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EuroHIV-HepMtg2024: Prevalence of HIV1 Resistance
Mutations to Rilpivirine and Cabotegravir in Treatment-Naïve Patients
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European Meeting on HIV & Hepatitis; May 22-24, 2024; Barcelona, Spain
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Costa O1, Gomes S1, Pereira K1, Dias I1, Lopes L1, Santos L1, Côrte-Real R1
1Unidade Local de Saúde São José, Lisbon, Portugal
ABSTRACT
Introduction: The use of long-acting (LA) injectable Calbotegravir (CAB) + Rilpivirine (RPV) was approved by the FDA in January 2021 as an optimization of oral therapy. This regimen should be used in patients who have been virologically suppressed for 6 months, with no history of treatment failure and no resistance or suspected resistance to CAB and/or RPV. The main factors for treatment failure are: archived resistance mutations to Rilpivirine, A1/A6 subtypes and body mass index > 30 kg/m2. Studies have shown low virological failure at 48 weeks (± 1%). When it does occur CAB and RPV resistances are common, and they are more frequent in the A1/A6 subtype. Currently in Portugal, the administration of this therapeutic regimen is not being carried out.
Background: To study the prevalence of resistance mutations to Rilpivirine and Calbotegravir in treatment-naïve patients followed in the clinical units and outpatient clinics of Infectious Diseases and Internal Medicine of a hospital center.
Material and Methods: A population of 712 treatment-naïve patients was studied between January 2020 and December 2023, 79% men, average age of 39 years and average viral load 597 846 copies/ml (5,8log). Due to a change in methodology, two genotypic sequencing tests were used - the Sanger method and Next Generation Sequencing (NGS), allowing simultaneously sequencing of HIV-1 reverse transcriptase, protease, and integrase regions. The results were interpreted according to the Stanford HIV Drug Resistance Database
(http://hivdb.stanford.edu). Mutations were defined according to the IAS-USA drug resistance mutations list.
Results: Our study showed 0.4% of patients had mutations conferring resistance to Cabotegravir, with 2 having R263K and 1 having Q148H, E138K, and G140S mutations. Patients with mutations conferring resistance to Rilpivirine were 2.2%, of which 1.3% had resistance and intermediate resistance, the most common K101E and G190A; 3.4% of patients had the E138A polymorphism, associated to a low level of resistance to Rilpivirine. Subtype A1, associated with a poorer response to CAB+RPV regimen was found in 2% of patients. The predominant subtypes were B (44%), CRF02_AG (15%), G (9.8%) and C (9.3%).
Conclusions: In our study, there was a low prevalence of resistance to both drugs (0.4% and 2.2%) which leads us to conclude that this regimen is a good alternative to current therapies. This regimen is also more convenient, protecting patients privacy. In the SOLAR study 90% of participants in BIC/FTC/TAF preferred to switch to CAB+RPV LA.
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