Bowman Conor, Ambrose Alissa, Kanitkar Tanmay, Flores Katia, Simoes Pedro, Hart Jennifer, Hunter Alan, Akodu Jane, Barber Tristan J
Ian Charles Day Centre, Royal Free Hospital.
Institute for Global Health, University College London, London, UK.
AIDS. 2023 Apr 1;37(5):785-788. doi: 10.1097/QAD.0000000000003480. Epub 2023 Jan 13.
Since 2015, we prescribed dolutegravir (DTG)-based two drug regimens (DTG-2DR) for 620 people [total cohort 3133 (19.8%)].
Clinic database search 1 January 15 to 31 October 21. Demographic, tolerability and HIV related data analysed.
In total, 620 people identified; 561 had complete data. 446 male (79.5%); median age 54 years (interquartile range 46, 59). 343 (61.1%) MSM. Nine people who initiated naïvely achieved viral suppression (100%). 546/552 (99.0%) switched or continued and were suppressed at data censor. 460/552 (83.3%) received DTG-lamivudine (DTG/3TC), 74/552 (13.4%) received DTG-rilpivirine (DTG/RPV) and 18/552 (3.3%) received DTG-emtricitabine (DTG/FTC). 70 (12.5%) switched off DTG-2DR (55 DTG/3TC, 13 DTG/RPV, two DTG/FTC) due to side-effects. 41 episodes of blip (1 off >50 copies/ml) occurred in 30 people (5.3%). 11/41 on DTG-RPV [ n = 7 multi-tablet regimen (MTR), n = 4 single tablet regimen (STR)]. 27/41 DTG-3TC, 3/41 DTG/FTC ( n = 26 MTR, n = 4 STR). Six people (1.1%) failed (confirmed viral load >200 copies/ml or persistent low level viraemia) ( n = 4 DTG-3TC STR, n = 1 DTG-3TC MTR, n = 1 DTG-RPV MTR). Four failures due to low level viraemia, one due to non-adherence and one due to high viral load. Resistance tests performed for 5/6 - mutations detected only in latter person with high viral load failure (on DTG-3TC MTR) who developed triple class resistance.
Majority of experience is in DTG/3TC stable switch. Minority of patients developed side-effects. Low number of virological failures, one developed integrase inhibitor resistance. Viral failure associated with MTR, commensurate with trial data showing no failure with resistance if DTG/3TC STR used. Overall DTG-2DR demonstrates high efficacy in real-world setting.
自2015年以来，我们为620人开具了基于度鲁特韦（DTG）的两药方案（DTG-2DR）[总队列3133人（19.8%）]。
检索2015年1月1日至2021年10月31日的临床数据库。分析人口统计学、耐受性和与HIV相关的数据。
共确定620人；561人有完整数据。男性446人（79.5%）；中位年龄54岁（四分位间距46，59）。男男性行为者343人（61.1%）。9名初治患者实现了病毒抑制（100%）。546/552（99.0%）的患者转换治疗或继续治疗，并在数据审查时实现病毒抑制。460/552（83.3%）的患者接受了DTG-拉米夫定（DTG/3TC），74/552（13.4%）的患者接受了DTG-利匹韦林（DTG/RPV），18/552（3.3%）的患者接受了DTG-恩曲他滨（DTG/FTC）。70人（12.5%）因副作用停用DTG-2DR（55人停用DTG/3TC，13人停用DTG/RPV，2人停用DTG/FTC）。30人（5.3%）出现41次病毒载量波动事件（1次超过50拷贝/ml）。11/41接受DTG-RPV治疗的患者 [n = 7多片制剂方案（MTR），n = 4单片制剂方案（STR）]。27/41接受DTG-3TC治疗，3/41接受DTG/FTC治疗（n = 26 MTR，n = 4 STR）。6人（1.1%）治疗失败（确认病毒载量>200拷贝/ml或持续低水平病毒血症）（n = 4 DTG-3TC STR，n = 1 DTG-3TC MTR，n = 1 DTG-RPV MTR）。4例因低水平病毒血症失败，1例因不依从失败，1例因高病毒载量失败。对5/6例患者进行了耐药检测——仅在最后1例高病毒载量失败的患者（接受DTG-3TC MTR治疗）中检测到突变，该患者产生了三类耐药。
大多数经验来自DTG/3TC的稳定转换。少数患者出现副作用。病毒学失败病例数较少，1例出现整合酶抑制剂耐药。病毒学失败与多片制剂方案相关，这与试验数据一致，即如果使用DTG/3TC单片制剂方案则不会出现耐药性失败。总体而言，DTG-2DR在现实环境中显示出高疗效。
