Dual Regimen Provides Simple and Safe Salvage Therapy in HIV-1

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Active HIV replication dropped from 40% at baseline to 6.1% by week 48.
Active HIV replication dropped from 40% at baseline to 6.1% by week 48.

The dual combination of dolutegravir (DTG) plus darunavir/ritonavir (DRV/r) provided a simple and safe salvage therapy to suppress viral replication without metabolic impact in patients infected with HIV-1, according to a retrospective-prospective observational study published in BMC Infectious Diseases.

Researchers identified 130 patients who were switched to a dual combination of DTG plus DRV/r and followed for a median of 56 months. Reasons that led to switching therapies included simplification, viral failure, toxicity, non-adherence, persistent low-level viremia, and drug-drug interactions. At baseline, 118 patients had drug resistance to between 1 and 5 antiretroviral classes, and virologic failure had occurred in 12 patients.

By week 48, 6.1% of patients had ongoing HIV replication compared with 40% at baseline, and 76.2% had an undetectable viral load compared with 38.5% at baseline. The success rate was 88.5% in patients who had active replication (³50 copies/mL) at baseline and 97.4% in patients who had ≤49 copies/mL at baseline.

Overall, 48% of baseline laboratory alterations returned to normal. By week 48, the proportion of patients with any metabolic alterations at baseline decreased for levels of serum glucose, creatinine, modified diet for renal disease of <90 mL/min, alanine aminotransferase, aspartate aminotransferase, triglycerides, and for total-, high-density lipoprotein-, and low-density lipoprotein-cholesterol.

Limitations of this study included poor patient selection criteria, which may have led to inclusion of a heterogeneous population.

“Switching to DTG plus DRV/r provided a simple and safe rescue regimen to all subjects, controlling viral replication in a high proportion of patients,” concluded the investigators. In addition, this treatment regimen demonstrated a positive metabolic effect in patients with metabolic alterations at baseline.

Reference

Capetti AF, Cossu MV, Orofino G, et al. A dual regimen of ritonavir/darunavir plus dolutegravir for rescue or simplification of rescue therapy: 48 weeks' observational data. BMC Infect Dis. 2017;17:658.

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