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Meta-Analysis
. 2018 Aug 30:7:1359.
doi: 10.12688/f1000research.15995.2. eCollection 2018.

Virologic failure and HIV drug resistance on simplified, dolutegravir-based maintenance therapy: Systematic review and meta-analysis

Gilles Wandeler #  1   2 , Marta Buzzi #  3 , Nanina Anderegg  2 , Delphine Sculier  3 , Charles Béguelin  1 , Matthias Egger  2 , Alexandra Calmy  3
Affiliations
Meta-Analysis

Virologic failure and HIV drug resistance on simplified, dolutegravir-based maintenance therapy: Systematic review and meta-analysis

Gilles Wandeler et al. F1000Res. .

Abstract

Background: Dolutegravir-containing maintenance therapy is a promising simplification strategy for virologically suppressed HIV-infected individuals. However, most of the available data to inform this strategy come from small, uncontrolled studies. We estimated the proportion of HIV-infected patients experiencing virological failure (VF) and developing drug resistance on dolutegravir (DTG)-based maintenance therapy. Methods: We searched Medline, Embase, Cochrane Central, Web of Science, and conference abstracts for studies assessing VF on DTG-based maintenance therapy. Studies including ≥5 adults with an undetectable viral load on antiretroviral therapy (ART) who switched to a DTG-based mono- or dual therapy were included. Pooled proportions of VF were estimated using random-intercept logistic meta-regression and acquired drug resistance mutations described for each strategy. Results: Of 1719 studies considered, 21 met our selection criteria, including seven interventional and 14 observational studies. Eight studies including 251 patients assessed VF on DTG monotherapy and fourteen studies including 1670 participants VF on dual therapy. The participant's median age ranged from 43 to 63 years, their median nadir CD4 count from 90 to 399 cells/µl, and 27.6% were female. The proportion of participants experiencing VF on DTG-monotherapy was 3.6% (95% confidence interval [CI] 1.9-6.7) at 24 weeks and 8.9% (95% CI 4.7-16.2) at 48 weeks. Resistance mutations developed in seven (3.6%) participants on DTG-monotherapy. Among patients on dual therapy, ten (0.7%, 95% CI 0.4-1.3) experienced VF by 48 weeks and none developed resistance to DTG. In adjusted analyses, VF at 24 weeks was less likely on dual therapy than on monotherapy (adjusted odds ratio: 0.10, 95% CI 0.03-0.30). Conclusions: Whereas VF is relatively common on DTG maintenance monotherapy, DTG-based dual therapy appears to be a promising simplification strategy for individuals with a suppressed HIV viral load on triple-ART.

Keywords: Dolutegravir; HIV; meta-analysis; simplified therapy.

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Conflict of interest statement

Competing interests: We declare no competing interests. AC received unrestricted educational grants (to her Institution) in 2016 and 2017 from ViiV (DTG originator manufacturer).

Figures

Figure 1.
Figure 1.. Flow chart of study selection process.
Figure 2.
Figure 2.. Meta-analysis of virological failure among patients on single or dual DTG-based simplification therapy.
See this image and copyright information in PMC

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