Impact of previous HIV resistance and virologic failures on virologic outcome following a switch to dolutegravir with 2 NRTIs among people living with HIV. Issue 47 (20th November 2020)

• Record Type: Journal Article
• Authors: Sangaré, Mohamed N'dongo; Baril, Jean-Guy; de Pokomandy, Alexandra; Laprise, Claudie; Deshaies, Catherine; Klein, Marina; Thomas, Réjean; Tremblay, Cécile; Roger, Michel; Pexos, Costa; Greenwald, Zoe; Machouf, Nima; Durand, Madeleine; Hardy, Isabelle; Dakouo, Mamadou; Laporte, Louise; Trottier, Helen
• Other Names: Lawal. Ismaheel section editor.
• Is Part Of: Medicine. Volume 99:Issue 47(2020)
• Publication Date: 2020-11-20
• Subjects: Human immunodeficiency virus -- antiretroviral therapy -- switch -- dolutegravir -- previous virologic failure -- exposure to mono/dual NRTI therapy -- virologic outcome; Medicine -- Periodicals; Medicine -- Periodicals; Médecine -- Périodiques; Geneeskunde; Medicine; Periodicals; Periodicals; 610.5
• DOI: 10.1097/MD.0000000000023335
• Languages: English
• ISSNs: 0025-7974

Abstract

Abstract : Abstract: There is uncertainty regarding the potential virologic outcome associated with a change in antiretroviral therapy (ARV) among PLHIV who had previous documented virologic failure or who have been exposure to mono/dual nucleoside reverse transcriptase inhibitors (NRTI) therapy. The objective was to measure the potential impact of exposure to previous virologic failure or mono/dual NRTI regimen on virologic outcome of PLHIV following a switch to dolutegravir with 2 NRTIs from a viremia suppressive ARV therapy. Data from the Quebec HIV Cohort including 10219 PLHIV were collected through routine clinical care at 4 clinical sites in Montreal, Canada. This study includes patients whose ARV therapy was switched to dolutegravir with 2 NRTIs since 2013 with undetectable viral load for ≥6 months before switch. The association between exposure and post-switch virologic outcome was measured by marginal hazard ratio estimated using the Inverse probability weighting Cox model. Among the 1199 eligible PLHIV, 478 (39.9%) previously experienced at least one virologic failure or were exposed to mono/dual therapy before dolutegravir switch. Post-switch virologic failure after 30 months occurred in 4.1% (95% CI 2.1–7.9) of exposed compared to 4.1% (95% CI 2.3–7.4) in unexposed participants. The adjusted hazard ratio for the association between exposure and post-switch virologic failure was 0.84 (95% CI 0.35–2.01). Our findings suggest that switch to dolutegravir with 2 NRTIs from a suppressive therapy is a safe option for PLHIV with documented virologic failure and/or previous exposure to mono/dual NRTI therapy. Abstract : Supplemental Digital Content is available in the text