Journal of Global Antimicrobial Resistance (Sep 2022)

Bictegravir/emtricitabine/tenofovir alafenamide ensures high rates of virological suppression maintenance despite previous resistance in PLWH who optimize treatment in clinical practice

  • Daniele Armenia,
  • Federica Forbici,
  • Ada Bertoli,
  • Giulia Berno,
  • Vincenzo Malagnino,
  • Roberta Gagliardini,
  • Vanni Borghi,
  • William Gennari,
  • Stefania Cicalini,
  • Annarita Buonomini,
  • Elisabetta Teti,
  • Simone Lanini,
  • Alessandra Latini,
  • Loredana Sarmati,
  • Cristina Mussini,
  • Massimo Andreoni,
  • Andrea Antinori,
  • Carlo F. Perno,
  • Francesca Ceccherini-Silberstein,
  • Maria M. Santoro

Journal volume & issue
Vol. 30
pp. 326 – 334

Abstract

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ABSTRACT: Objectives: We evaluated virological response and resistance profiles in individuals who were virologically suppressed who switched to bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) in real life. Methods: Survival analysis was used to assess probability of virological rebound (VR). Cumulative major resistance mutations (MRM) and cumulative genotypic susceptibility score (cGSS) were evaluated before the switch. Results: Overall, 283 individuals virologically suppressed for a median (interquartile [IQR]) time of 7 (3–9) y were analyzed. Of these, 20.8% were in first-line treatment, 13.1% were highly treatment-experienced (HTE), and 8.5% had experienced previous integrase inhibitor (INI)-failures. Before the switch, nucleotide reverse transcriptase inhibitor NRTI MRM prevalence was 29% (M184V:13.8%; any thymidine analogue mutation: 14.1%; K65R: 0.7%; K70E 0.4%); only three (2.1%) individuals showed INI major resistance mutations (Y143C/H/R [n = 1]; Y143C [n = 1]; N155H [n = 1]), and 82.0% of individuals received fully active B/F/TAF. Ninety-six wk after switch, the probability of VR was 5%, with only 12 events of VR at a median (IQR) viremia level of 284 (187–980) copies/mL, mainly transient. No significant associations between virological outcomes and genotypic susceptibility to B/F/TAF were observed. People who experienced previous INI failures showed a significantly higher adjusted hazard ratio (AHR [95% CI]) to experience VR under B/F/TAF (3.9 [1.1–13.4], P = 0.031). This AHR increased in people who experienced INI failures and received partially active B/F/TAF (5.5 [1.4–21.1], P = 0.013). Conclusion: Within 96 wk, a switch to B/F/TAF in individuals who were virologically suppressed ensured a very high rate of virological control in a clinical setting. Previous resistance alone did not affect B/F/TAF response. However, people who had previous INI failures were more prone to losing virological control under B/F/TAF.

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