Virologic Outcomes Among People Living With Human Immunodeficiency Virus With High Pretherapy Viral Load Burden Initiating on Common Core Agents.

Autor: Mills AM; Men's Health Foundation, Los Angeles, California, USA., Schulman KL; Epividian, Inc, Durham, North Carolina, USA., Fusco JS; Epividian, Inc, Durham, North Carolina, USA., Wohlfeiler MB; AIDS Healthcare Foundation, Miami, Florida, USA., Priest JL; ViiV Healthcare, Research Triangle Park, North Carolina, USA., Oglesby A; ViiV Healthcare, Research Triangle Park, North Carolina, USA., Brunet L; Epividian, Inc, Durham, North Carolina, USA., Lackey PC; Signature Healthcare, Charlotte, North Carolina, USA., Fusco GP; Epividian, Inc, Durham, North Carolina, USA.
Jazyk: angličtina
Zdroj: Open forum infectious diseases [Open Forum Infect Dis] 2021 Jul 09; Vol. 8 (8), pp. ofab363. Date of Electronic Publication: 2021 Jul 09 (Print Publication: 2021).
DOI: 10.1093/ofid/ofab363
Abstrakt: Background: People living with human immunodeficiency virus (PLWH) initiating antiretroviral therapy (ART) with viral loads (VLs) ≥100 000 copies/mL are less likely to achieve virologic success, but few studies have characterized real-world treatment outcomes.
Methods: ART-naive PLWH with VLs ≥100 000 copies/mL initiating dolutegravir (DTG), elvitegravir (EVG), raltegravir (RAL), or darunavir (DRV) between 12 August 2013 and 31 July 2017 were identified from the OPERA database. Virologic failure was defined as ( i ) 2 consecutive VLs ≥200 copies/mL after 36 weeks of ART; ( ii ) 1 VL ≥200 copies/mL with core agent discontinuation after 36 weeks; ( iii ) 2 consecutive VLs ≥200 copies/mL after suppression (≤50 copies/mL) before 36 weeks; or ( iv ) 1 VL ≥200 copies/mL with discontinuation after suppression before 36 weeks. Cox modeling estimated the association between regimen and virologic failure.
Results: There were 2038 ART-naive patients with high VL who initiated DTG (36%), EVG (46%), DRV (16%), or RAL (2%). Median follow-up was 18.1 (interquartile range, 12.4-28.9) months. EVG and DTG initiators were similar at baseline, but RAL initiators were older and more likely to be female with low CD4 cell counts while DRV initiators differed notably on factors associated with treatment failure. Virologic failure was experienced by 9.2% DTG, 13.2% EVG, 18.4% RAL, and 18.8% DRV initiators. Compared to DTG, the adjusted hazard ratio (95% confidence interval) was 1.46 (1.05-2.03) for EVG, 2.24 (1.50-3.34) for DRV, and 4.13 (1.85-9.24) for RAL.
Conclusions: ART-naive PLWH with high VLs initiating on DTG were significantly less likely to experience virologic failure compared to EVG, RAL, and DRV initiators.Antiretroviral therapy-naïve people living with HIV (PLWH) initiating therapy with viral loads ≥100,000 copies/mL varied markedly at baseline. In adjusted models, PLWH initiating dolutegravir-based regimens were less likely to experience virologic failure as compared to elvitegravir, raltegravir and darunavir initiators.
(© The Author(s) 2021. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)
Databáze: MEDLINE
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