Optimizing switching strategies to simplify antiretroviral therapy: the future of second-line from a public health perspective

Papot, Emmanuelle; Kaplan, Richard; Vitória, Marco; Polizzotto, Mark N.

doi:10.1097/qad.0000000000003108

Cited by 2 publications

(4 citation statements)

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“…[5] Furthermore, the encouraging rate of viral suppression suggests that virological success is mainly related to the use of very potent antiretrovirals with high genetic barrier to resistance, acting on a susceptible viral strain as informed by genotyping. [9,13,[27][28][29][30] Thus, in RLS like Cameroon with growing number of patients requiring third-line ART, scaling-up access to drug resistance testing, be it in terms of geographical distribution, affordability and staff training, will foster a long-term successful performance of ART programs at global level. This evidence, generated from the Cameroonian context, supports the need for enlarged analyses including other SSA countries, to ensure a wider representativeness of the observed outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…For treatment switch from second-to third-line ART after GRT, the most prescribed 3L regimen was dolutegravir + DRV/r + TDF + lamivudine (51%) and the median duration on 3L ART was 21 [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] months (see Table 1 for overall Regarding determinants of virological response, no association was found between gender distribution (<49 vs > 49 years) and virological response in our study population (P = .6). Furthermore, with respect to baseline viremia and CD4 count categorical variables (viral load < 1000 vs >1000 copies/mL; CD4 < 200 vs >200 cells/μL) at the moment of failure to second-line ART, no association was found with virological response (P = .6 and P = .3 respectively).…”

Section: Virological Response After Switch To Third-line Art Regimens...mentioning

confidence: 99%

“…At enrollment, all patients harbored resistance to reverse transcriptase inhibitors and 66% (25/38) to protease-inhibitors, although 63% (24/38) were still susceptible to darunavir/ritonavir. Preferred 3L regimen was dolutegravir + darunavir/r + tenofovir + lamivudine (51%) and median duration on 3L was 21 [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] months. Interestingly, 82% (31/38) of the participants achieved good virological response on 3L, regardless of genotypic profile at recruitment, variations in 3L regimens (P = .9) and baseline cluster of differentiation type 4 count (P = .3).…”

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confidence: 99%

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HIV-1 genotypic profiling ensures effective response to third-line antiretroviral therapy in Cameroon

et al. 2023

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In order to limit the emergence of human immunodeficiency virus (HIV) drug resistance in a context of limited antiretroviral options, we sought to evaluate the efficacy of third-line (3L) regimens considering HIV genotypic resistance profile at initiation of 3L in Cameroon. A cohort-study was conducted from January-September 2020 among patients initiating a 3L antiretroviral therapy regimen at the Yaoundé Central Hospital. HIV-1 protease-reverse transcriptase was sequenced at the Chantal Biya international reference center for research on HIV/AIDS prevention and management and results were interpreted using Stanford HIVdbv8.3. Good virological response (viral load < 390 copies/mL) was assessed after 12 months using OPP-ERA platform. Statistical analyses were performed using Epi Info v7.2.2.6, with P < .05 considered statistically significant. Of the 38 patients initiating 3L with an available genotyping (42% female; median age, 49 [39-57] years), median cluster of differentiation type 4 count and viral load were 173 cells/μL and 169,322 [30,826] copies/mL, respectively. At enrollment, all patients harbored resistance to reverse transcriptase inhibitors and 66% (25/38) to protease-inhibitors, although 63% (24/38) were still susceptible to darunavir/ritonavir. Preferred 3L regimen was dolutegravir + darunavir/r + tenofovir + lamivudine (51%) and median duration on 3L was 21 [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] months. Interestingly, 82% (31/38) of the participants achieved good virological response on 3L, regardless of genotypic profile at recruitment, variations in 3L regimens (P = .9) and baseline cluster of differentiation type 4 count (P = .3). Despite the high burden of reverse transcriptase inhibitor -and protease inhibitor boosted by ritonavir drug resistance, genotypingguided 3L regimens is accompanied by virological success in most patients. This high efficacy, most likely due to use of high genetic barrier antiretrovirals, requires continuous adherence support alongside close monitoring for long-term effectiveness in similar programmatic settings.

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Section: Discussionmentioning

confidence: 99%

Section: Virological Response After Switch To Third-line Art Regimens...mentioning

confidence: 99%

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confidence: 99%

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HIV-1 genotypic profiling ensures effective response to third-line antiretroviral therapy in Cameroon

et al. 2023

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“…In order to determine the best regimens depending on variables like the virus subtype, treatment history, and comorbidities, comparative efficacy studies have assessed a variety of ART switch techniques. These studies have provided valuable insights into the efficacy and safety profiles of different switch options, enabling clinicians to make informed and personalized treatment decisions [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Antiretroviral Therapy Switch in HIV-Infected Adults from a Regional HIV/AIDS Center in NE Romania

Loghin,

Rusu,

Vâţă

et al. 2024

Medicina

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Background and Objectives: Antiretroviral therapy (ART) has revolutionized the management of HIV infection, transforming it from a once-debilitating disease to a chronic, manageable condition. However, challenges such as treatment resistance, medication side effects, and long-term tolerability persist, prompting the exploration of novel therapeutic approaches. We aimed to highlight the characteristics and related comorbidities of HIV/AIDS cases in which the antiretroviral therapy was modified. Material and Methods: A cross-sectional clinical investigation was conducted on adults diagnosed with HIV/AIDS who were hospitalized at the “St. Parascheva” Clinical Hospital of Infectious Diseases in Iasi in the Northeastern region of Romania. The timeframe under investigation was 1 January 2023 to 30 June 2023. Results: In the Northeastern part of Romania, from a total of 1692 patients in the active records, there were a total of 148 recorded cases of antiretroviral therapy switch in HIV-infected patients. The main reason for the ART switch was the simplification of the ART regimen (82 cases, 55.40%), viro-immunological failure (16 cases, 10.66%), other disturbances correlated to the ART regimen, dyslipidemia (34 cases 22.97%), depression (3 cases, 2.02%), suicide attempt (1 case, 0.67%), new situations, including the appearance of pregnancy (3 cases 2.02%), and tuberculosis (9 cases, 6.08%). ART before the switch was represented by protease inhibitors that accounted for 84 cases (56.75%) of the ART switch. Following the therapy switch, integrase inhibitor-based ART single-tablet regimens accounted for 43.91% (65 cases) of all changeovers, with non-nucleoside reverse transcriptase inhibitor regimens coming in second, in 63 cases, 42.66%. Conclusions: ART switch as an experimental therapy offers a promising approach to optimizing HIV treatment outcomes. By focusing on viral suppression and immune reconstitution, addressing treatment challenges, and exploring novel ARV agents, ART switch strategies aim to improve the overall health and well-being of individuals living with HIV.

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Optimizing switching strategies to simplify antiretroviral therapy: the future of second-line from a public health perspective

Cited by 2 publications

References 82 publications

HIV-1 genotypic profiling ensures effective response to third-line antiretroviral therapy in Cameroon

HIV-1 genotypic profiling ensures effective response to third-line antiretroviral therapy in Cameroon

Antiretroviral Therapy Switch in HIV-Infected Adults from a Regional HIV/AIDS Center in NE Romania

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