P04. Effect of dolutegravir in combination with NRTI in HIV-1 infected individuals with pre-existing NRTI-mutations
Erik Sörstedt1, Christina Carlander 2, Leo Flamholc3, Bo Hejdeman4, Veronica Svedhem-Johansson5, Anders Sönnerborg5, 6, Magnus Gisslén1, Aylin Yilmaz1
Affiliates: 1Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, 413 90 Gothenburg, Sweden; 2Centre for Clinical Research, County Hospital Västerås, 721 89 Västerås, Sweden; 3Department of Infectious Diseases, Malmö University Hospital, 205 02 Malmö, Sweden; 4Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet and Unit of Infectious Diseases / Venhälsan, Södersjukhuset, SE-118 83 Stockholm, Sweden; 5Department of Infectious Diseases, Karolinska Institute, Karolinska University Hospital, 141 86 Stockholm, Sweden; 6Department of Clinical Microbiology, Karolinska Institute, Karolinska University Hospital, 141 86 Stockholm, Sweden.
People living with HIV (PLWH) with nucleoside reverse transcriptase inhibitor (NRTI) resistance mutations have had few other options than regimens based on ritonavir-boosted protease inhibitors (PI/r) until the introduction of dolutegravir. Here we report the virologic results from PLWH in Sweden with pre-existing NRTI-mutations on treatment with dolutegravir and 1–2 NRTIs.
All Swedish PLWH on treatment with dolutegravir and 1–2 NRTIs > 4 weeks and with pre-existing NRTI-mutations were retrospectively identified from the national InfCare HIV database. As controls we included PLWH on PI/r and 1–2 NRTIs, matched according to Genotypic Susceptibility Score (GSS). Median CD4 was 473/570 cells/μL among participants/controls and HIV RNA <1.30 log10 copies/ml in both groups. Virologic failure was defined as an HIV RNA increase from a previously supressed level ( 200 copies/mL for treated participants or never suppressed to < 50 copies/mL for naïve individuals or those starting treatment after an interruption.
In total, 197 participants (median age 50 years, 62% male) and 197 controls were included. Median observation time was 35 weeks (interquartile range (IQR) 21–54). Five participants and seven controls had viral failure resulting in success rates of 97.5% and 96.4%, respectively. The most prevalent pre-existing NRTI mutations were at positions M184 (27% of all samples), T215 (12%), and D67 (10%). Median (IQR) GSS was 2 (1.5–3.0) for both participants and controls.
Dolutegravir in combination with 1–2 NRTIs was as efficient as PI/r in individuals with pre-existing NRTI mutations. Even though follow-up was shorter for participants on dolutegravir than PI/r, we consider dolutegravir a solid alternative to PI/r-based antiretroviral therapy also in the presence of NRTI-resistance.