{"id":38780,"date":"2020-08-28T07:42:40","date_gmt":"2020-08-28T07:42:40","guid":{"rendered":"https:\/\/i-base.info\/htb\/?p=38780"},"modified":"2020-08-28T09:29:45","modified_gmt":"2020-08-28T09:29:45","slug":"switching-from-efavirenz-to-dolutegravir-based-art-second-line-achieved-good-rates-of-suppression-first-results-from-the-visend-study","status":"publish","type":"post","link":"https:\/\/i-base.info\/htb\/38780","title":{"rendered":"Switching from efavirenz- to dolutegravir-based ART second-line achieved good rates of suppression: first results from the VISEND study"},"content":{"rendered":"

\"\"Polly Clayden, HIV i-Base<\/strong><\/p>\n

In the VISEND study, looking at second-line ART,\u00a0 participants with viral load <1000 copies\/mL at time of switch, receiving tenofovir alafenamide\/emtricitabine\/dolutegravir (TAFED) and tenofovir disoproxil fumarate\/lamivudine\/dolutegravir (TLD)\u00a0 showed similar efficacy, with low rates of virologic failure at week 36. [1]<\/strong><\/p>\n

Participants with >1,000 copies\/mL at the time of switch showed slightly higher rates of suppression with TLD compared to other treatment arms. These data were shown at AIDS 2020.<\/p>\n

In ART programmes in sub-Saharan Africa, people taking NNRTI-based first-line regimens are being switched to TLD, often without recent viral load results.<\/p>\n

The ongoing VISEND study is looking at virologic outcomes among ART-treated adults switched from tenofovir disoproxil fumarate\/lamivudine or emtricitabine\/efavirenz (TLE or TEE) or less frequently nevirapine-containing regimens to TLD or TAFED with and without virologic suppression at the time of switch. There was no resistance testing before switching.<\/p>\n

Participants with viral load <1,000 copies\/mL were randomised to either TLD or TAFED: arm A. Those with viral >1,000 copies\/mL were randomised to TLD, TAFED, zidovudine\/lamivudine + ritonavir-boosted lopinavir or atazanavir (AZT\/3TC + LPV\/r or ATV\/r): arm B.<\/p>\n

Study visits are: baseline, week 4, 12, 24, 48, 72, 96 and 144. The primary treatment failure endpoint is week 24 and 48 viral load >50 copies\/mL. The investigators reported week 36 efficacy (Observed data analysis) and safety data at the virtual conference.<\/p>\n

Participants in arm A were approximately 42 years old at baseline and in arm B they were about 38 years. Over 60% of VISEND participants are women.<\/p>\n

A total of 1,126 participants were randomised to arm A (n=419) and arm B (n=707). In arm A, the percentage of participants with viral load <50 copies\/mL was 90% and 87% for TLD and TAFED. In arm B, the percentage with viral load <50 copies\/mL was 78%, 72% and 70% for TLD, TAFED and LPV\/r or ATV\/r, respectively.<\/p>\n

In arm A weight change was +1.8 kg and +0.4 kg for TAFED and TLD (p<0.05). In arm B this was +2.7 kg, +1.9 kg and +1.3 kg for TAFED, TLD and LPV\/r or ATV\/r, respectively (p<0.05 for differences TAFED and TLD vs LPV\/r or ATV\/r).<\/p>\n

comment<\/h3>\n

Switching to TLD and maintaining NRTI backbone second-line (as well as in people stable on TLE or TEE or with unknown viral load results) is becoming more common in low- and middle-income countries. The switch is partly supported by results from DAWNING, although this trial included viral load and resistance testing before switch. [2]<\/strong><\/p>\n

Currently, in the era of COVID-19, many treatment changes are happening without viral load testing (even in settings were this was usually standard) so these data from VISEND are reassuring.<\/strong><\/p>\n

Weight gain with dolutegravir, particularly in regimens with TAF has come to be expected. <\/strong><\/p>\n

References<\/p>\n

    \n
  1. Hill A et al. A randomized prospective study evaluating virologic outcomes among patients switching with detectable and undetectable viral loads from efavirenz and nevirapine-based first line ART regimens to DTG regimens in Zambia. AIDS 2020 virtual. 6\u201310 July 2020.\u00a0 Poster abstract LBPEB07.
    \nhttps:\/\/cattendee.abstractsonline.com\/meeting\/9289\/Presentation\/3761<\/a><\/li>\n
  2. Clayden P. Dolutegravir outperforms lopinavir\/ritonavir second-line: interim results from the DAWNING study. HTB. (10 August 2017).
    \n    https:\/\/i-base.info\/htb\/32241<\/a><\/li>\n<\/ol>\n

    This article was originally posted on 20 August 2020.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

    Polly Clayden, HIV i-Base In the VISEND study, looking at second-line ART,\u00a0 participants with viral load <1000 copies\/mL at time of switch, receiving tenofovir alafenamide\/emtricitabine\/dolutegravir (TAFED) and tenofovir disoproxil fumarate\/lamivudine\/dolutegravir (TLD)\u00a0 showed similar efficacy, with low rates of virologic failure …<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4,41],"tags":[295],"class_list":["post-38780","post","type-post","status-publish","format-standard","hentry","category-conference-reports","category-treatment-strategies","tag-aids2020"],"_links":{"self":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/38780","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/comments?post=38780"}],"version-history":[{"count":0,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/38780\/revisions"}],"wp:attachment":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/media?parent=38780"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/categories?post=38780"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/tags?post=38780"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}