1. Virologic outcomes of switching to dolutegravir functional mono- or dual therapy with a non-cytosine nucleoside analog: a retrospective study of treatment-experienced, patients living with HIV
- Author
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Edwin DeJesus, Vu Nguyen, Federico Hinestrosa, and Charlotte-Paige Rolle
- Subjects
0301 basic medicine ,medicine.medical_specialty ,Dual therapy ,Pyridones ,030106 microbiology ,HIV Infections ,Single Center ,Gastroenterology ,Cytosine nucleoside ,Piperazines ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Virology ,Internal medicine ,Oxazines ,HIV drug resistance ,Clinical endpoint ,Humans ,Medicine ,Pharmacology (medical) ,030212 general & internal medicine ,Retrospective Studies ,business.industry ,Research ,Nucleosides ,Retrospective cohort study ,Viral Load ,RC581-607 ,Resistance mutation ,Monotherapy ,Regimen ,Treatment Outcome ,chemistry ,Dolutegravir ,Molecular Medicine ,Immunologic diseases. Allergy ,business ,Heterocyclic Compounds, 3-Ring - Abstract
BackgroundDolutegravir (DTG) monotherapy results in virologic failure and the development of DTG resistance. Here, we evaluated virologic outcomes of patients switched to DTG functional mono- or dual therapy with a non-cytosine nucleoside analog (NA).MethodsThis retrospective, single center study included treatment-experienced patients switched to regimens containing ≥ 2 antiretrovirals between 8/13/13–11/22/14 who were later found to be on DTG functional mono- or dual therapy with a non-cytosine NA based on historical genotypes. Eligible patients were either suppressed or viremic at baseline and had ≥ 2 HIV-1 RNA measurements at least 4 weeks apart following switch. Demographics, laboratory values and clinical parameters were extracted from the charts of all eligible patients during study treatment until 12/31/2018 and were summarized using descriptive statistics. The primary endpoint was the proportion of patients with HIV-1 RNA ResultsOf 70 patients switched to DTG functional mono- or dual therapy, 39 were eligible; 19 (49%) were on DTG functional monotherapy and 20 (51%) were on DTG functional dual therapy with a non-cytosine NA. Historical genotypes indicated that all had an M184V/I, and 23 (59%) had an M184V/I and ≥ 1 additional NA mutation. The median duration of follow-up on study treatment was 50 weeks (range 12–244). Following switch, 32/39 (82%) patients achieved or maintained an HIV-1 RNA ConclusionsIn this real-world cohort, the majority of whom had virus with the M184V/I and ≥ 1 additional NA mutation, switching to DTG functional mono-or dual therapy with a non-cytosine NA resulted in persistent HIV-1 RNA ≥ 50 copies/mL in 18%. None with post-switch genotypes developed treatment-emergent resistance.
- Published
- 2021