Dolutegravir-based monotherapy or dual therapy maintains a high proportion of viral suppression even in highly experienced HIV-1-infected patients
Journal of Antimicrobial Chemotherapy April 2016 V.71 N.4 P.1046-1050
Camelia Gubavu, Thierry Prazuck, Mohamadou Niang, Jennifer Buret, Catherine Mille, Jérôme Guinard, Véronique Avettand-Fènoël, and Laurent Hocqueloux
1Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Régional, Orléans, France
2Laboratoire de Virologie, Centre Hospitalier Régional, Orléans, France
3Laboratoire de Virologie, Hôpital Necker-Enfants Malades, APHP, Paris, France
4Université Paris-Descartes Sorbonne Paris Cité, Faculté de Médecine, EA 7327, Paris, France
Dolutegravir is a powerful, well-tolerated integrase inhibitor with a high genetic barrier to resistance and may thus constitute the backbone of lightened regimens.
This was a monocentric, retrospective study. HIV-1-infected patients receiving dolutegravir as monotherapy (mDGV) or dual therapy (dDGV) were systematically identified. The primary outcome was the proportion of patients who maintained undetectable (<50 copies/mL) plasma HIV RNA [plasma viral load (PVL)].
We identified 21 patients on mDGV (50 mg/day) and 31 on dDGV (50 or 100 mg/day, with atazanavir±ritonavir, n=12; rilpivirine, n=11; maraviroc, n=3; lamivudine, n=3; darunavir/ritonavir, n=1; or abacavir, n=1). All of the patients were treatment experienced and 48% had experienced at least one virological failure. The baseline characteristics were as follows (for the mDGV/dDGV patients, respectively): 5%/29% had a history of AIDS; the median (IQR) highest PVL was 4.5 (4.3–5.5)/5.3 (4.7–5.6) log copies/mL; the median (IQR) nadir CD4+ count was 310 (280–468)/199 (134–281) cells/mm3; 100% had undetectable PVL before the mDGV for a median (IQR) duration of 5.9 (3.5–9.9) years/81% had undetectable PVL before the dDGV for a median (IQR) duration of 3.7 (1.4–8.3) years; and the median (IQR) HIV DNA level was 2.7 (2.1–3.1)/2.9 (2.7–3) log copies/106 PBMCs. At the last follow-up visit, 100% and 97% of patients showed undetectable PVL following mDGV and dDGV, respectively [median (IQR) follow-up of 32 (29–45) and 50 (30–74) weeks, respectively].
In our experience, dolutegravir-based lightened regimens provided a high proportion of viral suppression, even in highly treatment-experienced patients.
Any impact of blips and low-level viraemia episodes among HIV-infected patients with sustained virological suppression on ART? Mejora del diagnóstico de las infecciones por Chamydia trachomatis en la era molecular, una oportunidad para los sistemas de vigilancia