Gubavu Camelia, Prazuck Thierry, Niang Mohamadou, Buret Jennifer, Mille Catherine, Guinard Jérôme, Avettand-Fènoël Véronique, Hocqueloux Laurent
Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Régional, Orléans, France.
Laboratoire de Virologie, Centre Hospitalier Régional, Orléans, France.
J Antimicrob Chemother. 2016 Apr;71(4):1046-50. doi: 10.1093/jac/dkv430. Epub 2015 Dec 27.
Dolutegravir is a powerful, well-tolerated integrase inhibitor with a high genetic barrier to resistance and may thus constitute the backbone of lightened regimens.
This was a monocentric, retrospective study. HIV-1-infected patients receiving dolutegravir as monotherapy (mDGV) or dual therapy (dDGV) were systematically identified. The primary outcome was the proportion of patients who maintained undetectable (<50 copies/mL) plasma HIV RNA [plasma viral load (PVL)].
We identified 21 patients on mDGV (50 mg/day) and 31 on dDGV (50 or 100 mg/day, with atazanavir ± ritonavir, n = 12; rilpivirine, n = 11; maraviroc, n = 3; lamivudine, n = 3; darunavir/ritonavir, n = 1; or abacavir, n = 1). All of the patients were treatment experienced and 48% had experienced at least one virological failure. The baseline characteristics were as follows (for the mDGV/dDGV patients, respectively): 5%/29% had a history of AIDS; the median (IQR) highest PVL was 4.5 (4.3-5.5)/5.3 (4.7-5.6) log copies/mL; the median (IQR) nadir CD4+ count was 310 (280-468)/199 (134-281) cells/mm(3); 100% had undetectable PVL before the mDGV for a median (IQR) duration of 5.9 (3.5-9.9) years/81% had undetectable PVL before the dDGV for a median (IQR) duration of 3.7 (1.4-8.3) years; and the median (IQR) HIV DNA level was 2.7 (2.1-3.1)/2.9 (2.7-3) log copies/10(6) PBMCs. At the last follow-up visit, 100% and 97% of patients showed undetectable PVL following mDGV and dDGV, respectively [median (IQR) follow-up of 32 (29-45) and 50 (30-74) weeks, respectively].
In our experience, dolutegravir-based lightened regimens provided a high proportion of viral suppression, even in highly treatment-experienced patients.
多替拉韦是一种强效、耐受性良好的整合酶抑制剂，对耐药具有较高的基因屏障，因此可能构成简化治疗方案的核心。
这是一项单中心回顾性研究。系统性识别接受多替拉韦单药治疗（mDGV）或双药治疗（dDGV）的HIV-1感染患者。主要结局是血浆HIV RNA维持在不可检测水平（<50拷贝/mL）[血浆病毒载量（PVL）]的患者比例。
我们识别出21例接受mDGV（50mg/天）治疗的患者和31例接受dDGV（50或100mg/天，联合阿扎那韦±利托那韦，n = 12；rilpivirine，n = 11；马拉维罗，n = 3；拉米夫定，n = 3；达芦那韦/利托那韦，n = 1；或阿巴卡韦，n = 1）治疗的患者。所有患者均有治疗史，48%曾经历至少一次病毒学失败。基线特征如下（分别为mDGV/dDGV患者）：5%/29%有艾滋病病史；最高PVL的中位数（IQR）为4.5（4.3 - 5.5）/5.3（4.7 - 5.6）log拷贝/mL；CD4 + 细胞计数最低点的中位数（IQR）为310（280 - 468）/199（134 - 281）个细胞/mm³；100%在接受mDGV治疗前PVL不可检测，中位数（IQR）持续时间为5.9（3.5 - 9.9）年/81%在接受dDGV治疗前PVL不可检测，中位数（IQR）持续时间为3.7（1.4 - 8.3）年；HIV DNA水平的中位数（IQR）为2.7（2.1 - 3.1）/2.9（2.7 - 3）log拷贝/10⁶外周血单个核细胞。在最后一次随访时，mDGV和dDGV治疗后分别有100%和97%的患者PVL不可检测[随访的中位数（IQR）分别为32（29 - 45）周和50（30 - 74）周]。
根据我们的经验，即使在治疗经验丰富的患者中，基于多替拉韦的简化治疗方案也能实现较高比例的病毒抑制。
