Longer-term virologic outcomes on tenofovir-lamivudine-dolutegravir in second-line ART

Journal article

BackgroundDolutegravir in second-line antiretroviral therapy (ART) is more effective with recycled tenofovir than switching to zidovudine. However, dolutegravir resistance is more frequent in second-line compared to first-line ART.ObjectivesWe report long-term virologic outcomes from a clinical trial.MethodAntiRetroviral Therapy In Second-line: investigating Tenofovir-lamivudine-dolutegravir (ARTIST) was a randomised, double-blind, phase II clinical trial. Eligible participants had two consecutive HIV-1 RNA ≥ 1000 copies/mL on first-line ART, mostly tenofovir-emtricitabine-efavirenz. Participants were switched to tenofovir-lamivudine-dolutegravir (TLD) with lead-in 50 mg dolutegravir twice daily in stage one (n = 62), and randomised to TLD with additional lead-in 50 mg dolutegravir or placebo for the first 14 days in stage two (n = 130). We present results up to 158 weeks, combining stages one and two.ResultsWe enrolled 192 participants: 127/176 (72%) had resistance (Stanford score ≥ 15) to both tenofovir and lamivudine. At week 48, 151/186 (81%; 95% confidence interval [CI] 75%, 87%) had HIV-1 RNA ConclusionAmong adults switching to TLD with detectable HIV-1 RNA and substantial tenofovir and lamivudine resistance, a high proportion maintained virologic suppression up to 158 weeks. Emergent dolutegravir resistance occurred in ~1% of participants after 2-3 years on second-line TLD.

Authors: van Heerden, JK; Zhao, Y; Keene, CM; Griesel, R; Omar, Z

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: AOSIS Publishing
• Journal: Southern African Journal of HIV Medicine
• Volume: 26
• Issue: 1
• Pages: 1677
• Publication date: 2025-04-30
• Acceptance date: 2025-01-09
• DOI: 10.4102/sajhivmed.v26i1.1677
• EISSN: 2078-6751
• ISSN: 1608-9693
• Pmid: 40356938
• Language: English
• Keywords: Drug resistance; HIV; Second-line; Tenofovir-lamivudine-dolutegravir; South Africa; Dolutegravir