Clinical Outcomes Following the Use of Archived Proviral HIV-1 DNA Genotype to Guide Antiretroviral Therapy Adjustment.
Open Forum Infect Dis
; 7(1): ofz533, 2020 Jan.
Article
em En
| MEDLINE
| ID: mdl-31915714
ABSTRACT
BACKGROUND:
Evidence regarding the safety of using proviral HIV-1 DNA genotype (DNA GT) to guide antiretroviral therapy (ART) is limited. We hypothesized that HIV RNA would not increase following ART adjustment guided by DNA GT in a university HIV clinic.METHODS:
Data were obtained from electronic medical records of adult persons living with HIV-1 (PWH) who underwent DNA GT testing and changed ART between October 2014 and November 2017. Logistic regression was used to evaluate the effect of ART switch on HIV RNA over time.RESULTS:
Eighty-three PWH had DNA GT performed, 66 (80%) switched ART, and 59 had postswitch follow-up. Data were analyzed pre-/postswitch for these 59 PWH (median age, 54 years; 71% LWH ≥10 years; 46% ≥2 previous regimens; 36% recent low-level viremia; 34% unknown medication history). On DNA GT, 58% had ≥1-class ART resistance, 34% ≥2-class, and 10% 3-class. Median follow-up (range) was 337 (34-647) days. There was no change in probability of HIV RNA ≥50 copies/mL over time (Pâ >â .05). At baseline, 76% had HIV RNA <50 vs 88% at last postswitch follow-up (Pâ =â .092). Protease inhibitor use decreased from 58% to 24% (Pâ <â .001). Average daily pills and dosing frequency decreased from 3.48 to 2.05 (Pâ <â .001) and 1.39 to 1.09 (Pâ <â .001), respectively; ART cost did not change.CONCLUSIONS:
DNA GT facilitated changes in ART in a treatment-experienced population without increases in HIV RNA. Decreased pill burden occurred without increased ART cost. Further studies to identify optimal use of DNA GT are needed.
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MEDLINE
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En
Ano de publicação:
2020
Tipo de documento:
Article