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

• Published in: International journal of antimicrobial agents 2019-10, Vol.54 (4), p.487-490
• Main Authors: Lagi, F., Baldin, G., Colafigli, M., Capetti, A., Madeddu, G., Kiros, S. Tekle, Di Giambenedetto, S., Sterrantino, G.
• Format: Article
• Language: English
• Subjects: Acute HIV-1 Infection; Adult; Antiretroviral Therapy, Highly Active - adverse effects; Antiretroviral Therapy, Highly Active - methods; CD4 Lymphocyte Count; Dolutegravir, Italy; Female; Heterocyclic Compounds, 3-Ring - adverse effects; Heterocyclic Compounds, 3-Ring - therapeutic use; HIV Infections - drug therapy; HIV Integrase Inhibitors - adverse effects; HIV Integrase Inhibitors - therapeutic use; HIV Protease Inhibitors - adverse effects; HIV Protease Inhibitors - therapeutic use; Humans; Italy; Male; Middle Aged; Naive patients; Reverse Transcriptase Inhibitors - adverse effects; Reverse Transcriptase Inhibitors - therapeutic use; Sustained Virologic Response; Treatment Outcome
• ISSN: 0924-8579; 1872-7913
• DOI: 10.1016/j.ijantimicag.2019.06.003

•High prevalence of transmitted drug resistance (TDR) in acute HIV-1 patients•Good efficacy of dolutegravir (DTG)-based regimen even in the presence of TDR•Time to viro-suppression was similar for DTG and non-DTG-based regimens•Interruptions of DTG-based regimen were rare 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). 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. 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. 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.