Evaluation of virological response and resistance profile in HIV-1 infected patients starting a first-line integrase inhibitor-based regimen in clinical settings

Effectiveness of integrase strand transfer inhibitors in HIV‐infected treatment‐experienced individuals across Europe

“…Interestingly, this large multi‐cohort study confirmed the low rate of INSTI resistance mutations among INSTI‐naïve individuals (< 1%), similar to previous reports on other cohorts [48]. These data, together with the increasing use of high‐genetic‐barrier, second‐generation INSTIs as first‐line therapy, suggests that primary INSTI resistance will remain a minor issue, as recently outlined in a comprehensive survey [49].…”

“…These data, together with the increasing use of high-genetic-barrier, second-generation INSTIs as first-line therapy, suggests that primary INSTI resistance will remain a minor issue, as recently outlined in a comprehensive survey [49]. In our cohort, the prevalence of acquired INSTI resistance was also low, in contrast to higher rates reported in other studies [16,[48][49][50]. This discrepancy could be ex- probably because the last follow-up date in our study was the first trimester of 2020, substantially later than other studies, reflecting the increasing availability of newer INSTIs.…”

“…These data, together with the increasing use of high‐genetic‐barrier, second‐generation INSTIs as first‐line therapy, suggests that primary INSTI resistance will remain a minor issue, as recently outlined in a comprehensive survey [49]. In our cohort, the prevalence of acquired INSTI resistance was also low, in contrast to higher rates reported in other studies [16,48–50]. This discrepancy could be explained by an underestimation of acquired INSTI resistance due to lack of IN genotype information, namely for 48% of INSTI‐experienced viraemic individuals, by different representation of subjects failing first‐generation resistance‐prone INSTIs and by a substantial proportion of cases where the first failing INSTI had been discontinued for a considerable time before being treated with a second INSTI, allowing overgrowth of virus carrying wild‐type integrase.…”

Genotypic HIV-1 tropism determination might help to identify people with exhausted treatment options and advanced disease

“…Given the fact that concerns about individuals with MDR are still present (mainly among those with exhausted treatments options), 3 and resistance to INI might be challenging, our findings confirm that characterizing and seeking solutions for individuals with limited therapeutic options, taking tropism determination also into account, might provide useful information, as previously described. 29,41 Thus, although the majority of cART-experienced patients harboured strains susceptible to maraviroc, particular attention should be paid to those patients showing X4/dual mixed strains with low levels of FPR. On the other hand, patients harbouring R5 strains seem less prone to accumulate high levels of resistance regardless of FPR levels.…”

“…This assumption was based on the fact that in Italy the prevalence of primary INI resistance in INI-naive individuals (either drug-naive or drugexperienced) is very low (1%). [27][28][29] With regards to entry inhibitors, patients who harboured R5 viral strains (FPR 10%) were considered infected by viruses susceptible to maraviroc. Patients that had never taken enfuvirtide (T20) in their treatment history were considered infected by strains susceptible to this drug.…”