Simplified HIV Treatment Matches Standard Care Success

TOPLINE:

Among treatment-naive people with HIV (PWH), dolutegravir/lamivudine demonstrates effectiveness comparable with those of the commonly prescribed three-drug regimens but offers better persistence and lower discontinuation rates at 96 weeks.

METHODOLOGY:

• Researchers conducted a multicenter prospective cohort study to compare the effectiveness, tolerability, and persistence of dolutegravir/lamivudine with those of other first-line antiretroviral therapies (ARTs) in antiretroviral-naive PWH.
• Overall, 2359 PWH (age, ≥ 18 years) who started ART with dolutegravir/lamivudine or other first-line regimens between August 1, 2018, and November 30, 2021, were enrolled and followed-up for at least 96 weeks.
• The primary outcomes were viral suppression (VS; HIV RNA viral load 50 copies/mL or one > 1000 copies/mL after VS and before 96 weeks).
• The secondary endpoints were immunological response (IR), measured using changes in CD4 cell counts; treatment persistence; and incidence of adverse events over 96 weeks.

TAKEAWAY:

• Five ART regimens were reported, with bictegravir/tenofovir alafenamide/emtricitabine being the most frequently prescribed (in 48.1% patients), followed by dolutegravir/lamivudine (in 20.0% patients).
• In the intention-to-treat analysis, 94.0% PWH who started dolutegravir/lamivudine achieved VS at 96 weeks, with a mean increase in CD4 cell counts of 295.5 cells/μL (95% CI, 269.9-321.1), while only 1.6% subsequently experienced VF.
• VS and IR were comparable between PWH who started dolutegravir/lamivudine and other regimens, including those with high viral loads, those starting treatment within 7 days of enrollment, or those aged ≥ 50 years.
• The cumulative incidence of treatment discontinuation was higher (13.1%-73.8%) with regimens other than dolutegravir/lamivudine (9.8%) both overall and due to adverse events. Simplification of the drug regimen was the most common reason for discontinuation in those receiving regimens other than dolutegravir/lamivudine.

IN PRACTICE:

“These findings are consistent with the results of clinical trials and support the use of DTG/3TC [dolutegravir/lamivudine] as a first-line treatment for HIV infection,” the authors wrote. 

SOURCE:

The study was led by Inés Suárez-García, Infectious Diseases Group, Department of Internal Medicine, Hospital Universitario Infanta Sofía, Madrid, Spain. It was published online on December 23, 2024, in the Journal of Antimicrobial Chemotherapy.

LIMITATIONS:

The observational nature of the study was prone to bias among various parameters, which could have potentially affected the analysis. Also, some of the outcomes could not be assessed due to the low number of participants.

DISCLOSURES:

This study was partially supported by ViiV Healthcare. Four authors reported receiving grants, speaker fees, honoraria, consulting fees, and advisory fees from various pharmaceutical organizations.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.