Switching From a Protease Inhibitor-based Regimen to a Dolutegravir-based Regimen: A Randomized Clinical Trial to Determine the Effect on Peripheral Blood and Ileum Biopsies From Antiretroviral Therapy-suppressed Human Immunodeficiency Virus-infected Individuals.

Abstract

BACKGROUND:

Optimization of combination antiretroviral therapy (cART) can impact the human immunodeficiency virus (HIV) reservoir. We evaluated the effect on the HIV reservoir in peripheral blood and ileum biopsies in patients switching from boosted protease inhibitor (PI/r)-based therapy to dolutegravir (DTG)-based therapy.

METHODS:

Impact of Integrase-inhibitor DOlutegravir On the viral Reservoir (INDOOR) is a phase 4 open-label clinical trial that randomly included 42 HIV type 1-infected individuals on effective cART: 20 who switched from PI/r-based to DTG-based cART (switch group), and 22 who remained in PI/r-based regimens (control group). We analyzed blood and ileum biopsies to quantify episomal, total, and integrated HIV DNA, cell-associated HIV RNA, residual plasma viremia, T-cell subsets, cell activation, and inflammation markers.

RESULTS:

There were no related adverse events or treatment discontinuations due to drug intolerance. The HIV reservoir was consistently larger in ileal than in peripheral CD4+ T cells in both groups (P < .01). Residual viremia in plasma decreased in the switch group (P = .03). However, we did not observe significant longitudinal changes in low-level viral replication, total and integrated HIV reservoir, HIV transcription, T-cell maturation subsets, immunoactivation markers, inflammatory soluble proteins, or cellular markers of latently infected cells.

CONCLUSIONS:

The INDOOR study is the first evaluation of changes in HIV reservoir size in ileum biopsies and in peripheral blood in individuals switched from PI/r- to DTG-based cART. Although this switch was safe and well tolerated, it had no impact on a large array of immunological and inflammatory markers or on HIV reservoir markers in peripheral or in ileal CD4+ T cells.

CLINICAL TRIALS REGISTRATION:

EudraCT 2014-004331-39.

• Authors: Sara Morón-López, Jordi Navarro, Montse Jimenez, Sofie Rutsaert, Víctor Urrea, Maria C Puertas, Ariadna Torrella, Laura De Clercq, Bibiana Planas Ribas, Cristina Gálvez, Maria Salgado, Linos Vandekerckhove, Julià Blanco, Manel Crespo, Javier Martinez-Picado
• Journal: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (Clin Infect Dis) Vol. 69 Issue 8 Pg. 1320-1328 (09 27 2019) ISSN: 1537-6591 [Electronic] United States
• PMID: 30590412 (Publication Type: Clinical Trial, Phase IV, Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: © The Author(s) 2018. Published by Oxford University Press for the Infectious Diseases Society of America.

Chemical References

• Anti-Retroviral Agents
• HIV Integrase Inhibitors
• HIV Protease Inhibitors
• Heterocyclic Compounds, 3-Ring
• Oxazines
• Piperazines
• Pyridones
• dolutegravir

Topics

• Anti-Retroviral Agents (therapeutic use)
• Biopsy
• Female
• HIV (drug effects, physiology)
• HIV Infections (drug therapy, virology)
• HIV Integrase Inhibitors (therapeutic use)
• HIV Protease Inhibitors (therapeutic use)
• Heterocyclic Compounds, 3-Ring (therapeutic use)
• Humans
• Ileum (virology)
• Male
• Middle Aged
• Oxazines
• Piperazines
• Pyridones
• Viremia (drug therapy)
• Virus Replication (drug effects)