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Title: | Effectiveness and safety of integrase strand transfer inhibitors in Spain: a prospective real-world study |
Author: | Santos, José Ramón Casadellà, Maria Noguera Julian, Marc Micán Rivera, Rafael Domingo, Pere Antela, Antonio Portilla, Joaquín Sanz, Jesús Montero Alonso, Marta Navarro, Jordi Masiá, Maria Del Mar Valcarce Pardeiro, Nieves Ocampo, Antonio Pérez Martínez, Laura García Vallecillos, Coral Vivancos, María Jesús Imaz, Arkaitz Iribarren, José Antonio Hernández Quero, José Villar García, Judit Barrufet, Pilar Paredes, Roger Instinct Study Group |
Keywords: | Persones seropositives Inhibidors de la integrasa HIV-positive persons Integrase inhibitors |
Issue Date: | 26-Jun-2023 |
Publisher: | Frontiers Media SA |
Abstract: | IntroductionSecond-generation integrase strand transfer inhibitors (INSTIs) are preferred treatment options worldwide, and dolutegravir (DTG) is the treatment of choice in resource-limited settings. Nevertheless, in some resource-limited settings, these drugs are not always available. An analysis of the experience with the use of INSTIs in unselected adults living with HIV may be of help to make therapeutic decisions when second-generation INSTIs are not available. This study aimed to evaluate the real-life effectiveness and safety of dolutegravir (DTG), elvitegravir/cobicistat (EVG/c), and raltegravir (RAL) in a large Spanish cohort of HIV-1-infected patients. MethodsReal-world study of adults living with HIV who initiated integrase INSTIs DTG, EVG/c, and RAL-based regimens in three settings (ART-naive patients, ART-switching, and ART-salvage patients). The primary endpoint was the median time to treatment discontinuation after INSTI-based regimen initiation. Proportion of patients experiencing virological failure (VF) (defined as two consecutive viral loads (VL) & GE;200 copies/mL at 24 weeks or as a single determination of VL & GE;1,000 copies/mL while receiving DTG, EVG/c or RAL, and at least 3 months after INSTI initiation) and time to VF were also evaluated. ResultsVirological effectiveness of EVG/c- and RAL-based regimens was similar to that of DTG when given as first-line and salvage therapy. Treatment switching for reasons other than virological failure was more frequent in subjects receiving EVG/c and, in particular, RAL. Naive patients with CD4+ nadir <100 cells/& mu;L were more likely to develop VF, particularly if they initiated RAL or EVG/c. In the ART switching population, initiation of RAL and EVG/c was associated with both VF and INSTI discontinuation. There were no differences in the time to VF and INSTI discontinuation between DTG, EVG/c and RAL. Immunological parameters improved in the three groups and for the three drugs assessed. Safety and tolerability were consistent with expected safety profiles. DiscussionWhereas second-generation INSTIs are preferred treatment options worldwide, and DTG is one of the treatment of choices in resource-limited settings, first-generation INSTIs may still provide high virological and immunological effectiveness when DTG is not available. |
Note: | Reproducció del document publicat a: https://doi.org/10.3389/fcimb.2023.1187999 |
It is part of: | Frontiers in Cellular and Infection Microbiology, 2023, vol. 13 |
URI: | http://hdl.handle.net/2445/201088 |
Related resource: | https://doi.org/10.3389/fcimb.2023.1187999 |
ISSN: | 2235-2988 |
Appears in Collections: | Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL)) |
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fcimb-13-1187999.pdf | 1.68 MB | Adobe PDF | View/Open |
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