Effectiveness and safety of integrase strand transfer inhibitors in Spain : a prospective real-world study
Santos, José Ramón (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Casadellà, Maria (Institut Germans Trias i Pujol. Institut de Recerca de la Sida IrsiCaixa)
Noguera-Julian, Marc (Institut Germans Trias i Pujol. Institut de Recerca de la Sida IrsiCaixa)
Micán-Rivera, R. (Hospital Universitario La Paz (Madrid))
Domingo Pedrol, Pedro (Institut d'Investigació Biomèdica Sant Pau)
Antela, A. (Hospital Clínico Universitario (Santiago de Compostela, Galícia))
Portilla, J. (Hospital General Universitario Dr. Balmis de Alicante)
Sanz Sanz, Jesús (Hospital Universitario de la Princesa (Madrid))
Montero-Alonso, M. (Hospital Universitari i Politècnic La Fe (València))
Navarro, Jordi (Hospital Universitari Vall d'Hebron)
Masiá, M. (Instituto de Salud Carlos III)
Valcarce-Pardeiro, Nieves (Complejo Hospitalario Universitario de Ferrol)
Ocampo, A. (Hospital Álvaro Cunqueiro (Vigo))
Pérez-Martínez, L. (Centro de Investigación Biomédica de La Rioja)
García-Vallecillos, C. (Hospital Universitario Virgen de las Nieves (Granada))
Vivancos-Gallego, María J. (Hospital Universitario Ramón y Cajal (Madrid))
Imaz, Arkaitz (Hospital Universitari de Bellvitge)
Iribarren, José Antonio (Universidad del País Vasco)
Hernández Quero, José (Hospital Universitario San Cecilio (Granada))
Villar Garcia, Judit (Institut Hospital del Mar d'Investigacions Mèdiques)
Barrufet, M. Pilar (Hospital Mataró)
Paredes, Roger (Institut Germans Trias i Pujol. Institut de Recerca de la Sida IrsiCaixa)
Universitat Autònoma de Barcelona

Fecha:	2023
Resumen:	Second-generation integrase strand transfer inhibitors (INSTIs) are preferred treatment options worldwide, and dolutegravir (DTG) is the treatment of choice in resource-limited settings. Nevertheless, in some resource-limited settings, these drugs are not always available. An analysis of the experience with the use of INSTIs in unselected adults living with HIV may be of help to make therapeutic decisions when second-generation INSTIs are not available. This study aimed to evaluate the real-life effectiveness and safety of dolutegravir (DTG), elvitegravir/cobicistat (EVG/c), and raltegravir (RAL) in a large Spanish cohort of HIV-1-infected patients. Real-world study of adults living with HIV who initiated integrase INSTIs DTG, EVG/c, and RAL-based regimens in three settings (ART-naïve patients, ART-switching, and ART-salvage patients). The primary endpoint was the median time to treatment discontinuation after INSTI-based regimen initiation. Proportion of patients experiencing virological failure (VF) (defined as two consecutive viral loads (VL) ≥200 copies/mL at 24 weeks or as a single determination of VL ≥1,000 copies/mL while receiving DTG, EVG/c or RAL, and at least 3 months after INSTI initiation) and time to VF were also evaluated. Virological effectiveness of EVG/c- and RAL-based regimens was similar to that of DTG when given as first-line and salvage therapy. Treatment switching for reasons other than virological failure was more frequent in subjects receiving EVG/c and, in particular, RAL. Naïve patients with CD4+ nadir <100 cells/μL were more likely to develop VF, particularly if they initiated RAL or EVG/c. In the ART switching population, initiation of RAL and EVG/c was associated with both VF and INSTI discontinuation. There were no differences in the time to VF and INSTI discontinuation between DTG, EVG/c and RAL. Immunological parameters improved in the three groups and for the three drugs assessed. Safety and tolerability were consistent with expected safety profiles. Whereas second-generation INSTIs are preferred treatment options worldwide, and DTG is one of the treatment of choices in resource-limited settings, first-generation INSTIs may still provide high virological and immunological effectiveness when DTG is not available.
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Materia:	HIV ; Dolutegravir ; Elvitegravir ; Integrase strand transfer inhibitors (INSTI) ; Raltegravir ; Real-world study
Publicado en:	Frontiers in cellular and infection microbiology, Vol. 13 (2023) , p. 1187999, ISSN 2235-2988

DOI: 10.3389/fcimb.2023.1187999
PMID: 37434782

15 p, 1.6 MB

El registro aparece en las colecciones:
Documentos de investigación > Documentos de los grupos de investigación de la UAB > Centros y grupos de investigación (producción científica) > Ciencias de la salud y biociencias > Institut d'Investigació en Ciencies de la Salut Germans Trias i Pujol (IGTP)
Documentos de investigación > Documentos de los grupos de investigación de la UAB > Centros y grupos de investigación (producción científica) > Ciencias de la salud y biociencias > Institut de Recerca Sant Pau
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