TY - JOUR
T1 - Forgiveness of Dolutegravir-Based Triple Therapy Compared with Older Antiretroviral Regimens
T2 - A Prospective Multicenter Cohort of Adherence Patterns and HIV-RNA Replication
AU - Parienti, Jean Jacques
AU - Fournier, Anna L.
AU - Cotte, Laurent
AU - Schneider, Marie Paule
AU - Etienne, Manuel
AU - Unal, Guillemette
AU - Perré, Philippe
AU - Dutheil, Jean Jacques
AU - Morilland-Lecoq, Elodie
AU - Chaillot, Fabien
AU - Bangsberg, David R.
AU - Gagneux-Brunon, Amandine
AU - Prazuck, Thierry
AU - Cavassini, Matthias
AU - Verdon, Renaud
AU - Hocqueloux, Laurent
N1 - Publisher Copyright:
© 2021 The Author(s) 2021. Published by Oxford University Press on behalf of Infectious Diseases Society of America.
PY - 2021/7
Y1 - 2021/7
N2 - Background: For many people with HIV (PWH), taking antiretroviral therapy (ARV) every day is difficult. Methods: Average adherence (Av-Adh) and log-transformed treatment interruption (TI) to ARV were prospectively measured over 6 months using electronic drug monitoring (EDM) in several cohorts of PWH. Multivariate linear regression models including baseline confounders explored the influence of EDM-defined adherence (R2) on 6-month log10 HIV-RNA. Multivariate logistic regression models were used to compare the risk of HIV-RNA detection (VR) within subgroups stratified by lower (≤95%) and higher (>95%) Av-Adh. Results: Three hundred ninety-nine PWH were analyzed with different ARVs: dolutegravir (n = 102), raltegravir (n = 90), boosted PI (bPI; n = 107), and NNRTI (n = 100). In the dolutegravir group, the influence of adherence pattern measures on R2 for HIV-RNA levels was marginal (+2%). Av-Adh, TI, and Av-Adh × TI increased the R2 for HIV-RNA levels by 54% and 40% in the raltegravir and bPI treatment groups, respectively. TI increased the R2 for HIV-RNA levels by 36% in the NNRTI treatment group. Compared with the dolutegravir-based regimen, the risk of VR was significantly increased for raltegravir (adjusted odds ratio [aOR], 45.6; 95% CI, 4.5-462.1; P =. 001), NNRTIs (aOR, 24.8; 95% CI, 2.7-228.4; P =. 005), and bPIs (aOR, 28.3; 95% CI, 3.4-239.4; P =. 002) in PWH with Av-Adh ≤95%. Among PWH with >95% Av-Adh, there were no significant differences in the risk of VR among the different ARVs. Conclusions: These findings support the concept that dolutegravir in combination with 2 other active ARVs achieves greater virological suppression than older ARVs, including raltegravir, NNRTI, and bPI, among PWH with lower adherence.
AB - Background: For many people with HIV (PWH), taking antiretroviral therapy (ARV) every day is difficult. Methods: Average adherence (Av-Adh) and log-transformed treatment interruption (TI) to ARV were prospectively measured over 6 months using electronic drug monitoring (EDM) in several cohorts of PWH. Multivariate linear regression models including baseline confounders explored the influence of EDM-defined adherence (R2) on 6-month log10 HIV-RNA. Multivariate logistic regression models were used to compare the risk of HIV-RNA detection (VR) within subgroups stratified by lower (≤95%) and higher (>95%) Av-Adh. Results: Three hundred ninety-nine PWH were analyzed with different ARVs: dolutegravir (n = 102), raltegravir (n = 90), boosted PI (bPI; n = 107), and NNRTI (n = 100). In the dolutegravir group, the influence of adherence pattern measures on R2 for HIV-RNA levels was marginal (+2%). Av-Adh, TI, and Av-Adh × TI increased the R2 for HIV-RNA levels by 54% and 40% in the raltegravir and bPI treatment groups, respectively. TI increased the R2 for HIV-RNA levels by 36% in the NNRTI treatment group. Compared with the dolutegravir-based regimen, the risk of VR was significantly increased for raltegravir (adjusted odds ratio [aOR], 45.6; 95% CI, 4.5-462.1; P =. 001), NNRTIs (aOR, 24.8; 95% CI, 2.7-228.4; P =. 005), and bPIs (aOR, 28.3; 95% CI, 3.4-239.4; P =. 002) in PWH with Av-Adh ≤95%. Among PWH with >95% Av-Adh, there were no significant differences in the risk of VR among the different ARVs. Conclusions: These findings support the concept that dolutegravir in combination with 2 other active ARVs achieves greater virological suppression than older ARVs, including raltegravir, NNRTI, and bPI, among PWH with lower adherence.
KW - PWH
KW - adherence
KW - dolutegravir
KW - missed doses
UR - http://www.scopus.com/inward/record.url?scp=85112531893&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85112531893&partnerID=8YFLogxK
U2 - 10.1093/ofid/ofab316
DO - 10.1093/ofid/ofab316
M3 - Article
AN - SCOPUS:85112531893
SN - 2328-8957
VL - 8
JO - Open Forum Infectious Diseases
JF - Open Forum Infectious Diseases
IS - 7
M1 - ofab316
ER -