Table 6.
Dolutegravir (DTG) plus optimized background (OB) in persons with virological failure and INSTI resistance on a raltegravir (RAL)- or elvitegravir (EVG)-containing regimen
| AuthorYr | Population | Past ART | DTG ART | Subjects | Weeks | Percentage VF (95% CI)a |
|---|---|---|---|---|---|---|
| Eron13 | RCT (VIKING – Cohort I) | heavily treated; h/o RAL VF and resistance | DTG (50 mg q24h) + OB | 27 | 24 | 59.3 (38.8–77.6) |
| RCT (VIKING – Cohort II) | heavily treated; h/o RAL VF and resistance | DTG (50 mg q12h) + OB | 24 | 24 | 25 (9.8–46.7) | |
| Castagna14 | RCT (VIKING 3) | heavily treated; h/o RAL VF and resistance | DTG (50 mg q12h) + OB | 183 | 24 | 31.1 (24.5–38.4) |
| Akil15; Naeger16 | RCT (VIKING 4; with vs without OB × 7 days) | heavily treated; h/o INSTI VF and resistance | DTG (50 mg q12h) + OB | 30 | 24 | 53.3 (34.3–71.7) |
| 48 | 60 (40.6–77.3) | |||||
| Castagna18b | Cohort | heavily treated; h/o INSTI VF and resistance | DTG (50 mg q12h) + OB | 190 | 24 | 27.9 (21.6–34.8) |
| 48 | 38.9 (32–46.3) | |||||
| ALL, 24 weeksc | 454 | 24 | 36.9 (26.9–47.0), I2 = 75 | |||
| ALL, 48 weeksc | 220 | 48 | 47.9 (27.5–68.3), I2 = 79 |
h/o, history of.
VF, confirmed virus load ≥50 copies/mL or treatment discontinuation for any reason. For the cohort studies, the proportion of persons with VF after the median time of follow-up was provided.
31% of the persons in Castagna18 had previously been enrolled in one of the VIKING trials.
Pooled proportions and 95% CI of VF and VF with INST resistance estimated using a random-effects meta-regression.
Note: In VIKING Cohorts I and II and in VIKING-4, subjects had a period of functional dolutegravir monotherapy lead-in of 7 (VIKING-4) to 10 (VIKING Cohorts I and II) days before the ARVs accompanying dolutegravir were optimized.