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HIV VIRAL BLIPS IN ADULTS TREATED WITH InSTI-BASED REGIMENS THROUGH 144 WEEKS........no real difference in blips between arms, non-adherence found to cause blips.
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no real difference in blips between arms, non-adherence found to cause blips. Jules
CROI 2020
Reported by Jules Levin
Low-level viremia during ART and the risk of death, AIDS, and serious non-AIDS events (04/04/20)
Reversible effect on lipids by switching from tenofovir disoproxil fumarate to tenofovir alafenamide and back....http://www.natap.org/2018/AdverseReactComor/AdverseReactComor_12.htmhttp://www.natap.org/2019/HIV/121619_01.htm
Switching tenofovir disoproxil fumarate to tenofovir alafenamide - not only bone and kidney.....http://www.natap.org/2018/AdverseReactComor/AdverseReactComor_12.htm
Changes in Lipids After a Direct Switch from TDF to TAF....http://www.natap.org/2019/CROI/croi_48.htm
Rima K. Acosta1, Kristen Andreatta1, Michelle L. D'Antoni1, Sean E. Collins1, Hal Martin1, Kirsten L. White1
1Gilead Sciences, Inc, Foster City, CA, USA
The clinical impact of viral blips on virologic failure and resistance development depends on the resistance barrier and forgiveness of the regimen. Here, we investigated the blip frequency and virologic outcomes of those experiencing blips among treatment-nave people with HIV (PWH) initiating therapy on bictegravir (B)/emtricitabine (F)/tenofovir alafenamide (TAF), dolutegravir (DTG)/abacavir (ABC)/lamivudine (3TC), or DTG + F/TAF through 144 weeks of treatment in Studies 1489 and 1490.
PWH with at least one on-treatment post-baseline HIV RNA value were included in this analysis. HIV RNA and last observation carried forward (LOCF) outcome data through week 144 were used. A blip was an HIV RNA value ≥50 c/mL preceded and followed by HIV RNA <50 c/mL, after achieving confirmed suppression (two consecutive HIV RNA values <50 c/mL).
Of the 1240 participants with confirmed suppression, 143 (11.5%) had 1 blip through week 144 with similar blip frequencies between treatment arms (Table 1). An average of 1.3% of participants experienced blips per study visit, which was similar between treatment arms (Table 1). A total of 186 blip events occurred in the 143 individuals; 110 experienced a single blip and 33 experienced multiple blips.
Of the 186 blips, 87 (46.8%) were low-level (50-199 c/mL) and 99 (53.2%) were 200 c/mL. The proportions of participants with blips <200 c/mL or 200 c/mL were similar between treatment arms (Table 1). Most with blips 200 c/mL had adherence 95% by pill count (69.2%), while those with blips <200 c/mL mostly had adherence >95% (63.1%) (Table 1). Of participants without blips, 98.7% (1083/1097) had HIV RNA <50 c/mL at week 144 or last visit vs. 91.0% (71/78) with blips 200 c/mL (p<0.01), or vs. 96.9% (63/65) with blips <200 c/mL (p=0.2). The 7 with blips 200 c/mL and HIV RNA 50 c/mL at week 144 were all on DTG-based regimens, and 6/7 had evidence of continued low adherence. Of the 21 individuals included in the overall resistance analysis population, 5 experienced blips and none had emergent resistance to study drugs (Table 1).
Viral blips were infrequent and similar among PWH treated with B/F/TAF, DTG/ABC/3TC, or DTG + F/TAF. Blips 200 c/mL but not <200 c/mL were associated with adherence 95%. High level blips of 200 c/mL were associated with lower suppression at week 144 due to poor adherence; however, none developed resistance on these 3-drug regimens with high barriers to resistance.
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