Efficacy and safety of switching to dolutegravir/lamivudine in virologically suppressed people with HIV-1 aged ≥ 50 years: week 48 pooled results from the TANGO and SALSA studies

• Published in: AIDS research and therapy Vol. 21; no. 1; pp. 17 - 9
• Main Authors: Walmsley, Sharon, Smith, Don E, Górgolas, Miguel, Cahn, Pedro E, Lutz, Thomas, Lacombe, Karine, Kumar, Princy N, Wynne, Brian, Grove, Richard, Bontempo, Gilda, Moodley, Riya, Okoli, Chinyere, Kisare, Michelle, Jones, Bryn, Clark, Andrew, Ait-Khaled, Mounir
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 21.03.2024; BioMed Central; BMC
• Subjects: Age; Age groups; Aging; Antiretroviral agents; Biomarkers; Body mass index; CD4 antigen; CD8 antigen; Comorbidity; Diagnosis; Dosage and administration; Drug dosages; Drug interaction; Drug therapy; DTG/3TC; Effectiveness; Hepatitis; HIV; HIV infection; HIV-1; Human immunodeficiency virus; Lamivudine; Polypharmacy; Population studies; Ribonucleic acid; RNA; Safety; Single-tablet regimen; Switching; Testing; Canada; United States > US; HIV-1; Polypharmacy; Single-tablet regimen; Comorbidity; Suppressed switch; DTG/3TC; Aging; 50 years
• ISSN: 1742-6405; 1742-6405
• DOI: 10.1186/s12981-024-00604-9

As the population of people with HIV ages, concerns over managing age-related comorbidities, polypharmacy, immune recovery, and drug-drug interactions while maintaining viral suppression have arisen. We present pooled TANGO and SALSA efficacy and safety results dichotomized by age (< 50 and ≥ 50 years). Week 48 data from the open-label phase 3 TANGO and SALSA trials evaluating switch to once-daily dolutegravir/lamivudine (DTG/3TC) fixed-dose combination vs continuing current antiretroviral regimen (CAR) were pooled. Proportions of participants with HIV-1 RNA ≥ 50 and < 50 copies/mL (Snapshot, intention-to-treat exposed) and safety were analyzed by age category. Adjusted mean change from baseline in CD4 + cell count was assessed using mixed-models repeated-measures analysis. Of 1234 participants, 80% of whom were male, 29% were aged ≥ 50 years. Among those aged ≥ 50 years, 1/177 (< 1%) DTG/3TC participant and 3/187 (2%) CAR participants had HIV-1 RNA ≥ 50 copies/mL at 48 weeks; proportions with HIV-1 RNA < 50 copies/mL were high in both treatment groups (≥ 92%), consistent with overall efficacy and similar to observations in participants aged < 50 years (≥ 93%). Regardless of age category, CD4 + cell count increased or was maintained from baseline with DTG/3TC. Change from baseline in CD4 + /CD8 + ratio was similar across age groups and between treatment groups. One CAR participant aged < 50 years had confirmed virologic withdrawal, but no resistance was detected. In the DTG/3TC group, incidence of adverse events (AEs) was similar across age groups. Proportions of AEs leading to withdrawal were low and comparable between age groups. Although drug-related AEs were generally low, across age groups, drug-related AEs were more frequent in participants who switched to DTG/3TC compared with those who continued CAR. While few serious AEs were observed in both treatment groups, more were reported in participants aged ≥ 50 years vs < 50 years. Among individuals with HIV-1, switching to DTG/3TC maintained high rates of virologic suppression and demonstrated a favorable safety profile, including in those aged ≥ 50 years despite higher prevalence of concomitant medication use and comorbidities. TANGO, NCT03446573 (February 27, 2018); SALSA, NCT04021290 (July 16, 2019).