Viral Failure Rates for Dolutegravir-Based vs. Other Guideline Regimens

Rates of viral failure were compared in HIV patients initiated on dolutegravir-based vs. other guideline recommended regimens in clinical care.

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SAN DIEGO—”The observed rate of viral failure during follow-up was lower among people living with HIV initiating dolutegravir-based vs. darunavir-based regimens in routine clinical care sites across the U.S.,” reported Heidi M. Crane, MD, MPH, from the University of Washington, Seattle, WA.

Much of the existing literature on viral failure with integrase inhibitors is based on clinical trial results rather than clinical care settings, and little is known about recently approved agents, Dr. Crane said.

The research team compared viral failure rates among HIV patients who initiated on dolutegravir-based vs. other guideline recommended regimens in real-world clinical care settings. A total of 5,177 patients across 8 CFAR Network of Integrated Clinical Systems (CNICS) sites who were initiated on a recommended regimen between August 2013 to March 2017 were included for analysis. 

The researchers compared viral failure among patients initiated on dolutegravir vs. other INSTI regimens, and dolutegravir vs. darunavir-based regimens that are a part of current guidelines for starting antiretroviral therapy (ART). 

Viral failure (VF) was defined as a viral load of >400 copies/mL >6 months after initiation, explained Dr. Crane. Multivariate models were adjusted for age, gender, race/ethnicity, hepatitis B/C, tuberculosis, HIV risk factor, CD4 count, days since last HIV viral load, and site.

Patients who were initiated on a dolutegravir-based regimen experienced fewer viral failures than those on darunavir-based regimen (hazard ratio [HR] 0.41, 95% CI: 0.30–0.55). 

“The HR for dolutegravir vs. darunavir-based regimens ranged from 0.40 to 0.50 depending on censoring definitions for end of follow-up, but these associations were all [statistically] significant,” she said.

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Crane, HM. Viral Failure Among Persons Living with HIV Initiating Dolutegravir-Based vs. Other Recommended Regimens in Real-World Clinical Care Settings. Poster presented at IDWeek; October 4–8, 2017; San Diego, CA.