Clinical experience with dolutegravir: efficacy, safety, tolerability

Abstract

Introduction: Dolutegravir (DTG) is an effective antiretroviral drug, associated with rapid virologic responses. Intermittent viremia has been linked to a higher risk of virologic failure and immune activation. Material and methods: A retrospective, observational study of human immunodeficiency virus type 1 (HIV-1) infected adults who have started DTG between May 2015 and May 2017 was conducted, aiming to evaluate virologic responses. Baseline, 4-, 12-, 24-, and 48-week data were analyzed, including incidence of blips and low-level viremia (LLV), immunological progression and tolerability. The population was divided into three groups, including antiretroviral treatment (ART)-naïve, ART-experienced without virological failure (HIV-RNA < 200 copies/ml) at switch to DTG, and ART-experienced with virological failure (HIV-RNA ≥ 200 copies/ml) at switch to DTG. Results: Within the 227-patient population, 55 (24.2%) were ART-naïve and 172 (75.7%) switched from other regimens. Virologic suppression (< 50 copies/ml) at 48-week was observed in 92.7%, 88.4%, and 75% of naïve, ART-experienced without virological failure at switch, and ART-experienced with virological failure at switch patients, respectively. During follow-up, 4.9% of ART-experienced without virological failure patients had blips above 50 copies/ml, and 0.6% of them maintained LLV above 50 copies/ml. Conclusions: The use of dolutegravir in naïve patients was associated with a 92.7% rate of viral suppression at week 48. Experienced non-failing patients rarely developed intermittent viremia above 50 copies/ml.