Sangaré Mohamed N'dongo, Baril Jean-Guy, de Pokomandy Alexandra, Ferreira Guerra Steve, Carabali Mabel, Laprise Claudie, Thomas Réjean, Klein Marina, Tremblay Cécile, Roger Michel, Pexos Costa, Greenwald Zoë R, Machouf Nima, Durand Madeleine, Hardy Isabelle, Dakouo Mamadou, Trevisan Andrea, Laporte Louise, Schnitzer Mireille E, Trottier Helen
Department of Social and Preventive Medicine, Université de Montréal, Montreal, Québec, Canada.
Sainte Justine University Hospital Center, Montreal, Québec, Canada.
Open Forum Infect Dis. 2020 Sep 4;7(11):ofaa404. doi: 10.1093/ofid/ofaa404. eCollection 2020 Nov.
Switching antiretroviral regimens when human immunodeficiency virus (HIV) viremia is controlled for a new regimen is challenging when there is the potential for prior nucleoside reverse-transcriptase inhibitor (NRTI) resistance. The objective was to study virologic outcomes after switching to dolutegravir compared with remaining on a boosted protease inhibitor (protease inhibitor/ritonavir [PI/r]) regimen in people with HIV (PWH) with prior documented virologic failure and/or exposure to mono/dual NRTIs.
We used the Quebec HIV Cohort including 10 219 PWH whose data were collected at 4 sites in Montreal, Canada. We included all PWH with documented virologic failure or exposure to mono/dual NRTI therapy who were virologically suppressed on a PI/r-based regimen for at least 6 months on or after January 1, 2014 (n = 532). A marginal structural Cox model analysis was used to estimate the effect of the switch to dolutegravir on virologic outcome compared with remaining on PI/r. The outcome was defined as 2 consecutive viral loads (VLs) >50 copies/mL or 1 VL >50 copies/mL if it occurred at the last VL available.
Among 532 eligible participants, 216 (40.6%) had their regimen switched to dolutegravir with 2 NRTIs, whereas 316 (59.4%) remained on the PI/r with 2 NRTIs. The weighted hazard ratio for the effect of dolutegravir switch on virologic failure compared with patients whose regimen remained on PI/r was 0.57 (95% confidence interval, 0.21-1.52).
We did not find evidence of an increased risk for virologic failure after switching to dolutegravir from PI/r among patients with previous virologic failure or prior exposure to mono/dual NRTI.
当人类免疫缺陷病毒（HIV）病毒血症得到控制，而患者可能存在既往核苷类逆转录酶抑制剂（NRTI）耐药时，换用抗逆转录病毒治疗方案具有挑战性。本研究旨在比较在既往有病毒学失败记录和/或曾接受单药/双药NRTI治疗的HIV感染者（PWH）中，换用多替拉韦与继续使用增强型蛋白酶抑制剂（蛋白酶抑制剂/利托那韦[PI/r]）方案后的病毒学结局。
我们使用了魁北克HIV队列，该队列包括10219名PWH，其数据在加拿大蒙特利尔的4个地点收集。我们纳入了所有有病毒学失败记录或曾接受单药/双药NRTI治疗、在基于PI/r的方案上病毒学抑制至少6个月（自2014年1月1日及以后）的PWH（n = 532）。采用边际结构Cox模型分析来估计换用多替拉韦与继续使用PI/r相比对病毒学结局的影响。结局定义为连续两次病毒载量（VL）>50拷贝/mL，或如果在最后一次可获得的VL时出现一次VL>50拷贝/mL。
在532名符合条件的参与者中，216名（40.6%）换用了含两种NRTI的多替拉韦方案，而316名（59.4%）继续使用含两种NRTI的PI/r方案。与继续使用PI/r方案的患者相比，换用多替拉韦对病毒学失败影响的加权风险比为0.57（95%置信区间，0.21 - 1.52）。
在既往有病毒学失败或曾接受单药/双药NRTI治疗的患者中，我们未发现从PI/r换用多替拉韦后病毒学失败风险增加的证据。
