Comparison of treatment-emergent resistance associated mutations among single tablet regimens and cabotegravir plus rilpivirine for the treatment of virologically suppressed people with HIV: a systematic literature review and network meta-analysis
Recommended Citation
Rashid I, Dhippayom T, Willis C, Weston Schmutz H, Ramgopal M, Sherman E, Safran R, Yared N, Weinberg AR, Navadeh S, Unger NR, Chaiyakunapruk N. Comparison of treatment-emergent resistance associated mutations among single tablet regimens and cabotegravir plus rilpivirine for the treatment of virologically suppressed people with HIV: a systematic literature review and network meta-analysis. J Int AIDS Soc 2024; 27:60-62.
Document Type
Conference Proceeding
Publication Date
11-8-2024
Publication Title
J Int AIDS Soc
Abstract
Background: Treatment-emergent resistance associated mutations (TE-RAMs), including dual-class resistance, are developing in people with HIV (PWH) adherent to the injection schedule for cabotegravir+rilpivirine (CAB+RPV). TE-RAMs have not been observed in people adherent to HIV guideline recommended single tablet regimens (STRs) with a high barrier to resistance. This study compared the risk of TE-RAMs among STRs and CAB+RPV in virologically suppressed (VS) PWH. Methods: Randomized controlled trials (RCTs) investigating switching to any STR or CAB+RPV in VS PWH with ≥48 weeks of follow-up in both arms, and published 2003–March 2024, were retrieved from PubMed, Embase, Cochrane CENTRAL and EBSCO Open Dissertation. Arms comprised of multi-tablet regimens were included only if the intervention arm was an STR. For studies with multiple regimens in the comparison arm, the regimen with the most participants was used. Risk ratios (RR) with 95% confidence intervals were estimated using a random-effects model. Surface under the cumulative ranking curves (SUCRA) were used to rank interventions to prevent TE-RAMs. SUCRA scores signal the probability a treatment has of being among the best options in the network. Higher scores represent better ranking. Results: Nineteen RCTs (10,760 participants) were included. At 48 weeks, risk of TE-RAMs with B/F/TAF and DTG/ABC/3TC is potentially 80% lower than CAB+RPV Q8W (RR 0.20 [0.02–1.83] and 0.20 [0.002–16.67], respectively), and tended to be lower than CAB+RPV Q4W and all two- and three-drug STRs (Table 1). Risk of TE-RAMs with CAB+RPV Q4W appears 56% lower than Q8W (RR 0.44 [0.16–1.22]). CAB+RPV Q8W showed a trend towards a higher risk of TE-RAMs and a lower probability of preventing TE-RAMs than all INSTI- and PI-based STRs (Figure 1). B/F/TAF (74.3%) ranked highest and EFV/FTC/TDF (22.7%) ranked lowest for probability of preventing TE-RAMs. Conclusions: In VS PWH, B/F/TAF has the highest probability of preventing TE-RAMs and tended to have the lowest risk of TE-RAMs, whereas CAB+RPV Q8W performed similar to STRs with lower barriers to resistance. Since treatment is lifelong, and resistance impacts current and future treatment options, clinicians should include the differential risk of TE-RAMs in shared-decision making discussions when switching ART in stable, suppressed individuals.
Volume
27
First Page
60
Last Page
62
