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VIROLOGICAL EFFICACY OF DOLUTEGRAVIR PLUS DARUNAVIR IN MULTI-DRUG-RESISTANT HIV
PATIENTS: A REAL-WORLD COHORT STUDY WITH DATA FROM THE PRESTIGIO REGISTRY
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HIV Glasgow 2024 Nov 10-13
Conclusions: Among 4DR-PWH, DTG+DRV/b is associated with a lower odd of VF even after adjusting for the number of fully active drugs. This combination is also effective when not fully active or combined with other ARVs.
Background: This study evaluated the virological efficacy of DTG plus DRV/b in people with 4-class drug-resistant HIV (4DR PWH) in a real-world setting.
Materials and Methods: Retrospective study analyzing antiretroviral treatment (ART) used by adults with 4DR HIV from the PRESTIGIO Registry [1]. The ART regimes were categorized into three groups: i) DTG and DRV/b only (DTG+DRV/b); ii) DTG and DRV/b plus ≥1 additional antiretroviral drug (ARV) (DTG+DRV/b+other); iii) regimens not including the combination of DTG and DRV/b (Other). Follow-up started from the first evidence of 4DR (baseline) until death, loss to follow-up, or May 30 2024. A person
can change group multiple times during follow-up. The relationship between DTG+DRV/b and virological failure (VF) was analyzed using mixed-effects logistic regression. VF was defined as ≥2 HIV-RNA determinations >50 copies/mL or one ≥1000 cp/mL. Regimens were classified as 0 (not failed) or 1 (failed) at each HIV-RNA measurement. Regression was adjusted for age, ART duration, number of fully active ARV, sex at birth, and nadir CD4+. Individual failure predisposition was estimated with a random intercept.
Results: We evaluated 844 regimens from 249 4DR-PWH with a median follow-up of 8.7 years (5.9-11.5). Specifically, the 844 regimens were distributed as follows: 72 (8.5%) DTG+DRV/b, 264 (31.3%) DTG+DRV/b+Other, and 508 (60.2%) Other. Overall, 60 people were exposed to DTG+DRV/b , 136 people to DTG+DRV/b+Other, and 181 to Other. In the DTG+DRV/b, the median number of fully active ARV included and the percentage of full activity of DTG and DRV/b were higher than the other groups.
(table 1) Logistic analysis indicated the odds of VF is 77% and 35.9% lower with DTG+DRV/b and DTG+DRV/b+other, respectively, compared to "Other". Each fully active ARV in the regimen decreases VF odds by 40%. Older age and longer ART duration lessen the odds of VF, likely due to better HIV control over time. (Figure 1).
DTG+DRV/b remains virologically effective despite the partial activity of its components in the group (DRV/b fully active in 47.2%, DTG fully active in 63.9%).
DTG and DRV/b dual therapy remains virologically effective despite the partial activity of its individual components in the group (DRV/b fully active in 47.2% of cases and DTG in 63.9%) with only 30.6% of cases showing full activity to both drugs combined. Additionally, DTG+DRV/b+other seems to be more effective than Other, even when full activity of the combination is present in just 15.5% of cases.
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