Stable HIV‐1 reservoirs on dolutegravir maintenance monotherapy: the MONODO study

Objectives Dolutegravir (DTG) is a highly effective integrase inhibitor with a strong genetic resistance barrier and a potential role in simplified HIV maintenance treatment. We assessed the feasibility of DTG maintenance monotherapy and measured HIV reservoirs on DTG monotherapy. Methods An interve...

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Bibliographic Details
Published in:HIV medicine 2018-09, Vol.19 (8), p.572-577
Main Authors: Sculier, D, Doco‐Lecompte, T, Yerly, S, Metzner, KJ, Decosterd, LA, Calmy, A
Format: Article
Language:English
Subjects:
Cerebrospinal fluid
Compartments
Deoxyribonucleic acid
DNA
dolutegravir
Feasibility studies
Fluids
HIV
HIV reservoirs
Human immunodeficiency virus
Integrase
Maintenance
maintenance therapy
Patients
Ribonucleic acid
RNA
Short Communication
Short Communications
simplification
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Summary:Objectives Dolutegravir (DTG) is a highly effective integrase inhibitor with a strong genetic resistance barrier and a potential role in simplified HIV maintenance treatment. We assessed the feasibility of DTG maintenance monotherapy and measured HIV reservoirs on DTG monotherapy. Methods An interventional, open‐label, single‐arm study including eight virologically suppressed HIV‐1‐infected patients switched to DTG 50 mg once daily for 24 weeks was performed. HIV‐1 RNA levels in plasma and cerebrospinal and seminal fluids were measured at baseline and week 24, as well as HIV‐1 DNA in peripheral cells and DTG concentrations in these compartments. Results HIV‐1 RNA remained undetectable in all samples of blood, cerebrospinal fluid and sperm throughout the 24 weeks, except for one cerebrospinal fluid sample with a value of 28 HIV‐1 RNA copies/mL at week 24. One patient discontinued the study because of a neurological side effect. There was no change in the mean HIV‐1 DNA level between baseline and week 24. Plasma and cerebrospinal fluid DTG concentrations reached therapeutic levels in all patients in these two compartments. Conclusions In this small sample of carefully selected patients, HIV‐1 reservoirs were well controlled on DTG monotherapy over a period of 24 weeks. Viral suppression was also maintained throughout follow‐up.
ISSN:1464-2662
1468-1293
DOI:10.1111/hiv.12626