No impact of previous NRTIs resistance in HIV positive patients switched to DTG+2NRTIs under virological control: Time of viral suppression makes the difference.

Giacomelli, Andrea; Lai, Alessia; Franzetti, Marco; Maggiolo, Franco; Giambenedetto, Simona Di; Borghi, Vanni; Francisci, Daniela; Magnani, Giacomo; Pecorari, Monica; Monno, Laura; Vicenti, Ilaria; Lepore, Luciana; Lombardi, Francesca; Paolucci, Stefania; Rusconi, Stefano

doi:10.1016/j.antiviral.2019.104635

Cited by 8 publications

(2 citation statements)

References 22 publications

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“…Similar VLS rates were observed in our SDS cohort and 83% (73/88) of unsuppressed CALHIV were able to achieve VLS with an SDS using DTG. Multiple studies have found that the presence of M184V/I or other NRTI resistance-associated mutations (RAM), does not increase the risk of or have an impact on virological failure after switching to DTG, [34][35][36] including in LMIC settings. 33 Further, DTG plus lamivudine as dual therapy has demonstrated success in achieving VLS and cost-effectiveness in numerous studies.…”

Section: Discussionmentioning

confidence: 99%

Realizing the Promise of Dolutegravir in Effectively Treating Children and Adolescents Living With HIV in Real-world Settings in 6 Countries in Eastern and Southern Africa

Bacha

Dlamini

Anabwani³

et al. 2023

Pediatric Infectious Disease Journal

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Background: Despite encouraging results from clinical trials and in highincome countries, large-scale data on the effectiveness and safety of dolutegravir (DTG) in children and adolescents living with HIV (CALHIV) are lacking in low-and middle-income countries (LMICs). Methods: Retrospective analysis was performed among CALHIV 0-19 years old and weighing greater than or equal to 20 kg who received DTG from 2017 to 2020 at sites in Botswana, Eswatini, Lesotho, Malawi, Tanzania and Uganda to determine effectiveness, safety and predictors of viral load suppression (VLS) among CALHIV using DTG, including through single drug substitutions (SDS). Results: Among 9419 CALHIV using DTG, 7898 had a documented post-DTG VL, and VLS post-DTG was 93.4% (7378/7898). VLS for antiret-roviral therapy (ART) initiations was 92.4% (246/263), and VLS was maintained for the ART-experienced [92.9% (7026/7560) pre-vs. 93.5% (7071/7560) post-DTG; P = 0.14). Among previously unsuppressed, 79.8% (426/534) achieved VLS with DTG. Only 5 patients reported a Grade 3 or 4 adverse event (0.057 per 100 patient-years) requiring DTG discontinuation. History of protease inhibitor-based ART [odds ratio (OR) = 1.53; 95% confidence interval (CI): 1.16-2.03], care in Tanzania (OR = 5.45; 95% CI: 3.41-8.70), and being 15-19 years old (OR = 1.31; 95% CI: 1.03-1.65) were associated with gain of VLS post-DTG. Predictors of VLS on DTG included VLS before DTG (OR = 3.87; 95% CI: 3.03-4.95) and using the once-daily, single tab tenofovir-lamivudine-DTG regimen (OR = 1.78; 95% CI: 1.43-2.22). SDS maintained VLS [95.9% (2032/2120) pre-vs. 95.0% (2014/2120) post-SDS with DTG; P = 0.19], and 83.0% (73/88) of unsuppressed gained VLS using SDS with DTG. Conclusions: We found DTG to be highly effective and safe within our cohort of CALHIV in LMICs. These findings can empower clinicians to prescribe DTG confidently to eligible CALHIV.

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Section: Discussionmentioning

confidence: 99%

Realizing the Promise of Dolutegravir in Effectively Treating Children and Adolescents Living With HIV in Real-world Settings in 6 Countries in Eastern and Southern Africa

Bacha

Dlamini

Anabwani³

et al. 2023

Pediatric Infectious Disease Journal

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“…Data from observational studies suggest that the time of viral suppression before the switch in patients under virological control with previous NRTIs resistance could be one of the most important factors in determining the risk of virological failure [8]. The study by De Miguel et al underlines that patients with previous lamivudine resistance had a longer duration of viral suppression before the switch compared to those without lamivudine resistance (7.7 years vs 5.3 years) [5].…”

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confidence: 99%