No impact of previous NRTIs resistance in HIV positive patients switched to DTG+2NRTIs under virological control: Time of viral suppression makes the difference.

Autor: Giacomelli A; III Infectious Disease Unit, ASST-FBF-Sacco, Milan, Italy; Department of Biomedical and Clinical Sciences DIBIC L. Sacco, University of Milan, Milan, Italy. Electronic address: andrea.giacomelli@unimi.it., Lai A; Department of Biomedical and Clinical Sciences DIBIC L. Sacco, University of Milan, Milan, Italy., Franzetti M; UOC Infectious Disease Unit, ASST-Lecco, Lecco, Italy., Maggiolo F; Department of Infectious Diseases, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy., Di Giambenedetto S; Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma Italia, UOC Malattie Infettive, Italy; Università Cattolica del Sacro Cuore, Roma Italia, Istituto di Clinica Malattie Infettive, Italy., Borghi V; Infectious Diseases Clinic, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy., Francisci D; Clinical Infectious Diseases, University of Perugia, Perugia, Italy., Magnani G; Infectious Disease Unit, Reggio Emilia, Italy., Pecorari M; Unit of Virology and Molecular Microbiology, University Hospital, Modena, Italy., Monno L; Department of Biomedical Sciences and Human Oncology, Clinic of Infectious Diseases, University of Bari, Italy., Vicenti I; Department of Medical Biotechnologies, University of Siena, Siena, Italy., Lepore L; Department of Biomedical Sciences and Human Oncology, Clinic of Infectious Diseases, University of Bari, Italy., Lombardi F; Università Cattolica del Sacro Cuore, Roma Italia, Istituto di Clinica Malattie Infettive, Italy., Paolucci S; Molecular Virology Unit, Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy., Rusconi S; III Infectious Disease Unit, ASST-FBF-Sacco, Milan, Italy; Department of Biomedical and Clinical Sciences DIBIC L. Sacco, University of Milan, Milan, Italy.
Jazyk: angličtina
Zdroj: Antiviral research [Antiviral Res] 2019 Dec; Vol. 172, pp. 104635. Date of Electronic Publication: 2019 Oct 17.
DOI: 10.1016/j.antiviral.2019.104635
Abstrakt: The accumulation of drug-resistance mutations on combined antiretroviral regimens (ART) backbone could affect the virological efficacy of the regimen. Our aim was to assess the impact of previous drug resistance to nucleoside reverse transcriptase inhibitors (NRTIs) on the probability of virological failure (VF) in patients, under virological control, who switched to dolutegravir (DTG)+2NRTIs regimens. All HIV-1 positive drug-experienced patients who started a regimen composed by DTG+2NRTIs [abacavir/lamivudine or tenofovir disoproxil fumarate (TDF) or tenofovir alafenamide (TAF)/emtricitabine (FTC)] in the ARCA collaborative group with HIV-RNA <50 cp/mL were included in the analysis. Patients with a previous VF to integrase inhibitors were excluded. The impact of single and combined NRTIs mutations on the probability of VF (defined as 2 consecutive HIV-RNA >50 copies/mL or one HIV-RNA >1000 copies/mL) was assessed by Kaplan Meier curves. A multivariable Cox regression analysis was constructed to assess factors potentially related to VF. Five hundred and eighty-eight patients were included in the analysis with a median time of viral suppression before the switch of 37 months (IQR 12-78), of whom 148 (25.2%) had at least one previous NRTIs resistance mutation. In the multivariable model no association was observed between NRTIs mutations and VF. Conversely, the duration of viral suppression before switch resulted associated with a lower risk of VF (for 1 month increase, adjusted Hazard Ratio 0.98, 95%CI 0.96-0.99; p=0.024). Previous NRTIs mutations appeared to have no impact on the risk of VF in patients switched to DTG+2NRTIs, whereas a longer interval on a controlled viremia decreased significantly the risk of VF.
(Copyright © 2019 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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