Is TB a factor in viral suppression of HIV patients receiving DTG-based therapy? | Latest news for Doctors, Nurses and Pharmacists

Incident
tuberculosis (TB) appears to be a risk factor for virologic non-suppression (ie, viral load of >1,000 copies/mL) in

HIV patients who have transitioned to dolutegravir (DTG)-based therapy with recycled NRTIs*, according to a
retrospective subanalysis VISEND
study.

“It is so important to look for the occurrence of TB in patients on DTG-based therapy, especially when transitioning them to second-line therapy with recycled NRTIs,” said
Dr Nyuma Mabewe, the University Teaching Hospital, Lusaka (Zambia), is the presenting author at AIDS 2022. “Because if not, this is a possibility for emergent DTG resistance and … [TB IRIS**] whilst they do have TB.”

“Whilst there have been some studies … that did not show any TB-associated IRIS, we felt that the situation would be different in our patient population, especially as Zambia is one of the top 30 countries in the world with TB and HIV co-infections,” she continued.

The 144-week open-label, noninferiority VISEND
Study Included 1,201 treatment-experienced people living with HIV who were initially on TDF***/lamivudine/efavirenz. Arm A participants (viral load <1,000 copies/mL) were switched to either
TDF/lamivudine/DTG (TLD; number = 209)
TAF***/emtricitabine/DTG (TAFED; n=209). Those in arm B (viral load ≥1,000 copies/mL) were switched to DTG- (n=208 [TLD] 211 [TAFED]) or PI^#-based therapy (n=167 [AZT/3TC/LPV-r^##] 197 [AZT/3TC/ATV-r^##]). [AIDS 2022, abstract OALBB0105]

The current analysis included participants in arm B. The majority of participants were between 20-60 years old (94 percent), and female (62 percent).
had a baseline CD4 count >200 cells/mm³ (82 percent).

There were 35 cases of TB in the United States by week 48, 32 occurring in arm B (n=14). [DTG] 18 [PI]). More than half of the cases were diagnosed within 50 working days. All TB patients were treated within 48 weeks.

In terms of viral suppression Week 48The rate was lower with
DTG- vs. Pi-based Therapy (6 percent vs. 13%.

Five cases of incident TB were identified in a study of non-suppressed patients.
– three of which coming from the DTG arm (including one case of extrapulmonary TB [TB meningitis]). Mbewe noted that this means that DTG-based therapy was more effective for patients who are not TB-suppressed. “During the 48-week period, there was a greater chance of virologic death due to a TB event. … [N]Having TB was often associated with being [virologically] suppressed at the end of the study period.”

Other factors significantly associated with viral non-suppression among those on DTG-based therapy were age 20–59 years (adjusted odds ratio [adjOR], 3.44; (p=0.021), and CD4 countsAdjORs, 8.32; p=0.012 [50–200 cells/mm³] 18.43; P=0.001 [>200 cells/mm³]).

Three of the four reported deaths in week 48 were attributed TB.

The largest cohort of patients treated with DTG with recycled NRTIs has been included in this study. This adds to growing evidence that DTG-based therapy with NRTIs can be used in resource-constrained environments. Mbewe pointed out that they were not able to accurately characterize IRIS because the CD4 counts had been evaluated only at baseline, 6 months and 48 weeks. “Additionally, we were not able to measure drug levels to be assured of adherence, [and] not all TB was microbiologically confirmed.”

“[Nonetheless, our findings] For patients who are being transitioned to a nursing home, it is important to screen for TB.
DTG-based therapy with recycled NRTI backbone,” said Mbewe.