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Simplifying ARV Therapy in the Setting of Resistance.
Curr Infect Dis Rep 2019; 21(10):38CI

Abstract

PURPOSE OF REVIEW

HIV treatment simplification is typically indicated for virologically suppressed patients with no baseline resistance-associated mutations (RAMs) or prior virologic failure (VF) to the simplification regimen. Simplification can occur to minimize pill burden, toxicities, drug-drug interactions, or costs. As most studies for treatment simplification excluded patients with baseline RAMs or prior VF, this review is aimed to critically analyze data regarding treatment simplification in treatment-experienced patients.

RECENT FINDINGS

Antiretroviral (ARV) regimens containing three-, two-, and one-drug(s) have been scarcely studied to assess virologic efficacy in treatment-experienced patients. Three-drug regimens with the most data and highest efficacy are with integrase strand transfer inhibitors (INSTIs). Regimens including dolutegravir (DTG) and bictegravir have been shown to maintain efficacy in patients with certain baseline RAMs. Dual therapy regimens include the use of DTG plus either lamivudine (3TC), rilpivirine (RPV), or other ARVs. None of these studies evaluated patients with baseline DTG resistance. Baseline RAMs to 3TC were not a predictor of VF in patients on DTG/3TC. Efficacy was seen with DTG/RPV; however, studies showed high rates of discontinuation. DTG plus boosted-protease inhibitors were studied in smaller but promising studies. Two small studies assessed the use of monotherapy with boosted darunavir or DTG, both showing virologic efficacy. Currently, three- and two-drug ARV regimens may be considered in this population with most studies evaluating the use of DTG and bictegravir without baseline INSTI RAMs. Future studies should include heavily treatment-experienced patients with a variety of baseline RAMs and a larger sample size.

Authors+Show Affiliations

University of Maryland Baltimore School of Pharmacy, 20 North Pine Street, PHN417, Baltimore, MD, 21201, USA. npandit@rx.umaryland.edu.University of Georgia College of Pharmacy, Albany, GA, USA.Department of Pharmacy, Cleveland Clinic, Cleveland, OH, USA.College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA.Indiana University Health, Indianapolis, IN, USA.College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

31494771

Citation

Pandit, Neha Sheth, et al. "Simplifying ARV Therapy in the Setting of Resistance." Current Infectious Disease Reports, vol. 21, no. 10, 2019, p. 38.
Pandit NS, Chastain DB, Pallotta AM, et al. Simplifying ARV Therapy in the Setting of Resistance. Curr Infect Dis Rep. 2019;21(10):38.
Pandit, N. S., Chastain, D. B., Pallotta, A. M., Badowski, M. E., Huesgen, E. C., & Michienzi, S. M. (2019). Simplifying ARV Therapy in the Setting of Resistance. Current Infectious Disease Reports, 21(10), p. 38. doi:10.1007/s11908-019-0691-8.
Pandit NS, et al. Simplifying ARV Therapy in the Setting of Resistance. Curr Infect Dis Rep. 2019 Sep 7;21(10):38. PubMed PMID: 31494771.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Simplifying ARV Therapy in the Setting of Resistance. AU - Pandit,Neha Sheth, AU - Chastain,Daniel B, AU - Pallotta,Andrea M, AU - Badowski,Melissa E, AU - Huesgen,Emily C, AU - Michienzi,Sarah M, Y1 - 2019/09/07/ PY - 2019/9/9/entrez PY - 2019/9/9/pubmed PY - 2019/9/9/medline KW - Antiretroviral KW - HIV KW - Simplification SP - 38 EP - 38 JF - Current infectious disease reports JO - Curr Infect Dis Rep VL - 21 IS - 10 N2 - PURPOSE OF REVIEW: HIV treatment simplification is typically indicated for virologically suppressed patients with no baseline resistance-associated mutations (RAMs) or prior virologic failure (VF) to the simplification regimen. Simplification can occur to minimize pill burden, toxicities, drug-drug interactions, or costs. As most studies for treatment simplification excluded patients with baseline RAMs or prior VF, this review is aimed to critically analyze data regarding treatment simplification in treatment-experienced patients. RECENT FINDINGS: Antiretroviral (ARV) regimens containing three-, two-, and one-drug(s) have been scarcely studied to assess virologic efficacy in treatment-experienced patients. Three-drug regimens with the most data and highest efficacy are with integrase strand transfer inhibitors (INSTIs). Regimens including dolutegravir (DTG) and bictegravir have been shown to maintain efficacy in patients with certain baseline RAMs. Dual therapy regimens include the use of DTG plus either lamivudine (3TC), rilpivirine (RPV), or other ARVs. None of these studies evaluated patients with baseline DTG resistance. Baseline RAMs to 3TC were not a predictor of VF in patients on DTG/3TC. Efficacy was seen with DTG/RPV; however, studies showed high rates of discontinuation. DTG plus boosted-protease inhibitors were studied in smaller but promising studies. Two small studies assessed the use of monotherapy with boosted darunavir or DTG, both showing virologic efficacy. Currently, three- and two-drug ARV regimens may be considered in this population with most studies evaluating the use of DTG and bictegravir without baseline INSTI RAMs. Future studies should include heavily treatment-experienced patients with a variety of baseline RAMs and a larger sample size. SN - 1523-3847 UR - https://www.unboundmedicine.com/medline/citation/31494771/Simplifying_ARV_Therapy_in_the_Setting_of_Resistance L2 - https://dx.doi.org/10.1007/s11908-019-0691-8 DB - PRIME DP - Unbound Medicine ER -