Need More Time on Dolutegravir Before Switching: ADVANCE Trial Study

Core Concepts

Adherence issues cause virologic failure on dolutegravir; more time needed before switching.

Abstract

The ADVANCE trial data presented at the IAS Conference on HIV Science in Brisbane, Australia, highlights the importance of continued treatment on dolutegravir despite high viral load. Adherence counseling led to re-suppression rates without resistance emergence. Comparing dolutegravir and efavirenz arms, dolutegravir showed faster re-suppression and higher suppression rates. Recommendations suggest giving more time on dolutegravir due to its high genetic barrier to resistance.

Stats

"95% of patients in the two dolutegravir arms of the study were able to achieve re-suppression of their viral load — defined as below 50 viral RNA copies per mL — without any emergence of resistance."
"At 24 weeks after restarting treatment, 88% of people in the dolutegravir group had re-suppressed their viral RNA compared with 46% of people in the efavirenz group."
"At 48 weeks, those figures were 95% and 66%, respectively."

Quotes

"If you can get through those difficult phases, people can go back on their meds." - Andrew Hill
"We've talked about high-barrier drugs in the past, and you do start seeing resistance emerge." - Laura Waters

Key Insights Distilled From

More Time on Dolutegravir Needed Before Drug Switch: Study

by Bianca Nogra... at www.medscape.com 08-04-2023

https://www.medscape.com/viewarticle/995179

Deeper Inquiries

How can societal factors like homelessness impact adherence to HIV treatment

Societal factors like homelessness can significantly impact adherence to HIV treatment. Individuals experiencing homelessness often face challenges in maintaining a consistent treatment regimen due to unstable living conditions, lack of access to healthcare facilities, and limited resources. The stress and uncertainty associated with homelessness can lead to disruptions in medication schedules, missed appointments, and difficulties in storing and taking medications properly. Additionally, issues such as mental health concerns, substance abuse, and lack of social support can further hinder adherence to HIV treatment among this population. Addressing these societal factors requires a holistic approach that goes beyond medical interventions, including providing stable housing, access to support services, and tailored adherence support programs.

What are the potential drawbacks of giving more time on dolutegravir before switching

While giving more time on dolutegravir before switching can have benefits in terms of achieving viral re-suppression without resistance emergence, there are potential drawbacks to consider. Prolonging the use of dolutegravir in cases of virologic failure due to adherence issues may increase the risk of developing resistance over time. Delaying the switch to an alternative regimen could allow the virus to mutate and become resistant to dolutegravir, limiting future treatment options. Moreover, continued use of dolutegravir without addressing underlying adherence challenges may not effectively control HIV replication, leading to suboptimal outcomes and potential transmission of drug-resistant strains. Balancing the benefits of giving more time on dolutegravir with the risks of resistance development requires careful monitoring, individualized assessment, and timely intervention.

How can monitoring be improved to detect resistance emergence early on

Monitoring for resistance emergence early on is crucial in optimizing HIV treatment outcomes and preventing the spread of drug-resistant strains. To improve monitoring practices, healthcare providers can implement regular viral load testing at specified intervals to detect changes in viral replication levels. Early identification of virologic failure can prompt further assessments, including genotypic resistance testing, to identify specific mutations that may impact treatment efficacy. Additionally, enhancing patient engagement through adherence counseling, education on treatment importance, and addressing barriers to adherence can help prevent resistance development. Utilizing electronic health records, telemedicine, and mobile health technologies can facilitate real-time monitoring and communication between patients and healthcare teams, enabling prompt interventions in case of resistance emergence. Collaborative efforts between healthcare providers, public health agencies, and community organizations are essential in establishing comprehensive monitoring strategies that prioritize early detection and management of resistance in HIV treatment.