1. Virological outcomes of various first-line ART regimens in patients harbouring HIV-1 E157Q integrase polymorphism: a multicentre retrospective study.
- Author
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Uno, Shunsuke, Gatanaga, Hiroyuki, Hayashida, Tsunefusa, Imahashi, Mayumi, Minami, Rumi, Koga, Michiko, Samukawa, Sei, Watanabe, Dai, Fujii, Teruhisa, Tateyama, Masao, Nakamura, Hideta, Matsushita, Shuzo, Yoshino, Yusuke, Endo, Tomoyuki, Horiba, Masahide, Taniguchi, Toshibumi, Moro, Hiroshi, Igari, Hidetoshi, Yoshida, Shigeru, and Teshima, Takanori
- Subjects
HIV ,HIV-positive persons ,RETROSPECTIVE studies - Abstract
Background Integrase strand transfer inhibitors (INSTIs) are recommended as first-line ART for people living with HIV (PLWH) in most guidelines. The INSTI-resistance-associated mutation E157Q, a highly prevalent (2%–5%) polymorphism of the HIV-1 (human immunodeficiency virus type 1) integrase gene, has limited data on optimal first-line ART regimens. We assessed the virological outcomes of various first-line ART regimens in PLWH with E157Q in real-world settings. Methods A multicentre retrospective observational study was conducted on PLWH who underwent integrase genotypic drug-resistance testing before ART initiation between 2008 and 2019 and were found to have E157Q. Viral suppression (<50 copies/mL) rate at 24 and 48 weeks, time to viral suppression and time to viral rebound (≥100 copies/mL) were compared among the first-line ART regimens. Results E157Q was detected in 167 (4.1%) of 4043 ART-naïve PLWH. Among them, 144 had available clinical data after ART initiation with a median follow-up of 1888 days. Forty-five started protease inhibitors + 2 NRTIs (PI group), 33 started first-generation INSTI (raltegravir or elvitegravir/cobicistat) + 2 NRTIs (INSTI-1 group), 58 started once-daily second-generation INSTI (dolutegravir or bictegravir) + 2 NRTIs (INSTI-2 group) and eight started other regimens. In the multivariate analysis, the INSTI-2 group showed similar or favourable outcomes compared with the PI group for viral suppression rates, time to viral suppression and time to viral rebound. Two cases in the INSTI-1 group experienced virological failure. Conclusions The general guideline recommendation of second-generation INSTI-based first-line ART for most PLWH is also applicable to PLWH harbouring E157Q. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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