Viro-immunological efficacy and tolerability of dolutegravir-based regimens compared to regimens based on other integrase strand inhibitors, protease inhibitors or non-nucleoside reverse transcriptase inhibitors in patients with acute HIV-1 infection: A multicenter retrospective cohort study.
Int J Antimicrob Agents
; 54(4): 487-490, 2019 Oct.
Article
in En
| MEDLINE
| ID: mdl-31195121
ABSTRACT
OBJECTIVES:
The aim of this study was to compare the tolerability and viro-immunological efficacy of dolutegravir-based regimens (DTG group) with regimens based on EVG, RAL, PI or NNRTI (NODTG group) in patients with acute HIV-1 infections (AHI).METHODS:
All patients diagnosed with AHI and on antiretroviral therapy (ART) between January 2015 and December 2017 from five centers in Italy were included and followed-up to 30th April 2018. AHI was defined by the presence of the positive p24 antigen with negative or indeterminate western blot.RESULTS:
Forty-three patients were enrolled 20 in the DTG group, 23 in the NODTG group. Nine patients (20.9%; four in the DTG group, five in the NODTG group) were prescribed a four-drug regimen. In the cohort, 81.4% were Italian and 83.7% were male, with a median age of 41 years (interquartile range [IQR] 31-48). Median time between HIV diagnosis and ART initiation was 12 days (IQR 5-28). Seven patients harbored a virus with transmitted mutations at baseline (16.2%), all were in the DTG group (P=0.005). All patients had undetectable HIV-RNA at the end of follow-up except two patients, one of whom had 57 copies and one who was lost to follow-up. In Kaplan-Meier analysis, time to virological suppression was similar in the two groups (log rank P= 0.7155). After achieving virological suppression, four patients stopped ART because of toxicity two on DTG, two on EVG for neurological and gastrointestinal toxicity, respectively.CONCLUSION:
In our setting, ART in AHI is started very early. DTG showed good viro-immunological efficacy even in the presence of NRTI-transmitted mutations. DTG interruptions were rare.Key words
Full text:
1
Database:
MEDLINE
Main subject:
HIV Infections
/
HIV Protease Inhibitors
/
Reverse Transcriptase Inhibitors
/
HIV Integrase Inhibitors
/
Antiretroviral Therapy, Highly Active
/
Heterocyclic Compounds, 3-Ring
Type of study:
Clinical_trials
/
Etiology_studies
/
Observational_studies
Limits:
Adult
/
Female
/
Humans
/
Male
/
Middle aged
Country/Region as subject:
Europa
Language:
En
Journal:
Int J Antimicrob Agents
Year:
2019
Type:
Article