OBJECTIVES: This study aims to compare the tolerability and viro-immunologic efficacy of dolutegravir-based regimens (DTG group) with regimens based on EVG, RAL, PI, NNRTI (NODTG group) in patients with acute HIV-1 infections (AHI). METHODS: All patients diagnosed with AHI between 2015 and 2017, who started ART in 5 different centers in Italy, were included and followed-up to 30th April 2018. AHI was defined by the presence of the positive p24 antigen with negative or indeterminate western blot. RESULTS: Forty-three patients were enrolled: 20 on DTG, 23 in NODTG. Nine patients (20.9%), 4 in DTG and 5 in NODTG group, were prescribed a four-drug regimen. In the cohort, 81.4% were Italian and 83.7% males with a median age of 41 years (IQR 31-48). The median time elapsed between HIV diagnosis and ART initiation was 12 days [IQR 5-28]. Seven patients harbored a virus with transmitted mutations at baseline (16.2%), all in DTG group (p=0.005). All patients achieved HIV-RNA undetectable at the end of follow up except two subjects, of whom one had 57 copies and one was lost to follow-up. In Kaplan-Meier analysis, time to virologic suppression was not different between the two groups (log rank: p= 0.7155). After achieving virologic suppression, four patients stopped first ART due to toxicity: 2 on DTG, 2 on EVG for neurological and gastrointestinal toxicity, respectively. CONCLUSION: In our setting, ART in AHI is started very early. DTG showed a good viro-immunologic efficacy even when NRTI transmitted mutations were present. DTG interruption rarely occurred. Copyright © 2019. Published by Elsevier B.V.

Lagi, F., Baldin, G., Colafigli, M., Capetti, A., Madeddu, G., Kiros, S. T., Di Giambenedetto, S., Sterrantino, G., Viro-immunological efficacy and tolerability of dolutegravir-based regimens compared to regimens based on other integrase strand inhibitors, protease inhibitors, non-nucleoside reverse transcriptase inhibitors in patients with acute HIV-1 infection: a multicenter retrospective cohort study, <<INTERNATIONAL JOURNAL OF ANTIMICROBIAL AGENTS>>, 2019; (n/a): N/A-N/A. [doi:10.1016/j.ijantimicag.2019.06.003] [http://hdl.handle.net/10807/139273]

Viro-immunological efficacy and tolerability of dolutegravir-based regimens compared to regimens based on other integrase strand inhibitors, protease inhibitors, non-nucleoside reverse transcriptase inhibitors in patients with acute HIV-1 infection: a multicenter retrospective cohort study

Baldin, Gianmaria;Colafigli, Manuela;Di Giambenedetto, Simona;
2019

Abstract

OBJECTIVES: This study aims to compare the tolerability and viro-immunologic efficacy of dolutegravir-based regimens (DTG group) with regimens based on EVG, RAL, PI, NNRTI (NODTG group) in patients with acute HIV-1 infections (AHI). METHODS: All patients diagnosed with AHI between 2015 and 2017, who started ART in 5 different centers in Italy, were included and followed-up to 30th April 2018. AHI was defined by the presence of the positive p24 antigen with negative or indeterminate western blot. RESULTS: Forty-three patients were enrolled: 20 on DTG, 23 in NODTG. Nine patients (20.9%), 4 in DTG and 5 in NODTG group, were prescribed a four-drug regimen. In the cohort, 81.4% were Italian and 83.7% males with a median age of 41 years (IQR 31-48). The median time elapsed between HIV diagnosis and ART initiation was 12 days [IQR 5-28]. Seven patients harbored a virus with transmitted mutations at baseline (16.2%), all in DTG group (p=0.005). All patients achieved HIV-RNA undetectable at the end of follow up except two subjects, of whom one had 57 copies and one was lost to follow-up. In Kaplan-Meier analysis, time to virologic suppression was not different between the two groups (log rank: p= 0.7155). After achieving virologic suppression, four patients stopped first ART due to toxicity: 2 on DTG, 2 on EVG for neurological and gastrointestinal toxicity, respectively. CONCLUSION: In our setting, ART in AHI is started very early. DTG showed a good viro-immunologic efficacy even when NRTI transmitted mutations were present. DTG interruption rarely occurred. Copyright © 2019. Published by Elsevier B.V.
2019
Inglese
Lagi, F., Baldin, G., Colafigli, M., Capetti, A., Madeddu, G., Kiros, S. T., Di Giambenedetto, S., Sterrantino, G., Viro-immunological efficacy and tolerability of dolutegravir-based regimens compared to regimens based on other integrase strand inhibitors, protease inhibitors, non-nucleoside reverse transcriptase inhibitors in patients with acute HIV-1 infection: a multicenter retrospective cohort study, <<INTERNATIONAL JOURNAL OF ANTIMICROBIAL AGENTS>>, 2019; (n/a): N/A-N/A. [doi:10.1016/j.ijantimicag.2019.06.003] [http://hdl.handle.net/10807/139273]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10807/139273
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