development, Beerse, Belgium (H.C., S.V., P.E.W., W.P.)
| | - Marty St Clair
- From Queen Mary University of London, London (C.O.), and ViiV Healthcare, Brentford (V.C.) - both in the United Kingdom; EPIMED, Berlin (K.A.); Fundación Jiménez Díaz, Madrid (M.G.H.-M.); Central Research Institute of Epidemiology, Moscow (V.P.); the University of Alabama at Birmingham, Birmingham (E.T.O.); Hôpital Saint Antoine, Paris (P.-M.G.), and Hôpital Européen, Marseille (P. Philibert) - both in France; the National Center for Global Health and Medicine, Tokyo (S.O.); the University Health Network, University of Toronto, Toronto (S.W.), and GlaxoSmithKline, Mississauga (S.L.F., D.D.) - both in Ontario, Canada; North Texas Infectious Disease Consultants, Dallas (C. Bettacchi), and Central Texas Clinical Research, Austin (C. Brinson); Josha Research, Bloemfontein, South Africa (J.L.); ViiV Healthcare, Research Triangle Park, NC (M.S.C., P. Patel, R.D., A.C., S.G., D.A.M., K.Y.S., W.R.S.); and Janssen Research and Development, Beerse, Belgium (H.C., S.V., P.E.W., W.P.)
| | - Herta Crauwels
- From Queen Mary University of London, London (C.O.), and ViiV Healthcare, Brentford (V.C.) - both in the United Kingdom; EPIMED, Berlin (K.A.); Fundación Jiménez Díaz, Madrid (M.G.H.-M.); Central Research Institute of Epidemiology, Moscow (V.P.); the University of Alabama at Birmingham, Birmingham (E.T.O.); Hôpital Saint Antoine, Paris (P.-M.G.), and Hôpital Européen, Marseille (P. Philibert) - both in France; the National Center for Global Health and Medicine, Tokyo (S.O.); the University Health Network, University of Toronto, Toronto (S.W.), and GlaxoSmithKline, Mississauga (S.L.F., D.D.) - both in Ontario, Canada; North Texas Infectious Disease Consultants, Dallas (C. Bettacchi), and Central Texas Clinical Research, Austin (C. Brinson); Josha Research, Bloemfontein, South Africa (J.L.); ViiV Healthcare, Research Triangle Park, NC (M.S.C., P. Patel, R.D., A.C., S.G., D.A.M., K.Y.S., W.R.S.); and Janssen Research and Development, Beerse, Belgium (H.C., S.V., P.E.W., W.P.)
| | - Susan L Ford
- From Queen Mary University of London, London (C.O.), and ViiV Healthcare, Brentford (V.C.) - both in the United Kingdom; EPIMED, Berlin (K.A.); Fundación Jiménez Díaz, Madrid (M.G.H.-M.); Central Research Institute of Epidemiology, Moscow (V.P.); the University of Alabama at Birmingham, Birmingham (E.T.O.); Hôpital Saint Antoine, Paris (P.-M.G.), and Hôpital Européen, Marseille (P. Philibert) - both in France; the National Center for Global Health and Medicine, Tokyo (S.O.); the University Health Network, University of Toronto, Toronto (S.W.), and GlaxoSmithKline, Mississauga (S.L.F., D.D.) - both in Ontario, Canada; North Texas Infectious Disease Consultants, Dallas (C. Bettacchi), and Central Texas Clinical Research, Austin (C. Brinson); Josha Research, Bloemfontein, South Africa (J.L.); ViiV Healthcare, Research Triangle Park, NC (M.S.C., P. Patel, R.D., A.C., S.G., D.A.M., K.Y.S., W.R.S.); and Janssen Research and Development, Beerse, Belgium (H.C., S.V., P.E.W., W.P.)
| | - Parul Patel
- From Queen Mary University of London, London (C.O.), and ViiV Healthcare, Brentford (V.C.) - both in the United Kingdom; EPIMED, Berlin (K.A.); Fundación Jiménez Díaz, Madrid (M.G.H.-M.); Central Research Institute of Epidemiology, Moscow (V.P.); the University of Alabama at Birmingham, Birmingham (E.T.O.); Hôpital Saint Antoine, Paris (P.-M.G.), and Hôpital Européen, Marseille (P. Philibert) - both in France; the National Center for Global Health and Medicine, Tokyo (S.O.); the University Health Network, University of Toronto, Toronto (S.W.), and GlaxoSmithKline, Mississauga (S.L.F., D.D.) - both in Ontario, Canada; North Texas Infectious Disease Consultants, Dallas (C. Bettacchi), and Central Texas Clinical Research, Austin (C. Brinson); Josha Research, Bloemfontein, South Africa (J.L.); ViiV Healthcare, Research Triangle Park, NC (M.S.C., P. Patel, R.D., A.C., S.G., D.A.M., K.Y.S., W.R.S.); and Janssen Research and Development, Beerse, Belgium (H.C., S.V., P.E.W., W.P.)
| | - Vasiliki Chounta
- From Queen Mary University of London, London (C.O.), and ViiV Healthcare, Brentford (V.C.) - both in the United Kingdom; EPIMED, Berlin (K.A.); Fundación Jiménez Díaz, Madrid (M.G.H.-M.); Central Research Institute of Epidemiology, Moscow (V.P.); the University of Alabama at Birmingham, Birmingham (E.T.O.); Hôpital Saint Antoine, Paris (P.-M.G.), and Hôpital Européen, Marseille (P. Philibert) - both in France; the National Center for Global Health and Medicine, Tokyo (S.O.); the University Health Network, University of Toronto, Toronto (S.W.), and GlaxoSmithKline, Mississauga (S.L.F., D.D.) - both in Ontario, Canada; North Texas Infectious Disease Consultants, Dallas (C. Bettacchi), and Central Texas Clinical Research, Austin (C. Brinson); Josha Research, Bloemfontein, South Africa (J.L.); ViiV Healthcare, Research Triangle Park, NC (M.S.C., P. Patel, R.D., A.C., S.G., D.A.M., K.Y.S., W.R.S.); and Janssen Research and Development, Beerse, Belgium (H.C., S.V., P.E.W., W.P.)
| | - Ronald D'Amico
- From Queen Mary University of London, London (C.O.), and ViiV Healthcare, Brentford (V.C.) - both in the United Kingdom; EPIMED, Berlin (K.A.); Fundación Jiménez Díaz, Madrid (M.G.H.-M.); Central Research Institute of Epidemiology, Moscow (V.P.); the University of Alabama at Birmingham, Birmingham (E.T.O.); Hôpital Saint Antoine, Paris (P.-M.G.), and Hôpital Européen, Marseille (P. Philibert) - both in France; the National Center for Global Health and Medicine, Tokyo (S.O.); the University Health Network, University of Toronto, Toronto (S.W.), and GlaxoSmithKline, Mississauga (S.L.F., D.D.) - both in Ontario, Canada; North Texas Infectious Disease Consultants, Dallas (C. Bettacchi), and Central Texas Clinical Research, Austin (C. Brinson); Josha Research, Bloemfontein, South Africa (J.L.); ViiV Healthcare, Research Triangle Park, NC (M.S.C., P. Patel, R.D., A.C., S.G., D.A.M., K.Y.S., W.R.S.); and Janssen Research and Development, Beerse, Belgium (H.C., S.V., P.E.W., W.P.)
| | - Simon Vanveggel
- From Queen Mary University of London, London (C.O.), and ViiV Healthcare, Brentford (V.C.) - both in the United Kingdom; EPIMED, Berlin (K.A.); Fundación Jiménez Díaz, Madrid (M.G.H.-M.); Central Research Institute of Epidemiology, Moscow (V.P.); the University of Alabama at Birmingham, Birmingham (E.T.O.); Hôpital Saint Antoine, Paris (P.-M.G.), and Hôpital Européen, Marseille (P. Philibert) - both in France; the National Center for Global Health and Medicine, Tokyo (S.O.); the University Health Network, University of Toronto, Toronto (S.W.), and GlaxoSmithKline, Mississauga (S.L.F., D.D.) - both in Ontario, Canada; North Texas Infectious Disease Consultants, Dallas (C. Bettacchi), and Central Texas Clinical Research, Austin (C. Brinson); Josha Research, Bloemfontein, South Africa (J.L.); ViiV Healthcare, Research Triangle Park, NC (M.S.C., P. Patel, R.D., A.C., S.G., D.A.M., K.Y.S., W.R.S.); and Janssen Research and Development, Beerse, Belgium (H.C., S.V., P.E.W., W.P.)
| | - David Dorey
- From Queen Mary University of London, London (C.O.), and ViiV Healthcare, Brentford (V.C.) - both in the United Kingdom; EPIMED, Berlin (K.A.); Fundación Jiménez Díaz, Madrid (M.G.H.-M.); Central Research Institute of Epidemiology, Moscow (V.P.); the University of Alabama at Birmingham, Birmingham (E.T.O.); Hôpital Saint Antoine, Paris (P.-M.G.), and Hôpital Européen, Marseille (P. Philibert) - both in France; the National Center for Global Health and Medicine, Tokyo (S.O.); the University Health Network, University of Toronto, Toronto (S.W.), and GlaxoSmithKline, Mississauga (S.L.F., D.D.) - both in Ontario, Canada; North Texas Infectious Disease Consultants, Dallas (C. Bettacchi), and Central Texas Clinical Research, Austin (C. Brinson); Josha Research, Bloemfontein, South Africa (J.L.); ViiV Healthcare, Research Triangle Park, NC (M.S.C., P. Patel, R.D., A.C., S.G., D.A.M., K.Y.S., W.R.S.); and Janssen Research and Development, Beerse, Belgium (H.C., S.V., P.E.W., W.P.)
| | - Amy Cutrell
- From Queen Mary University of London, London (C.O.), and ViiV Healthcare, Brentford (V.C.) - both in the United Kingdom; EPIMED, Berlin (K.A.); Fundación Jiménez Díaz, Madrid (M.G.H.-M.); Central Research Institute of Epidemiology, Moscow (V.P.); the University of Alabama at Birmingham, Birmingham (E.T.O.); Hôpital Saint Antoine, Paris (P.-M.G.), and Hôpital Européen, Marseille (P. Philibert) - both in France; the National Center for Global Health and Medicine, Tokyo (S.O.); the University Health Network, University of Toronto, Toronto (S.W.), and GlaxoSmithKline, Mississauga (S.L.F., D.D.) - both in Ontario, Canada; North Texas Infectious Disease Consultants, Dallas (C. Bettacchi), and Central Texas Clinical Research, Austin (C. Brinson); Josha Research, Bloemfontein, South Africa (J.L.); ViiV Healthcare, Research Triangle Park, NC (M.S.C., P. Patel, R.D., A.C., S.G., D.A.M., K.Y.S., W.R.S.); and Janssen Research and Development, Beerse, Belgium (H.C., S.V., P.E.W., W.P.)
| | - Sandy Griffith
- From Queen Mary University of London, London (C.O.), and ViiV Healthcare, Brentford (V.C.) - both in the United Kingdom; EPIMED, Berlin (K.A.); Fundación Jiménez Díaz, Madrid (M.G.H.-M.); Central Research Institute of Epidemiology, Moscow (V.P.); the University of Alabama at Birmingham, Birmingham (E.T.O.); Hôpital Saint Antoine, Paris (P.-M.G.), and Hôpital Européen, Marseille (P. Philibert) - both in France; the National Center for Global Health and Medicine, Tokyo (S.O.); the University Health Network, University of Toronto, Toronto (S.W.), and GlaxoSmithKline, Mississauga (S.L.F., D.D.) - both in Ontario, Canada; North Texas Infectious Disease Consultants, Dallas (C. Bettacchi), and Central Texas Clinical Research, Austin (C. Brinson); Josha Research, Bloemfontein, South Africa (J.L.); ViiV Healthcare, Research Triangle Park, NC (M.S.C., P. Patel, R.D., A.C., S.G., D.A.M., K.Y.S., W.R.S.); and Janssen Research and Development, Beerse, Belgium (H.C., S.V., P.E.W., W.P.)
| | - David A Margolis
- From Queen Mary University of London, London (C.O.), and ViiV Healthcare, Brentford (V.C.) - both in the United Kingdom; EPIMED, Berlin (K.A.); Fundación Jiménez Díaz, Madrid (M.G.H.-M.); Central Research Institute of Epidemiology, Moscow (V.P.); the University of Alabama at Birmingham, Birmingham (E.T.O.); Hôpital Saint Antoine, Paris (P.-M.G.), and Hôpital Européen, Marseille (P. Philibert) - both in France; the National Center for Global Health and Medicine, Tokyo (S.O.); the University Health Network, University of Toronto, Toronto (S.W.), and GlaxoSmithKline, Mississauga (S.L.F., D.D.) - both in Ontario, Canada; North Texas Infectious Disease Consultants, Dallas (C. Bettacchi), and Central Texas Clinical Research, Austin (C. Brinson); Josha Research, Bloemfontein, South Africa (J.L.); ViiV Healthcare, Research Triangle Park, NC (M.S.C., P. Patel, R.D., A.C., S.G., D.A.M., K.Y.S., W.R.S.); and Janssen Research and Development, Beerse, Belgium (H.C., S.V., P.E.W., W.P.)
| | - Peter E Williams
- From Queen Mary University of London, London (C.O.), and ViiV Healthcare, Brentford (V.C.) - both in the United Kingdom; EPIMED, Berlin (K.A.); Fundación Jiménez Díaz, Madrid (M.G.H.-M.); Central Research Institute of Epidemiology, Moscow (V.P.); the University of Alabama at Birmingham, Birmingham (E.T.O.); Hôpital Saint Antoine, Paris (P.-M.G.), and Hôpital Européen, Marseille (P. Philibert) - both in France; the National Center for Global Health and Medicine, Tokyo (S.O.); the University Health Network, University of Toronto, Toronto (S.W.), and GlaxoSmithKline, Mississauga (S.L.F., D.D.) - both in Ontario, Canada; North Texas Infectious Disease Consultants, Dallas (C. Bettacchi), and Central Texas Clinical Research, Austin (C. Brinson); Josha Research, Bloemfontein, South Africa (J.L.); ViiV Healthcare, Research Triangle Park, NC (M.S.C., P. Patel, R.D., A.C., S.G., D.A.M., K.Y.S., W.R.S.); and Janssen Research and Development, Beerse, Belgium (H.C., S.V., P.E.W., W.P.)
| | - Wim Parys
- From Queen Mary University of London, London (C.O.), and ViiV Healthcare, Brentford (V.C.) - both in the United Kingdom; EPIMED, Berlin (K.A.); Fundación Jiménez Díaz, Madrid (M.G.H.-M.); Central Research Institute of Epidemiology, Moscow (V.P.); the University of Alabama at Birmingham, Birmingham (E.T.O.); Hôpital Saint Antoine, Paris (P.-M.G.), and Hôpital Européen, Marseille (P. Philibert) - both in France; the National Center for Global Health and Medicine, Tokyo (S.O.); the University Health Network, University of Toronto, Toronto (S.W.), and GlaxoSmithKline, Mississauga (S.L.F., D.D.) - both in Ontario, Canada; North Texas Infectious Disease Consultants, Dallas (C. Bettacchi), and Central Texas Clinical Research, Austin (C. Brinson); Josha Research, Bloemfontein, South Africa (J.L.); ViiV Healthcare, Research Triangle Park, NC (M.S.C., P. Patel, R.D., A.C., S.G., D.A.M., K.Y.S., W.R.S.); and Janssen Research and Development, Beerse, Belgium (H.C., S.V., P.E.W., W.P.)
| | - Kimberly Y Smith
- From Queen Mary University of London, London (C.O.), and ViiV Healthcare, Brentford (V.C.) - both in the United Kingdom; EPIMED, Berlin (K.A.); Fundación Jiménez Díaz, Madrid (M.G.H.-M.); Central Research Institute of Epidemiology, Moscow (V.P.); the University of Alabama at Birmingham, Birmingham (E.T.O.); Hôpital Saint Antoine, Paris (P.-M.G.), and Hôpital Européen, Marseille (P. Philibert) - both in France; the National Center for Global Health and Medicine, Tokyo (S.O.); the University Health Network, University of Toronto, Toronto (S.W.), and GlaxoSmithKline, Mississauga (S.L.F., D.D.) - both in Ontario, Canada; North Texas Infectious Disease Consultants, Dallas (C. Bettacchi), and Central Texas Clinical Research, Austin (C. Brinson); Josha Research, Bloemfontein, South Africa (J.L.); ViiV Healthcare, Research Triangle Park, NC (M.S.C., P. Patel, R.D., A.C., S.G., D.A.M., K.Y.S., W.R.S.); and Janssen Research and Development, Beerse, Belgium (H.C., S.V., P.E.W., W.P.)
| | - William R Spreen
- From Queen Mary University of London, London (C.O.), and ViiV Healthcare, Brentford (V.C.) - both in the United Kingdom; EPIMED, Berlin (K.A.); Fundación Jiménez Díaz, Madrid (M.G.H.-M.); Central Research Institute of Epidemiology, Moscow (V.P.); the University of Alabama at Birmingham, Birmingham (E.T.O.); Hôpital Saint Antoine, Paris (P.-M.G.), and Hôpital Européen, Marseille (P. Philibert) - both in France; the National Center for Global Health and Medicine, Tokyo (S.O.); the University Health Network, University of Toronto, Toronto (S.W.), and GlaxoSmithKline, Mississauga (S.L.F., D.D.) - both in Ontario, Canada; North Texas Infectious Disease Consultants, Dallas (C. Bettacchi), and Central Texas Clinical Research, Austin (C. Brinson); Josha Research, Bloemfontein, South Africa (J.L.); ViiV Healthcare, Research Triangle Park, NC (M.S.C., P. Patel, R.D., A.C., S.G., D.A.M., K.Y.S., W.R.S.); and Janssen Research and Development, Beerse, Belgium (H.C., S.V., P.E.W., W.P.)
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Swindells S, Andrade-Villanueva JF, Richmond GJ, Rizzardini G, Baumgarten A, Masiá M, Latiff G, Pokrovsky V, Bredeek F, Smith G, Cahn P, Kim YS, Ford SL, Talarico CL, Patel P, Chounta V, Crauwels H, Parys W, Vanveggel S, Mrus J, Huang J, Harrington CM, Hudson KJ, Margolis DA, Smith KY, Williams PE, Spreen WR. Long-Acting Cabotegravir and Rilpivirine for Maintenance of HIV-1 Suppression. N Engl J Med 2020; 382:1112-1123. [PMID: 32130809 DOI: 10.1056/nejmoa1904398] [Citation(s) in RCA: 236] [Impact Index Per Article: 59.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Simplified regimens for the treatment of human immunodeficiency virus type 1 (HIV-1) infection may increase patient satisfaction and facilitate adherence. METHODS In this phase 3, open-label, multicenter, noninferiority trial involving patients who had had plasma HIV-1 RNA levels of less than 50 copies per milliliter for at least 6 months while taking standard oral antiretroviral therapy, we randomly assigned participants (1:1) to either continue their oral therapy or switch to monthly intramuscular injections of long-acting cabotegravir, an HIV-1 integrase strand-transfer inhibitor, and long-acting rilpivirine, a nonnucleoside reverse-transcriptase inhibitor. The primary end point was the percentage of participants with an HIV-1 RNA level of 50 copies per milliliter or higher at week 48, determined with the use of the Food and Drug Administration snapshot algorithm. RESULTS Treatment was initiated in 308 participants per group. At week 48, HIV-1 RNA levels of 50 copies per milliliter or higher were found in 5 participants (1.6%) receiving long-acting therapy and in 3 (1.0%) receiving oral therapy (adjusted difference, 0.6 percentage points; 95% confidence interval [CI], -1.2 to 2.5), a result that met the criterion for noninferiority for the primary end point (noninferiority margin, 6 percentage points). An HIV-1 RNA level of less than 50 copies per milliliter at week 48 was found in 92.5% of participants receiving long-acting therapy and in 95.5% of those receiving oral therapy (adjusted difference, -3.0 percentage points; 95% CI, -6.7 to 0.7), a result that met the criterion for noninferiority for this end point (noninferiority margin, -10 percentage points). Virologic failure was confirmed in 3 participants who received long-acting therapy and 4 participants who received oral therapy. Adverse events were more common in the long-acting-therapy group and included injection-site pain, which occurred in 231 recipients (75%) of long-acting therapy and was mild or moderate in most cases; 1% withdrew because of this event. Serious adverse events were reported in no more than 5% of participants in each group. CONCLUSIONS Monthly injections of long-acting cabotegravir and rilpivirine were noninferior to standard oral therapy for maintaining HIV-1 suppression. Injection-related adverse events were common but only infrequently led to medication withdrawal. (Funded by ViiV Healthcare and Janssen; ATLAS ClinicalTrials.gov number, NCT02951052.).
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Affiliation(s)
- Susan Swindells
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Jaime-Federico Andrade-Villanueva
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Gary J Richmond
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Giuliano Rizzardini
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Axel Baumgarten
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Mar Masiá
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Gulam Latiff
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Vadim Pokrovsky
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Fritz Bredeek
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Graham Smith
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Pedro Cahn
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Yeon-Sook Kim
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Susan L Ford
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Christine L Talarico
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Parul Patel
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Vasiliki Chounta
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Herta Crauwels
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Wim Parys
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Simon Vanveggel
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Joseph Mrus
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Jenny Huang
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Conn M Harrington
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Krischan J Hudson
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - David A Margolis
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Kimberly Y Smith
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Peter E Williams
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - William R Spreen
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
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Matza LS, Paulus T, Garris C, Van de Velde N, Chounta V, Deger KA. 2496. Qualitative Thematic Analysis of Social Media Data to Assess Perceptions of Daily Oral and Long-Acting Injectable Antiretroviral Treatment among People Living with HIV. Open Forum Infect Dis 2019. [PMCID: PMC6810282 DOI: 10.1093/ofid/ofz360.2174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Current HIV treatment options consist of daily oral antiretroviral therapies (ART). A long-acting injectable HIV treatment is in development for monthly or every other month administration. Patient preferences for ART are important to understand and can impact retention in care, adherence and outcomes. The purpose of this study was to obtain and analyze patient perceptions of oral and injectable ART using a novel approach. Methods Qualitative thematic analysis was conducted to examine online discussion threads posted by people living with HIV (PLHIV) in POZ Community Forums from 2013 to 2018. Perceptions of ART were analyzed using keywords (e.g., dose, pill, daily, long-acting, injection, monthly, cabotegravir). Relevant threads were extracted, reviewed and coded using qualitative data analysis software (ATLAS.ti.8). Results Analyses identified 684 relevant discussion threads including 2,629 coded quotations posted by 568 PLHIV. Oral ART (2,517 quotations) was discussed more frequently than injectable ART (112). Positive statements on oral ART commonly mentioned the small number of pills (278), dose frequency (248), ease of scheduling (154), and ease-of-use (146). PLHIV also noted disadvantages of oral ART including negative emotional impact (179), difficulty with medication access (137), scheduling (131), and treatment adherence (128). Among the PLHIV discussing injectable ART, common positive comments focused on less frequent administration (34), emotional benefits of not taking a daily pill (7), potential benefits for adherence (6), overall convenience (6), and benefits for traveling (6). Some quotations (10) perceived the frequency of injections negatively, and others had negative perceptions of needles (8) or appointments required to receive injections (8). Conclusion ART was frequently discussed among PLHIV on this online forum. This innovative approach for obtaining and analyzing unsolicited comments revealed that while many PLHIV expressed positive views about their daily oral regimen, others perceived inconveniences and challenges. Among PLHIV who were aware of a possible long-acting injectable treatment, many viewed this potential new option as a convenient alternative with the potential to improve adherence. Disclosures All authors: No reported disclosures.
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Oglesby A, Angelis K, Punekar Y, Chounta V, Antela A, Matthews J, Kahl L, Gartland M, Wynne B, Murray M, Andre Van Wyk J. 2484. Patient Reported Outcomes After Switching to a 2-Drug Regimen of Dolutegravir + Rilpivirine: Week 148 Results from the Sword-1 and Sword-2 Studies. Open Forum Infect Dis 2019. [PMCID: PMC6809953 DOI: 10.1093/ofid/ofz360.2162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The SWORD-1 and SWORD-2 studies previously demonstrated that high rates of virologic suppression were maintained for 148 weeks after switching virologically suppressed HIV-1 infected adults from their current 3- or 4-drug antiretroviral regimen (CAR) to the 2-drug regimen (2DR) of dolutegravir + rilpivirine on Day 1 (Early Switch (ES) DTG+RPV group). This abstract reports the pooled SWORD-1/2 results of patient reported outcomes (PRO) measures through Week 148.
Methods
HIV Treatment Satisfaction Questionnaire (HIVTSQ) and Symptom Distress Module (SDM) were secondary PRO endpoints in the SWORD trials. For HIVTSQ, high scores represent greater treatment satisfaction (range 0 to 60). SDM was assessed using the Symptom Bother Score with low values indicating less symptom bother (range 0 to 80). The EQ-5D-5L measure of general health status was assessed as an exploratory endpoint with maximum utility score of 1 to indicate perfect health. Change from Baseline in these endpoints was calculated for the ES subjects (over 148 weeks). Subjects randomized to CAR switched to DTG+RPV at Week 52 (Late Switch (LS) DTG+RPV group) and change from LS Baseline (i.e., last pre-switch assessment) was calculated (over 96 weeks).
Results
Low Symptom Bother (9.6 and 10.3) and high TSQ scores (54.4 and 54.3) were reported pre-switch in the ES and LS groups, respectively.
ES subjects reported modest improvements from Baseline in both symptom burden and overall treatment satisfaction in all visits through Week 148 (Figures 1 and 2). Among the LS group, there was little change in symptom burden but similar improvement in treatment satisfaction. Pre-switch health status was high in ES and LS groups (EQ-5D mean utility: 0.96 and 0.94, respectively) and remained stable in both groups at all time points.
Conclusion
High treatment satisfaction and low symptom burden that were observed in patients under CAR were maintained long term after switching to DTG+RPV. These results corroborate DTG+RPV as a well-tolerated 2DR alternative treatment option in patients currently suppressed on other 3/4-drug regimens without previous virologic failure.
Disclosures
All authors: No reported disclosures.
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Affiliation(s)
- Alan Oglesby
- ViiV Healthcare, Research Triangle Park, North Carolina
| | | | | | | | - Antonio Antela
- Hospital Clínico Universitario de santiago de Compostela, Coruna, Galicia, Spain
| | | | - Lesley Kahl
- ViiV Healthcare, Research Triangle Park, North Carolina
| | | | - Brian Wynne
- ViiV Healthcare, Research Triangle Park, North Carolina
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Tremblay G, Chounta V, Piercy J, Holbrook T, Garib SA, Bukin EK, Punekar YS. Cost-Effectiveness of Dolutegravir as a First-Line Treatment Option in the HIV-1-Infected Treatment-Naive Patients in Russia. Value Health Reg Issues 2018; 16:74-80. [PMID: 30296624 DOI: 10.1016/j.vhri.2018.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 06/28/2018] [Accepted: 08/17/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To evaluate the cost effectiveness of dolutegravir + abacavir/lamivudine (DTG + ABC/3TC) compared with raltegravir + abacavir/lamivudine (RAL + ABC/3TC) and ritonavir-boosted darunavir + abacavir/lamivudine (DRV/r + ABC/3TC) in HIV-1-infected treatment-naive patients in Russia. METHODS A dynamic Markov model was developed with five response states and six CD4+-based health states. Efficacy estimated as probability of viral suppression (HIV RNA <50 copies/ml) at 48 weeks was obtained from a published network meta-analysis. Baseline cohort characteristics and health state utilities were informed using DTG phase 3 clinical trials. Health care resource use was obtained from literature and costed using published unit costs. Costs (presented in Russian rubles) included antiretroviral drug costs; HIV management costs such as routine care; costs of treating cardiovascular conditions, opportunistic infections, and drug-related adverse effects; and mortality costs. A patient lifetime analysis was conducted using the societal perspective. Outcomes were quality-adjusted life-years (QALYs), life-years, incremental cost per QALY ratio, and incremental cost per responder. RESULTS The viral suppression rate among patients receiving DTG + ABC/3TC was 71.7% compared with 65.2% for RAL + ABC/3TC and 59.6% for DRV/r + ABC/3TC. The mean duration of response per patient was 116.6 months for DTG + ABC/3TC, 108.6 months for RAL + ABC/3TC, and 98.9 months for DRV/r + ABC/3TC. Total discounted costs for treatment over patient lifetime were RUB 2.89, 5.32, and 4.38 million for DTG + ABC/3TC, RAL + ABC/3TC, and DRV/r + ABC/3TC, respectively. Lifetime discounted QALYs were 12.73 for patients on DTG + ABC/3TC and 12.72 each for patients on RAL + ABC/3TC and DRV/r + ABC/3TC. DTG + ABC/3TC thus dominated the other two alternatives. CONCLUSIONS With lower costs, higher response rates, and comparable QALYs, DTG + ABC/3TC can be considered as a cost-effective alternative.
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