Original Research

Virologic outcomes with tenofovir-lamivudine-dolutegravir in adults failing PI-based second-line ART

Ying Zhao, Jacqueline Voget, Isaac Singini, Zaayid Omar, Vanessa Mudaly, Andrew Boulle, Gary Maartens, Graeme Meintjes
Southern African Journal of HIV Medicine | Vol 25, No 1 | a1567 | DOI: https://doi.org/10.4102/sajhivmed.v25i1.1567 | © 2024 Ying Zhao, Jacqueline Voget, Isaac Singini, Zaayid Omar, Vanessa Mudaly, Andrew Boulle, Gary Maartens, Graeme Meintjes | This work is licensed under CC Attribution 4.0
Submitted: 23 January 2024 | Published: 26 April 2024

About the author(s)

Ying Zhao, Department of Medicine, Faculty of Health Science, University of Cape Town, Cape Town, South Africa; and Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa
Jacqueline Voget, Western Cape Government Department of Health and Wellness, Cape Town, South Africa
Isaac Singini, Biostatistics Research Unit, South African Medical Research Council, Cape Town, South Africa
Zaayid Omar, Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa
Vanessa Mudaly, Western Cape Government Department of Health and Wellness, Cape Town, South Africa
Andrew Boulle, Provincial Health Data Centre, Western Cape Department of Health and CIDER, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
Gary Maartens, Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa; and Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
Graeme Meintjes, Department of Medicine, Faculty of Health Science, University of Cape Town, Cape Town, South Africa; and Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa

Abstract

Background: In South African antiretroviral guidelines, selected patients failing second-line protease inhibitor (PI)-based therapy qualify for genotypic resistance testing – those with PI resistance receive darunavir-based third-line regimens; those without PI resistance continue current regimen with adherence support. The Western Cape province, from September 2020, implemented a strategy of tenofovir-lamivudine-dolutegravir (TLD) for patients, provided there was no tenofovir resistance, irrespective of PI resistance.

Objectives: To evaluate virologic outcomes with TLD among adults failing second-line PI regimens with no tenofovir resistance.

Method: An observational cohort study comparing outcomes in patients switched to TLD with those continuing the same PI or switched to darunavir-based regimens. Follow-up was until virologic suppression (HIV-1 RNA < 400 copies/mL), or at the point of censoring.

Results: One hundred and thirty-three patients switched to TLD, 101 to darunavir-based regimens, and 121 continued with the same PI. By 12 months, among patients with PI resistance, 42/47 (89%) in the TLD group had HIV-1 RNA < 400 copies/mL compared to 91/99 (92%) in the darunavir group (hazard ratio, 1.11; 95% confidence interval, 0.77–1.60). In patients without PI resistance, 66/86 (77%) in the TLD group had HIV-1 RNA < 400 copies/mL compared to 42/120 (35%) in those continuing with the same PI (hazard ratio, 4.03; 95% confidence interval, 2.71–5.98). Two patients receiving TLD developed virologic failure with high-level dolutegravir resistance.

Conclusion: Amongst patients failing second-line PI with no PI resistance, switching to TLD was associated with higher virologic suppression, likely due to improved adherence. Virologic outcomes were similar in patients with PI resistance switched to darunavir-based regimens or TLD.


Keywords

antiretroviral therapy; dolutegravir; HIV; virologic failure; third-line.

Sustainable Development Goal

Goal 3: Good health and well-being

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