Should We Be Testing for Baseline Integrase Resistance in Patients Newly Diagnosed With Human Immunodeficiency Virus?
| Autor: | Naomi F Fields, Paul E. Sax, Emily P. Hyle, Yiannis Koullias, Rochelle P. Walensky |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
0301 basic medicine
Microbiology (medical) Adult medicine.medical_specialty Cost effectiveness Cost-Benefit Analysis Integrase inhibitor HIV Infections Virus 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Internal medicine Virology Drug Resistance Viral Medicine Humans 030212 general & internal medicine HIV Integrase Inhibitors Prospective Studies Prospective cohort study Articles and Commentaries Darunavir biology Integrases business.industry HIV Middle Aged 030112 virology Integrase Molecular Typing Infectious Diseases Treatment Outcome chemistry Dolutegravir Multivariate Analysis Practice Guidelines as Topic biology.protein HIV-1 Ritonavir business medicine.drug |
| Zdroj: | Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 65(8) |
| ISSN: | 1537-6591 |
| Popis: | Background Current guidelines recommend genotype resistance testing at diagnosis to guide initial selection of antiretroviral therapy (ART). Many standard resistance genotypes exclude testing for resistance to integrase inhibitors ("IR testing"), although this class of drugs is a component of most recommended first-line regimens. Methods We compared the 96-week clinical outcomes and cost-effectiveness of 2 strategies: no IR testing vs IR testing performed at human immunodeficiency virus (HIV) diagnosis. The base case prevalence of transmitted integrase strand transfer inhibitor (INSTI)-resistant (INSTI-R) virus is estimated at 0.1%. With no IR testing, all patients start dolutegravir (DTG)-based ART after genotype; 12-week suppression rates are 90% (INSTI-susceptible [INSTI-S] virus) and 35% (INSTI-R virus). Those not suppressed at 12 weeks undergo IR testing; if diagnosed with INSTI-R virus, they change to ritonavir-boosted darunavir (DRV/r)-based ART. With IR testing, all patients are diagnosed with INSTI-S/INSTI-R virus prior to ART initiation and start DTG- or DRV/r-based regimens, respectively. Costs include IR tests (175 US dollars [USD]) and ART (41100-44900 USD/year). We examined the impact of key parameters in sensitivity analyses. Results IR testing resulted in worse clinical outcomes compared to no IR testing and increased costs by 200 USD/person/year. Prevalence of transmitted INSTI-R virus did not affect the favored strategy. No IR testing remained clinically preferred unless DTG suppression of INSTI-R virus was 92%. If quality of life was worse with DRV/r- than DTG-based ART, no IR testing was clinically preferred over an even broader range of parameters. Conclusions In patients with newly diagnosed HIV, IR testing is projected to result in worse outcomes and is not cost-effective. Pretreatment assessment for INSTI resistance should not be recommended in treatment guidelines. |
| Databáze: | OpenAIRE |
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