Incidence of low-level viremia and its impact on virologic failure among people living with HIV-1 who switched to elvitegravir-based antiretroviral therapy. (June 2022)

• Record Type: Journal Article
• Authors: Hsu, Jen-Yu; Sun, Hsin-Yun; Hsieh, Tan-Wen; Chang, Sui-Yuan; Chuang, Yu-Chung; Huang, Yu-Shan; Hsiao, Ching-Yu; Su, Yi-Ching; Liu, Wen-Chun; Chang, Shu-Fang; Hung, Chien-Ching
• Is Part Of: Journal of global antimicrobial resistance. Volume 29(2022)
• Page Start: 7
• Page End: 16
• Publication Date: 2022-06
• Subjects: Integrase strand transfer inhibitor -- Plasma HIV RNA load -- Virologic response -- Viral blip -- Resistance-associated mutation; Drug resistance -- Periodicals; Drug resistance -- Periodicals; Drug resistance; Periodicals; 616.9041
• DOI: 10.1016/j.jgar.2022.02.007
• Languages: English
• ISSNs: 2213-7165

Abstract

HIGHLIGHTS: The incidence rates of low-level viremia (LLV) (plasma HIV RNA load of 50–999 copies/mL) and virologic failure (VF) (plasma HIV RNA load ≥1000 copies/mL) were low after the switch to co-formulated elvitegravir, cobicistat, emtricitabine, and tenofovir alafenamide (EVG/c/FTC/TAF) in people living with HIV-1 who had been receiving suppressive antiretroviral therapy. LLV before and after the switch to EVG/c/FTC/TAF and prior exposure to integrase inhibitor-based regimens were associated with occurrences of LLV during the follow-up. VF was associated with LLV before and after the switch to EVG/c/FTC/TAF and prior exposure to raltegravir. ABSTRACT: Objectives: We aimed to investigate the incidence of low-level viremia (LLV) and its impact on virologic failure (VF) in people living with HIV (PLWH) on stable antiretroviral therapy (ART) who switched to co-formulated elvitegravir, cobicistat, emtricitabine and tenofovir alafenamide (EVG/c/FTC/TAF). Methods: PLWH aged 18 years or older who had received ART with plasma HIV RNA load (PVL) <50 copies/mL for 6 months or longer and switched to EVG/c/FTC/TAF between March and October 2018 were retrospectively included. The incidence of LLV (defined as PVL of 50–999 copies/mL) and VF (PVL ≥1000 copies/mL) was calculated and represented by Kaplan-Meier plots. The generalised estimating equation model was constructed to identify factors associated with LLV and VF. Resistance-associated mutations were determined using population sequencing. Results: A total of 1078 PLWH were included. The incidence rates of LLV and VF after the switch to EVG/c/FTC/TAF were 3.5 and 0.8 events per 100 person-years of follow-up, respectively, whereas the respective cumulative incidence of LLV and VF reached 11.7% and 2.9% within 3 years of follow-up. LLV was associated with any LLV episode before or after the switch and prior exposure to integrase strand transfer inhibitor-based ART. VF was associated with any LLV before or after the switch and prior exposure to raltegravir, but not the level or frequency of LLV. Conclusion: The risks of LLV and VF were low in PLWH who had achieved virologic suppression and switched to EVG/c/FTC/TAF, and the presence of LLV and prior exposure to raltegravir increased the risk of VF.