1. Impact of previous HIV resistance and virologic failures on virologic outcome following a switch to dolutegravir with 2 NRTIs among people living with HIV
- Author
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Zoë R Greenwald, Marina B. Klein, Réjean Thomas, Alexandra de Pokomandy, Michel Roger, Cécile Tremblay, Helen Trottier, Isabelle Hardy, Catherine Deshaies, Mamadou Dakouo, Nima Machouf, Madeleine Durand, Mohamed Ndongo Sangaré, Claudie Laprise, Jean-Guy Baril, Louise Laporte, and Costa Pexos
- Subjects
Male ,medicine.medical_specialty ,Pyridones ,antiretroviral therapy ,Human immunodeficiency virus (HIV) ,Observational Study ,Viremia ,HIV Infections ,medicine.disease_cause ,Piperazines ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Internal medicine ,Antiretroviral Therapy, Highly Active ,Drug Resistance, Viral ,Oxazines ,medicine ,Humans ,030212 general & internal medicine ,HIV Integrase Inhibitors ,Hiv resistance ,business.industry ,Human immunodeficiency virus ,Hazard ratio ,Quebec ,virus diseases ,General Medicine ,Middle Aged ,Viral Load ,medicine.disease ,switch ,dolutegravir ,Regimen ,exposure to mono/dual NRTI therapy ,chemistry ,030220 oncology & carcinogenesis ,Cohort ,Dolutegravir ,Reverse Transcriptase Inhibitors ,Female ,business ,Viral load ,Heterocyclic Compounds, 3-Ring ,previous virologic failure ,Research Article ,virologic outcome - Abstract
There is uncertainty regarding the potential virologic outcome associated with a change in antiretroviral therapy (ARV) among PLHIV who had previous documented virologic failure or who have been exposure to mono/dual nucleoside reverse transcriptase inhibitors (NRTI) therapy. The objective was to measure the potential impact of exposure to previous virologic failure or mono/dual NRTI regimen on virologic outcome of PLHIV following a switch to dolutegravir with 2 NRTIs from a viremia suppressive ARV therapy. Data from the Quebec HIV Cohort including 10219 PLHIV were collected through routine clinical care at 4 clinical sites in Montreal, Canada. This study includes patients whose ARV therapy was switched to dolutegravir with 2 NRTIs since 2013 with undetectable viral load for ≥6 months before switch. The association between exposure and post-switch virologic outcome was measured by marginal hazard ratio estimated using the Inverse probability weighting Cox model. Among the 1199 eligible PLHIV, 478 (39.9%) previously experienced at least one virologic failure or were exposed to mono/dual therapy before dolutegravir switch. Post-switch virologic failure after 30 months occurred in 4.1% (95% CI 2.1–7.9) of exposed compared to 4.1% (95% CI 2.3–7.4) in unexposed participants. The adjusted hazard ratio for the association between exposure and post-switch virologic failure was 0.84 (95% CI 0.35–2.01). Our findings suggest that switch to dolutegravir with 2 NRTIs from a suppressive therapy is a safe option for PLHIV with documented virologic failure and/or previous exposure to mono/dual NRTI therapy.
- Published
- 2020