2026-04-17T06:02:14Zhttps://recercat.cat/oai/request

oai:recercat.cat:2117/4006352026-01-27T03:26:34Zcom_2072_1033col_2072_452950

00925njm 22002777a 4500 dc Ramon Santos, Jose author Casadellà, Maria author Noguera Julian, Marc author Micán Rivera, Rafael author Domingo Pedrol, Pere author Antela, Antonio author Portilla, Joaquin author Sanz Sanz, Jesús author Montero Alonso, Marta author Navarro Mercade, Jordi author Masiá, Mar author Valcarce Pardeiro, Nieves author Pérez Álvarez, Nuria author 2023-06-26 Introduction: Second-generation integrase strand transfer inhibitors (INSTIs) are preferred treatment options worldwide, and dolutegravir (DTG) is the treatment of choice in resource-limited settings. Nevertheless, in some resource-limited settings, these drugs are not always available. An analysis of the experience with the use of INSTIs in unselected adults living with HIV may be of help to make therapeutic decisions when second-generation INSTIs are not available. This study aimed to evaluate the real-life effectiveness and safety of dolutegravir (DTG), elvitegravir/cobicistat (EVG/c), and raltegravir (RAL) in a large Spanish cohort of HIV-1-infected patients. Methods: Real-world study of adults living with HIV who initiated integrase INSTIs DTG, EVG/c, and RAL-based regimens in three settings (ART-naïve patients, ART-switching, and ART-salvage patients). The primary endpoint was the median time to treatment discontinuation after INSTI-based regimen initiation. Proportion of patients experiencing virological failure (VF) (defined as two consecutive viral loads (VL) =200 copies/mL at 24 weeks or as a single determination of VL =1,000 copies/mL while receiving DTG, EVG/c or RAL, and at least 3 months after INSTI initiation) and time to VF were also evaluated. Results: Virological effectiveness of EVG/c- and RAL-based regimens was similar to that of DTG when given as first-line and salvage therapy. Treatment switching for reasons other than virological failure was more frequent in subjects receiving EVG/c and, in particular, RAL. Naïve patients with CD4+ nadir <100 cells/µL were more likely to develop VF, particularly if they initiated RAL or EVG/c. In the ART switching population, initiation of RAL and EVG/c was associated with both VF and INSTI discontinuation. There were no differences in the time to VF and INSTI discontinuation between DTG, EVG/c and RAL. Immunological parameters improved in the three groups and for the three drugs assessed. Safety and tolerability were consistent with expected safety profiles. Discussion: Whereas second-generation INSTIs are preferred treatment options worldwide, and DTG is one of the treatment of choices in resource-limited settings, first-generation INSTIs may still provide high virological and immunological effectiveness when DTG is not available. Peer Reviewed Postprint (published version) Àrees temàtiques de la UPC::Matemàtiques i estadística::Matemàtica aplicada a les ciències Biomathematics Biomatemàtica Classificació AMS::92 Biology and other natural sciences::92B Mathematical biology in general Effectiveness and safety of integrase strand transfer inhibitors in Spain: a prospective real-world study