Viro-immunological efficacy and tolerability of dolutegravir-based regimens compared to regimens based on other integrase strand inhibitors, protease inhibitors, non-nucleoside reverse transcriptase inhibitors in patients with acute HIV-1 infection: a multicenter retrospective cohort study

OBJECTIVES: This study aims to compare the tolerability and viro-immunologic efficacy of dolutegravir-based regimens (DTG group) with regimens based on EVG, RAL, PI, NNRTI (NODTG group) in patients with acute HIV-1 infections (AHI). METHODS: All patients diagnosed with AHI between 2015 and 2017, who started ART in 5 different centers in Italy, were included and followed-up to 30th April 2018. AHI was defined by the presence of the positive p24 antigen with negative or indeterminate western blot. RESULTS: Forty-three patients were enrolled: 20 on DTG, 23 in NODTG. Nine patients (20.9%), 4 in DTG and 5 in NODTG group, were prescribed a four-drug regimen. In the cohort, 81.4% were Italian and 83.7% males with a median age of 41 years (IQR 31-48). The median time elapsed between HIV diagnosis and ART initiation was 12 days [IQR 5-28]. Seven patients harbored a virus with transmitted mutations at baseline (16.2%), all in DTG group (p=0.005). All patients achieved HIV-RNA undetectable at the end of follow up except two subjects, of whom one had 57 copies and one was lost to follow-up. In Kaplan-Meier analysis, time to virologic suppression was not different between the two groups (log rank: p= 0.7155). After achieving virologic suppression, four patients stopped first ART due to toxicity: 2 on DTG, 2 on EVG for neurological and gastrointestinal toxicity, respectively. CONCLUSION: In our setting, ART in AHI is started very early. DTG showed a good viro-immunologic efficacy even when NRTI transmitted mutations were present. DTG interruption rarely occurred. Copyright © 2019. Published by Elsevier B.V.