Real life use of dolutegravir doravirine dual regimen in experienced elderly PLWH with multiple comorbidities and on polypharmacy: A retrospective analysis

• Published in: Medicine (Baltimore) Vol. 100; no. 52; p. e28488
• Main Authors: Mazzitelli, Maria, Sasset, Lolita, Leoni, Davide, Putaggio, Cristina, Cattelan, Anna Maria
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins 30.12.2021
• Subjects: Aged; Aged, 80 and over; Anti-HIV Agents - therapeutic use; Female; Heterocyclic Compounds, 3-Ring - therapeutic use; HIV Infections - drug therapy; HIV Infections - epidemiology; Humans; Infant; Male; Middle Aged; Observational Study; Oxazines - therapeutic use; Piperazines - therapeutic use; Polypharmacy; Pyridones - therapeutic use; Retrospective Studies; Treatment Outcome; Triazoles - therapeutic use; Viral Load - drug effects
• ISSN: 0025-7974; 1536-5964; 1536-5964
• DOI: 10.1097/MD.0000000000028488

By increasing life expectancy of people living with HIV, the most clinical challenge is managing both drug-to-drug interactions and comorbidities (especially metabolic). Doravirine (DOR), a new non-nucleoside reverse transcriptase inhibitor, recently approved for the treatment of HIV, could be a good companion of dolutegravir (DTG) in a dual regimen for experienced elderly patients with multimorbidity and polypharmacy.We herein report our preliminary experience in a small cohort of elderly patients (>50 years of age) with multimorbidity and on polypharmacy who were switched to DOR/DTG dual regimen and followed-up for 3 months. The study was conducted at the Infectious and Tropical Diseases Unit of Padua University Hospital, Italy.Eighteen patients were included, 72.2% males and 27.8% postmenopausal women, mean age was of 61.3 years (7.6), 50% experienced AIDS events. Switches to DOR and DTG were mainly due to high cardiovascular and metabolic risk (72.2%), and interactions among comedications (50%). Antiretrovirals that subjects were switched off were mostly boosted protease inhibitors 66.7%. We observed a viral suppression among all subjects. Interestingly, we observed a statistically significant reduction in body mass index, body weight and waist circumference, eGFR, and a significant increase in serum creatinine levels. No significant changes in CD4+ T cell count was observed from the baseline. Lipid and fasting glucose values did not change significantly.To the best of our knowledge this is the first experience reporting real-life outcome of switch to DTG + DOR in elderly with multimorbidity and on polypharmacy. From our very preliminary data the dual combination of DTG and DOR could be a good treatment strategy for these subjects. However, our findings need to be validated on a greater number of patients.