Effectiveness of switching from protease inhibitors to dolutegravir in combination with nucleoside reverse transcriptase inhibitors as maintenance antiretroviral therapy among HIV-positive patients
Journal
International Journal of Antimicrobial Agents
Journal Volume
54
Journal Issue
1
Pages
35-42
Date Issued
2019
Author(s)
Chen G.-J.
Su Y.-C.
Liu W.-C.
Abstract
Prolonged exposure to regimens containing protease inhibitors (PIs) as second-line therapy for human immunodeficiency virus (HIV) infection may have a negative impact on metabolic profiles and increase the risk of cardiovascular diseases. Real-world experience with dolutegravir (DTG)-based regimens as alternatives to PI-based regimens is limited in antiretroviral-experienced patients with previous failure or intolerance to first-line therapy. The current study included HIV-positive patients receiving PI-containing regimens with viral suppression for ?6 months. Virological response and lipid profiles were compared between patients who were subsequently switched to DTG-based therapy plus nucleoside reverse transcriptase inhibitors (NRTIs) and those remaining on their PI-containing regimen at Week 48. In total, 189 patients were switched to DTG-based regimens and 313 remained on PI-containing regimens during the observation period. Patients in the DTG group were younger (mean age 40.0 years vs. 44.6 years) and were more likely to have a previous history of virological failure (44.4% vs. 19.5%) than those in the PI group. At Week 48, 1.1% of the DTG group and 3.8% of the PI group had virological non-response (HIV-RNA load >50 copies/mL) (difference, –2.7%, 95% CI –5.5% to 0.5%). The presence of M184V/I mutation and other NRTI resistance-associated mutations (RAMs) did not increase the risk of virological failure in either group. Patients switched to DTG-based therapy had statistically significant improvement of lipid profiles. Among virally suppressed HIV-positive patients, a switch to DTG-based therapy was non-inferior to continuation of PI-based therapy in virological effectiveness at Week 48, even in the presence of NRTI RAMs. ? 2019 Elsevier B.V. and International Society of Chemotherapy
SDGs
Other Subjects
abacavir; atazanavir; darunavir; dolutegravir; emtricitabine; high density lipoprotein cholesterol; lamivudine; lopinavir; low density lipoprotein cholesterol; tenofovir disoproxil; triacylglycerol; zidovudine; integrase inhibitor; proteinase inhibitor; RNA directed DNA polymerase inhibitor; adult; antiretroviral therapy; Article; cholesterol blood level; cohort analysis; controlled study; demography; drug efficacy; drug substitution; drug withdrawal; estimated glomerular filtration rate; female; human; Human immunodeficiency virus 1; Human immunodeficiency virus 1 infection; major clinical study; male; nonhuman; observational study; population research; priority journal; risk factor; treatment outcome; treatment response; triacylglycerol blood level; virus load; adverse event; drug substitution; dyslipidemia; highly active antiretroviral therapy; Human immunodeficiency virus infection; maintenance chemotherapy; middle aged; procedures; sustained virologic response; Adult; Antiretroviral Therapy, Highly Active; Drug Substitution; Dyslipidemias; Female; HIV Infections; HIV Integrase Inhibitors; Humans; Maintenance Chemotherapy; Male; Middle Aged; Protease Inhibitors; Reverse Transcriptase Inhibitors; Sustained Virologic Response; Treatment Outcome
Type
journal article