Real-life study of dual therapy based on dolutegravir and ritonavir-boosted darunavir in HIV-1-infected treatment-experienced patients

• Published in: PloS one Vol. 14; no. 1; p. e0210476
• Main Authors: Jabłonowska, Elżbieta, Siwak, Ewa, Bociąga-Jasik, Monika, Gąsiorowski, Jacek, Kalinowska, Anna, Firląg Burkacka, Ewa, Wójcik-Cichy, Kamila, Piątek, Anna, Cielniak, Iwona, Horban, Andrzej
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 17.01.2019; Public Library of Science (PLoS)
• Subjects: Acquired immune deficiency syndrome; Adult; AIDS; Anti-HIV Agents - therapeutic use; Antiretroviral agents; Antiretroviral drugs; Antiretroviral Therapy, Highly Active - methods; Antiviral drugs; Biology and Life Sciences; CD4 antigen; CD4 Lymphocyte Count; Cholesterol; Darunavir; Darunavir - therapeutic use; Dolutegravir; Drug therapy; Drug Therapy, Combination; Epidermal growth factor receptors; Female; Glomerular filtration rate; Hepatology; Heterocyclic Compounds, 3-Ring - therapeutic use; HIV; HIV infections; HIV Infections - drug therapy; HIV-1 - drug effects; Hospitals; Human immunodeficiency virus; Humans; Infections; Infectious diseases; Kidney diseases; Lipids; Male; Medicine and Health Sciences; Middle Aged; Myalgia; Outcome Assessment, Health Care - methods; Outcome Assessment, Health Care - statistics & numerical data; Parameters; Patients; Proteinuria; Research and Analysis Methods; Retrospective Studies; Ritonavir; Ritonavir - therapeutic use; Therapy; Triglycerides; Viral Load - drug effects; Viremia; Poland
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0210476

Dual therapy based on dolutegravir and ritonavir-boosted darunavir (DTG/DRV/r) is a combination of well-known drugs with a high genetic barrier to HIV resistance. A retrospective analysis of all HIV-1 infected treatment-experienced patients who switched to DTG/DRV/r from May 2014 till March 2017 in 4 Polish centres-results of a 48-week treatment. The study group consisted of 59 men and 17 women. Median baseline parameters were: age- 42.7 years, CD4 cells count- 560.5 cells/μl, CD4 cells nadir- 150 cells/μl, number of prior antiretroviral regimens- 3. The introduction of dual therapy was primarily due to virologic failure (30 patients), adverse events on previous regimens (17 patients) and therapy simplification (27 patients). At week 48 the treatment was continued in 70/76 of patients and the median CD4 cells count increased from 560.5 to 641.0 cells/μl. The therapy was discontinued in six patients (1 -virologic failure, 1 -decrease of estimated glomerular filtration rate (eGFR), 1 -myalgia, 3 -lost to follow-up). At week 48 six patients had detectable viremia, but only in one patient viremia was higher than 200 copies/ml. At week 48 the level of serum total cholesterol of the investigated subjects was statistically significantly higher than at the moment of dual therapy introduction (185.8 mg/dl vs. 174.8 mg/dl- p<0.05). However, in patients previously not treated with TDF, there were no changes in lipid parameters during therapy. Proteinuria was observed in 13.2% of patients before the switch to dual therapy and in 7.1% of patients at week 48. The investigated dual therapy was effective and safe. The observed increase in lipid parameters only concerned the patients who had used a TDF-based regimen prior to analysed dual treatment.