• Mohamed N'dongo Sangaré, Jean-Guy Baril, Alexandra de Pokomandy, Ferreira GuerraSteveSDepartment of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada., Mabel Carabali, Claudie Laprise, Réjean Thomas, Marina Klein, Cécile Tremblay, Michel Roger, Costa Pexos, Zoë R Greenwald, Nima Machouf, Madeleine Durand, Isabelle Hardy, Mamadou Dakouo, Andrea Trevisan, Louise Laporte, Mireille E Schnitzer, and Helen Trottier.
• Department of Social and Preventive Medicine, Université de Montréal, Montreal, Québec, Canada.
• Open Forum Infect Dis. 2020 Nov 1; 7 (11): ofaa404.

BackgroundSwitching antiretroviral regimens when human immunodeficiency virus (HIV) viremia is controlled for a new regimen is challenging when there is the potential for prior nucleoside reverse-transcriptase inhibitor (NRTI) resistance. The objective was to study virologic outcomes after switching to dolutegravir compared with remaining on a boosted protease inhibitor (protease inhibitor/ritonavir [PI/r]) regimen in people with HIV (PWH) with prior documented virologic failure and/or exposure to mono/dual NRTIs.MethodsWe used the Quebec HIV Cohort including 10 219 PWH whose data were collected at 4 sites in Montreal, Canada. We included all PWH with documented virologic failure or exposure to mono/dual NRTI therapy who were virologically suppressed on a PI/r-based regimen for at least 6 months on or after January 1, 2014 (n = 532). A marginal structural Cox model analysis was used to estimate the effect of the switch to dolutegravir on virologic outcome compared with remaining on PI/r. The outcome was defined as 2 consecutive viral loads (VLs) >50 copies/mL or 1 VL >50 copies/mL if it occurred at the last VL available.ResultsAmong 532 eligible participants, 216 (40.6%) had their regimen switched to dolutegravir with 2 NRTIs, whereas 316 (59.4%) remained on the PI/r with 2 NRTIs. The weighted hazard ratio for the effect of dolutegravir switch on virologic failure compared with patients whose regimen remained on PI/r was 0.57 (95% confidence interval, 0.21-1.52).ConclusionsWe did not find evidence of an increased risk for virologic failure after switching to dolutegravir from PI/r among patients with previous virologic failure or prior exposure to mono/dual NRTI.© The Author(s) 2020. Published by Oxford University Press on behalf of Infectious Diseases Society of America.

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