Objectives: To assess the impact of switching to dolutegravir plus lamivudine maintenance therapy on the HIV cellular reservoir size.Patients and methods: This was a prospective, longitudinal, matched, controlled study. We enrolled virologically suppressed patients on stable three-drug ART who switched at baseline (BL) to dolutegravir/lamivudine (DT group) or maintained triple therapy (TT group); subjects in the TT group were matched 1:1 with those in the DT group according to age, gender, years since HIV diagnosis, years on ART and anchor drug. Total blood-associated HIV DNA levels were assessed by droplet digital PCR at BL and after 48weeks (T48). Results were expressed as log(10)HIV DNAcopies/10(6) leucocytes.Results: We enrolled 40 patients in the DT group and 40 in the TT group; the two groups were homogeneous for all main characteristics except nadir CD4 cell count. At BL, HIV DNA levels were comparable between the DT and TT groups: 2.27 (IQR 1.97-2.47) and 2.26 (IQR 2.05-2.61) log(10)HIV DNAcopies/10(6) leucocytes, respectively. Change in HIV DNA load from BL to T48 was -0.105 (IQR -0.384 to 0.121, P=0.041) in the DT group and -0.132 (IQR -0.362 to 0.046, P=0.005) in the TT group, with a comparable decline observed between the two groups (P=0.821). A higher HIV DNA decline was associated with higher BL CD4/CD8 ratio.Conclusions: Maintenance therapy with dolutegravir/lamivudine had the same impact as the triple regimen on HIV DNA levels after 48weeks of treatment. These data seem to support the effectiveness of a dolutegravir/lamivudine dual regimen in controlling the magnitude of the cellular reservoir (www.clinicaltrials.gov, number NCT02836782).

Lombardi, F., Belmonti, S., Borghetti, A., Fabbiani, M., Marchetti, S., Tamburrini, E., Cauda, R., Di Giambenedetto, S., Evolution of cellular HIV DNA levels in virologically suppressed patients switching to dolutegravir/lamivudine versus maintaining a triple regimen: a prospective, longitudinal, matched, controlled study, <<JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY>>, 2020; 75 (6): 1599-1603. [doi:10.1093/jac/dkaa058] [https://hdl.handle.net/10807/231570]

Evolution of cellular HIV DNA levels in virologically suppressed patients switching to dolutegravir/lamivudine versus maintaining a triple regimen: a prospective, longitudinal, matched, controlled study

Lombardi, Francesca;Borghetti, Alberto;Marchetti, Simona;Tamburrini, Enrica;Cauda, Roberto;Di Giambenedetto, Simona
2020

Abstract

Objectives: To assess the impact of switching to dolutegravir plus lamivudine maintenance therapy on the HIV cellular reservoir size.Patients and methods: This was a prospective, longitudinal, matched, controlled study. We enrolled virologically suppressed patients on stable three-drug ART who switched at baseline (BL) to dolutegravir/lamivudine (DT group) or maintained triple therapy (TT group); subjects in the TT group were matched 1:1 with those in the DT group according to age, gender, years since HIV diagnosis, years on ART and anchor drug. Total blood-associated HIV DNA levels were assessed by droplet digital PCR at BL and after 48weeks (T48). Results were expressed as log(10)HIV DNAcopies/10(6) leucocytes.Results: We enrolled 40 patients in the DT group and 40 in the TT group; the two groups were homogeneous for all main characteristics except nadir CD4 cell count. At BL, HIV DNA levels were comparable between the DT and TT groups: 2.27 (IQR 1.97-2.47) and 2.26 (IQR 2.05-2.61) log(10)HIV DNAcopies/10(6) leucocytes, respectively. Change in HIV DNA load from BL to T48 was -0.105 (IQR -0.384 to 0.121, P=0.041) in the DT group and -0.132 (IQR -0.362 to 0.046, P=0.005) in the TT group, with a comparable decline observed between the two groups (P=0.821). A higher HIV DNA decline was associated with higher BL CD4/CD8 ratio.Conclusions: Maintenance therapy with dolutegravir/lamivudine had the same impact as the triple regimen on HIV DNA levels after 48weeks of treatment. These data seem to support the effectiveness of a dolutegravir/lamivudine dual regimen in controlling the magnitude of the cellular reservoir (www.clinicaltrials.gov, number NCT02836782).
2020
Inglese
Lombardi, F., Belmonti, S., Borghetti, A., Fabbiani, M., Marchetti, S., Tamburrini, E., Cauda, R., Di Giambenedetto, S., Evolution of cellular HIV DNA levels in virologically suppressed patients switching to dolutegravir/lamivudine versus maintaining a triple regimen: a prospective, longitudinal, matched, controlled study, <<JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY>>, 2020; 75 (6): 1599-1603. [doi:10.1093/jac/dkaa058] [https://hdl.handle.net/10807/231570]
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