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Virological and Immunological Outcomes of an Intensified Four-Drug versus a Standard Three-Drug Antiretroviral Regimen, Both Integrase Strand Transfer Inhibitor-Based, in Primary HIV Infection
| Content Provider | MDPI |
|---|---|
| Author | Mondi, Annalisa Pinnetti, Carmela Lorenzini, Patrizia Plazzi, Maria Maddalena Abbate, Isabella Camici, Marta Agrati, Chiara Grilli, Elisabetta Gili, Francesca Esvan, Rozenn Orchi, Nicoletta Rozera, Gabriella Amendola, Alessandra Forbici, Federica Gori, Caterina Gagliardini, Roberta Bellagamba, Rita Ammassari, Adriana Cicalini, Stefania Capobianchi, Maria Rosaria Antinori, Andrea |
| Copyright Year | 2022 |
| Description | The optimal therapeutic approach for primary HIV infection (PHI) is still debated. We aimed to compare the viroimmunological response to a four- versus a three-drug regimen, both INSTI-based, in patients with PHI. This was a monocentric, prospective, observational study including all patients diagnosed with PHI from December 2014 to April 2018. Antiretroviral therapy (ART) was started, before genotype resistance test results, with tenofovir/emtricitabine and either raltegravir plus boosted darunavir or dolutegravir. Cumulative probability of virological suppression [VS] (HIV-1 RNA< 40 cp/mL), low-level HIV-1 DNA [LL-HIVDNA] (HIV-1 DNA < 200 $copies/10^{6}$PBMC), and CD4/CD8 ratio ≥1 were estimated using Kaplan–Meier curves. Factors associated with the achievement of VS, LL-HIVDNA, and CD4/CD8 ≥ 1 were assessed by a Cox regression model. We enrolled 144 patients (95.8% male, median age 34 years): 110 (76%) started a four-drug-based therapy, and 34 (24%) a three-drug regimen. Both treatment groups showed a comparable high probability of achieving VS and a similar probability of reaching LL-HIVDNA and a CD4/CD8 ratio ≥1 after 48 weeks from ART initiation. Higher baseline HIV-1 RNA and HIV-1 DNA levels lowered the chance of VS, whereas a better preserved immunocompetence increased that chance. Not statistically significant factors associated with LL-HIVDNA achievement were found, whereas a higher baseline CD4/CD8 ratio predicted the achievement of immune recovery. In PHI patients, the rapid initiation of either an intensified four-drug or a standard three-drug INSTI-based regimen showed comparable responses in terms of VS, viral reservoir size, and immunological recovery. |
| Starting Page | 403 |
| e-ISSN | 14248247 |
| DOI | 10.3390/ph15040403 |
| Journal | Pharmaceuticals |
| Issue Number | 4 |
| Volume Number | 15 |
| Language | English |
| Publisher | MDPI |
| Publisher Date | 2022-03-26 |
| Access Restriction | Open |
| Subject Keyword | Pharmaceuticals Infectious Diseases Primary Hiv Infection Antiretroviral Therapy Integrase Stand Transfer Inhibitors Rapid Art |
| Content Type | Text |
| Resource Type | Article |
