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Virologic Failure Among People Living With HIV Initiating Dolutegravir-Based Versus Other Recommended Regimens in Real-World Clinical Care Settings.

Authors
  • Nance, Robin M1
  • Vannappagari, Vani2
  • Smith, Kimberly2
  • Johannes, Catherine B3
  • Calingaert, Brian4
  • Saltus, Catherine W4
  • Mayer, Kenneth H5
  • Whitney, Bridget M1
  • Rodriguez, Benigno6
  • Moore, Richard D7
  • Eron, Joseph J8
  • Geng, Elvin9
  • Mathews, William Christopher10
  • Mugavero, Michael J11
  • Saag, Michael S11
  • Kitahata, Mari M12
  • Delaney, Joseph A C1
  • Crane, Heidi M12
  • 1 University of Washington, Collaborative Health Studies Coordinating Center, Seattle, WA.
  • 2 ViiV Healthcare, Research Triangle Park, NC.
  • 3 RTI Health Solutions, Waltham, MA.
  • 4 RTI Health Solutions, Research Triangle Park, NC.
  • 5 Department of Medicine, Harvard Medical School, Fenway Institute, Boston, MA.
  • 6 Department of Medicine, Case Western University, Cleveland, OH.
  • 7 Department of Medicine, Johns Hopkins, Baltimore, MD.
  • 8 Department of Medicine, University of North Carolina, Chapel Hill, NC.
  • 9 Department of Medicine, University of California San Francisco, San Francisco, CA.
  • 10 Department of Medicine, University of California San Diego, UCSD Medical Center, San Diego, CA.
  • 11 Department of Medicine, University of Alabama at Birmingham, Birmingham, AL.
  • 12 Department of Medicine, University of Washington, Seattle, WA.
Type
Published Article
Journal
Journal of acquired immune deficiency syndromes (1999)
Publication Date
Aug 15, 2019
Volume
81
Issue
5
Pages
572–577
Identifiers
DOI: 10.1097/QAI.0000000000002075
PMID: 31107299
Source
Medline
Language
English
License
Unknown

Abstract

Guidelines for initial antiretroviral treatment (ART) regimens have evolved, with integrase strand transfer inhibitors (INSTIs) increasingly prominent. Research on virologic failure (VF) with INSTI therapy is predominantly from clinical trials not care settings, especially for recently approved medications including dolutegravir. We compared outcomes among people living with HIV (PLWH) who initiated recommended regimens in clinical care across the United States. We examined 2 groups of PLWH at 8 clinics who initiated ART regimens (August 1, 2013-March 31, 2017): those ART treatment-naive at initiation, and those treatment-experienced. The outcome in this longitudinal cohort study was VF, defined as a viral load of ≥400 copies/mL ≥6 months after ART initiation. We examined the proportion of individuals who remained on, switched, or discontinued the regimen. Associations between regimens and outcomes were examined with adjusted Cox proportional hazards models. Among 5177 PLWH, a lower proportion experienced VF on dolutegravir- versus other INSTI- or darunavir-based regimens for previously treatment-naive (7% vs. 12% vs. 28%) and treatment-experienced PLWH (6% vs. 10% vs. 21%). In adjusted analyses, hazard ratios were similar across regimens for the combined outcome of regimen discontinuation or treatment switch. The hazard ratios for VF comparing dolutegravir- to darunavir-based regimens was 0.30 (95% CI: 0.2 to 0.6) among previously treatment-naive PLWH and was 0.60 (95% CI: 0.4 to 0.8) among treatment-experienced PLWH. The proportion of previously treatment-naive PLWH remaining on recommended ART regimens did not differ by regimen. The likelihood of VF was lower with dolutegravir- than darunavir-based regimens for previously treatment-naive and treatment-experienced PLWH.

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