No evidence of an effect of the M184I/V on the doravirine/lamivudine/tenofovir switch efficacy in people with HIV

Abstract

Objectives: The effect of the M184I/V mutation on the rate of virological failure in people with HIV (PWH) with plasma HIV RNA viral load less than 50 copies/ml switching to a triple-therapy regimen of doravirine+lamivudine+ tenofovir or abacavir has not been evaluated.

Design: A retrospective national study of antiretroviral-experienced PWH who were switched to a doravirine plus lamivudine and abacavir or tenofovir regimen in the context of maintenance (viral load <50 copies/ml) was conducted. Virological failure was characterized by either two consecutive plasma viral loads at least 50 copies/ml or a single viral load at least 200 copies/ml. Viral blip was defined as an isolated viral load 50_200 copies/ml at any time up to month 6 after switching to the doravirine-containing regimen.

Results: Among the 338 PWH, doravirine was mainly associated with tenofovir+lamivudine (311/338, 92.0%). Of these, 45 had a M184I/V mutation before switching. Virological failure at M6 was 14.0 and 17.8% in the absence and presence of M184I/V, respectively, with an adjusted odds ratio (aOR) of 2.409, 95% confidence interval (95% CI) 0.574-10.113, P = 0.21. The risk of virological failure at M6 was associated with the level of zenith plasma HIV viral load, with an aOR of 1.646, 95% CI 1.163-2.328, P = 0.0049, per additional log 10 unit. The proportion of viral blip at M6 was 2.4 and 6.7% in PWH in the absence and presence of M184I/V, respectively, with an aOR of 0.818, 95% CI 0.187-3.587, P = 0.7897.

Conclusion: Among PWH with antiretroviral experience, there was no evidence that switching to doravirine + lamivudine plus tenofovir affected short-term treatment response in individuals harboring HIV M184I/V mutations.

Keywords: HIV; doravirine; nonnucleoside reverse transcriptase inhibitors; resistance; switch.