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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
biochemistry, genetics and molecular biology
Virologic failure and HIV drug resistance on simplified, dolutegravir-based maintenance therapy: Systematic review and meta-analysis
F1000Research, Volume 7, Article 1359, Year 2018
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Description
Background: Dolutegravir-containing maintenance therapy is a promising simplification strategy for virologically suppressed HIV-infected individuals. However, most of the available data to inform this strategy come from small, uncontrolled studies. We estimated the proportion of HIV-infected patients experiencing virological failure (VF) and developing drug resistance on dolutegravir (DTG)-based maintenance therapy. Methods: We searched Medline, Embase, Cochrane Central, Web of Science, and conference abstracts for studies assessing VF on DTG-based maintenance therapy. Studies including ≥5 adults with an undetectable viral load on antiretroviral therapy (ART) who switched to a DTG-based mono- or dual therapy were included. Pooled proportions of VF were estimated using random-intercept logistic meta-regression and acquired drug resistance mutations described for each strategy. Results: Of 1719 studies considered, 21 met our selection criteria, including seven interventional and 14 observational studies. Eight studies including 251 patients assessed VF on DTG monotherapy and fourteen studies including 1670 participants VF on dual therapy. The participant's median age ranged from 43 to 63 years, their median nadir CD4 count from 90 to 399 cells/μl, and 27.6% were female. The proportion of participants experiencing VF on DTG-monotherapy was 3.6% (95% confidence interval [CI] 1.9-6.7) at 24 weeks and 8.9% (95% CI 4.7-16.2) at 48 weeks. Resistance mutations developed in seven (3.6%) participants on DTG-monotherapy. Among patients on dual therapy, ten (0.7%, 95% CI 0.4-1.3) experienced VF by 48 weeks and none developed resistance to DTG. In adjusted analyses, VF at 24 weeks was less likely on dual therapy than on monotherapy (adjusted odds ratio: 0.10, 95% CI 0.03-0.30). Conclusions: Whereas VF is relatively common on DTG maintenance monotherapy, DTG-based dual therapy appears to be a promising simplification strategy for individuals with a suppressed HIV viral load on triple-ART. © 2018 Wandeler G et al.
Authors & Co-Authors
Wandeler, Gilles
Switzerland, Bern
University Hospital Bern
Switzerland, Bern
University of Bern
Buzzi, Marta
Switzerland, Geneva
Hôpitaux Universitaires de Genève
Anderegg, Nanina
Switzerland, Bern
University of Bern
Sculier, Delphine
Switzerland, Geneva
Hôpitaux Universitaires de Genève
Egger, Matthias
Switzerland, Bern
University of Bern
Calmy, Alexandra L.
Switzerland, Geneva
Hôpitaux Universitaires de Genève
Sued, Omar G.
Argentina, Buenos Aires
Fundacion Huesped
Hocqueloux, Laurent
France, Orleans
Chr D'orléans
Martínez, Estebán Sampedro
Spain, Barcelona
Hospital Clinic Barcelona
Statistics
Citations: 33
Authors: 9
Affiliations: 6
Identifiers
Doi:
10.5256/f1000research.17470.r37755
ISSN:
20461402
Research Areas
Infectious Diseases
Study Design
Case-Control Study
Study Approach
Systematic review
Participants Gender
Female