Forgiveness of Dolutegravir-Based Triple Therapy Compared with Older Antiretroviral Regimens: A Prospective Multicenter Cohort of Adherence Patterns and HIV-RNA Replication

Jean Jacques Parienti, Anna L. Fournier, Laurent Cotte, Marie Paule Schneider, Manuel Etienne, Guillemette Unal, Philippe Perré, Jean Jacques Dutheil, Elodie Morilland-Lecoq, Fabien Chaillot, David R. Bangsberg, Amandine Gagneux-Brunon, Thierry Prazuck, Matthias Cavassini, Renaud Verdon, Laurent Hocqueloux

Research output: Contribution to journalArticlepeer-review

Abstract

Background: For many people with HIV (PWH), taking antiretroviral therapy (ARV) every day is difficult. Methods: Average adherence (Av-Adh) and log-transformed treatment interruption (TI) to ARV were prospectively measured over 6 months using electronic drug monitoring (EDM) in several cohorts of PWH. Multivariate linear regression models including baseline confounders explored the influence of EDM-defined adherence (R2) on 6-month log10 HIV-RNA. Multivariate logistic regression models were used to compare the risk of HIV-RNA detection (VR) within subgroups stratified by lower (≤95%) and higher (>95%) Av-Adh. Results: Three hundred ninety-nine PWH were analyzed with different ARVs: dolutegravir (n = 102), raltegravir (n = 90), boosted PI (bPI; n = 107), and NNRTI (n = 100). In the dolutegravir group, the influence of adherence pattern measures on R2 for HIV-RNA levels was marginal (+2%). Av-Adh, TI, and Av-Adh × TI increased the R2 for HIV-RNA levels by 54% and 40% in the raltegravir and bPI treatment groups, respectively. TI increased the R2 for HIV-RNA levels by 36% in the NNRTI treatment group. Compared with the dolutegravir-based regimen, the risk of VR was significantly increased for raltegravir (adjusted odds ratio [aOR], 45.6; 95% CI, 4.5-462.1; P =. 001), NNRTIs (aOR, 24.8; 95% CI, 2.7-228.4; P =. 005), and bPIs (aOR, 28.3; 95% CI, 3.4-239.4; P =. 002) in PWH with Av-Adh ≤95%. Among PWH with >95% Av-Adh, there were no significant differences in the risk of VR among the different ARVs. Conclusions: These findings support the concept that dolutegravir in combination with 2 other active ARVs achieves greater virological suppression than older ARVs, including raltegravir, NNRTI, and bPI, among PWH with lower adherence.

Original languageEnglish (US)
Article numberofab316
JournalOpen Forum Infectious Diseases
Volume8
Issue number7
DOIs
StatePublished - Jul 2021

Keywords

  • adherence
  • dolutegravir
  • missed doses
  • PWH

ASJC Scopus subject areas

  • Oncology
  • Clinical Neurology

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