Forgiveness of Dolutegravir-Based Triple Therapy Compared With Older Antiretroviral Regimens: A Prospective Multicenter Cohort of Adherence Patterns and HIV-RNA Replication

Autor: David R. Bangsberg, Jean Jacques Dutheil, Elodie Morilland-Lecoq, Laurent Cotte, P. Perré, A. Fournier, Matthias Cavassini, Fabien Chaillot, Manuel Etienne, Thierry Prazuck, Amandine Gagneux-Brunon, Guillemette Unal, Marie Paule Schneider, Jean-Jacques Parienti, Laurent Hocqueloux, Renaud Verdon
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Zdroj: Open Forum Infectious Diseases
Open forum infectious diseases, vol. 8, no. 7, pp. ofab316
ISSN: 2328-8957
Popis: Background For many people with HIV (PWH), taking antiretroviral therapy (ARV) every day is difficult. Methods Average adherence (Av-Adh) and log-transformed treatment interruption (TI) to ARV were prospectively measured over 6 months using electronic drug monitoring (EDM) in several cohorts of PWH. Multivariate linear regression models including baseline confounders explored the influence of EDM-defined adherence (R2) on 6-month log10 HIV-RNA. Multivariate logistic regression models were used to compare the risk of HIV-RNA detection (VR) within subgroups stratified by lower (≤95%) and higher (>95%) Av-Adh. Results Three hundred ninety-nine PWH were analyzed with different ARVs: dolutegravir (n = 102), raltegravir (n = 90), boosted PI (bPI; n = 107), and NNRTI (n = 100). In the dolutegravir group, the influence of adherence pattern measures on R2 for HIV-RNA levels was marginal (+2%). Av-Adh, TI, and Av-Adh × TI increased the R2 for HIV-RNA levels by 54% and 40% in the raltegravir and bPI treatment groups, respectively. TI increased the R2 for HIV-RNA levels by 36% in the NNRTI treatment group. Compared with the dolutegravir-based regimen, the risk of VR was significantly increased for raltegravir (adjusted odds ratio [aOR], 45.6; 95% CI, 4.5–462.1; P = .001), NNRTIs (aOR, 24.8; 95% CI, 2.7–228.4; P = .005), and bPIs (aOR, 28.3; 95% CI, 3.4–239.4; P = .002) in PWH with Av-Adh ≤95%. Among PWH with >95% Av-Adh, there were no significant differences in the risk of VR among the different ARVs. Conclusions These findings support the concept that dolutegravir in combination with 2 other active ARVs achieves greater virological suppression than older ARVs, including raltegravir, NNRTI, and bPI, among PWH with lower adherence.
Ninety-five percent adherence rule revisited: compared to older antiretroviral combinations, dolutegravir-based triple therapy had a unique forgiveness profile to low-to-moderate electronic drug monitoring adherence levels in terms of HIV RNA replication and emerging resistance mutations amongst PWH.
Databáze: OpenAIRE
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