Real-world prevalence of integrase inhibitor resistance and virological failure since adoption as guideline-preferred therapy

Jenna Januszka, Emily Drwiega, Rodrigo Burgos, Renata Smith, Melissa Badowski

Abstract

Background: Limited data reporting real-world prevalence of integrase strand transfer inhibitor resistance (INSTI-R) in the USA are available because their recommendation as first-line treatment in 2017. Reported national surveillance data in the USA estimated INSTI-R to be 6.3% as of 2018. This article aims to describe estimated prevalence of INSTI-R within a single clinic network in Chicago, IL, USA, and identify risk factors for resistance and virological failure (VF).

Methods: This was a retrospective, single-centre study of adults with HIV starting an INSTI-containing regimen between September 2017 and 2020. The primary endpoint was the difference in INSTI-R of the sample population compared with the national prevalence. Other outcomes included VF and documented INSTI-R mutations.

Results: Of 948 participants screened, 321 were included. Eight people had baseline INSTI-R testing results available, of which five had INSTI-R at baseline for an estimated prevalence of 1.6%. This estimation was significantly less than the national estimated prevalence of 6.3% (p<0.001). VF occurred in 26 (7.8%) individuals. Because no participants acquired INSTI-R during the study period, investigators were unable to identify risk factors associated with the development of INSTI-R. People with high pre-treatment viral loads had 1.21 (95% CI 1.05–1.39) higher odds of VF.

Conclusions: Amongst participants on INSTI-containing regimens, INSTI-R rates were estimated to be lower than the estimated national prevalence. Detectable preswitch viral loads were more associated with VF than undetectable viral loads.

Article Details

Article Type

Original Research

DOI

10.7573/dic.2023-12-4

Categories

Publication Dates

Accepted: ; Published: .

Citation

Januszka J, Drwiega E, Burgos R, Smith R, Badowski M. Real-world prevalence of integrase inhibitor resistance and virological failure since adoption as guideline-preferred therapy. Drugs Context. 2024;13:2023-12-4. https://doi.org/10.7573/dic.2023-12-4

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