HIV integrase inhibitors in ART-experienced patients

Abstract

Purpose of review: We review the most recent clinical trials of integrase inhibitors (INIs) in antiretroviral therapy (ART)-experienced patients, including trails of new strategies such as intensification and simplification therapy with this new class of compounds.

Recent findings: After the excellent results of the first-generation INIs [raltegravir (RAL) and elvitegravir] in the treatment of ART-experienced patients, dolutegravir--a new second-generation compound in this drug class--adds the possibility of rescuing ART-experienced patients after virologic failure to first-generation INIs like RAL. RAL may have a role in an intensification strategy--adding RAL to a suppressive ART therapy--that could have an effect in avoiding new cycles of infection and cellular activation. On the contrary, RAL has clearly shown efficacy in switching away from boosted protease inhibitors (PI/r). This simplification strategy may be an interesting option in patients suffering from side effects of boosted protease inhibitors. In simplification, the length of time of HIV suppression before the switch may be used as a marker of probable success.

Summary: In ART-experienced patients INIs are a new and exciting part of the armamentarium for the control of HIV replication. INIs could play an interesting role in strategies such as intensification or simplification.