Journal article
Recycling tenofovir in second-line antiretroviral treatment with dolutegravir: outcomes and viral load trajectories to 72 weeks
- Abstract:
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Background:
Recycling tenofovir and lamivudine/emtricitabine with dolutegravir (TLD) after failure of non-nucleoside transcriptase inhibitor first-line antiretroviral therapy is more tolerable and scalable than dolutegravir plus optimized nucleoside reverse transcriptase inhibitors. Studies have demonstrated TLD's efficacy as second line, but long-term follow-up is limited.
Methods:
ARTIST is a single arm, prospective, interventional study conducted in Khayelitsha, South Africa, which switched 62 adults with 2 viral loads >1000 copies/mL from tenofovir, lamivudine/emtricitabine, and an non-nucleoside transcriptase inhibitor to TLD. We report efficacy to 72 weeks and, in a post hoc analysis, evaluated viral load trajectories of individuals with viremic episodes.
Results:
Virologic suppression was 86% [95% confidence interval (CI) 74 to 93], 74% (95% CI: 61 to 84), and 75% (95% CI: 63 to 86) <50 copies/mL and 95%, 84%, and 77% <400 copies/mL at week 24, 48, and 72, respectively, with 89% (50/56) resistant (Stanford score ≥15) to tenofovir and/or lamivudine preswitch. No participants developed integrase-inhibitor resistance. Of the 20 participants not suppressed at week 24 and/or 48, 2 developed virologic failure, 1 switched regimen (adverse event), 2 were lost to follow-up, 1 missed the visit, 1 transferred out, 9 resuppressed <50 copies/mL with enhanced adherence counseling, and 4 remained viremic (3 with <200 copies/mL) at week 72.
Conclusions:
Recycling NRTIs with dolutegravir was effective for most participants to 72 weeks. Most with viremia did not develop virologic failure and subsequently suppressed with enhanced adherence counseling or continued to have low-level viremia. No integrase-inhibitor resistance was detected despite low-level viremia in a minority of participants.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
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- Files:
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(Preview, Accepted manuscript, pdf, 593.3KB, Terms of use)
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- Publisher copy:
- 10.1097/qai.0000000000003157
Authors
- Publisher:
- Lippincott, Williams and Wilkins
- Journal:
- Journal of Acquired Immune Deficiency Syndromes More from this journal
- Volume:
- 92
- Issue:
- 5
- Pages:
- 422-429
- Publication date:
- 2023-04-01
- Acceptance date:
- 2022-12-19
- DOI:
- EISSN:
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1944-7884
- ISSN:
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1525-4135
- Pmid:
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36706364
- Language:
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English
- Keywords:
- Pubs id:
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1325964
- Local pid:
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pubs:1325964
- Deposit date:
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2023-08-31
- ARK identifier:
Terms of use
- Copyright holder:
- Keene et al
- Copyright date:
- 2023
- Rights statement:
- © 2023 Keene et al. This work was supported by the Wellcome Trust [212265/Z/18/Z] (GaM) and the Médecins Sans Frontières Khayelitsha project. The Wellcome Centre for Infectious Diseases Research in Africa is supported with core funding from the Wellcome Trust [203135/Z/16/Z]. GrM was supported by the Wellcome Trust [214321/Z/18/Z], and the South African Research Chairs Initiative of the Department of Science and Technology and National Research Foundation (NRF) of South Africa [Grant No 64787]. For the purpose of Open Access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript (AAM) version arising from this submission.
- Licence:
- CC Attribution (CC BY)
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