Journal Article

Dolutegravir-based Antiretroviral Therapy for Patients Coinfected With Tuberculosis and Human Immunodeficiency Virus

Kaplan, Richard, Tenorio, Allan R., Singh, Rajendra, Keegan, Michael R., Ait-Khaled, Mounir, Dooley, Kelly E., Belonosova, Elena, Brown, Dannae, Ticona, Eduardo, Talarico, Christine L., Aboud, Michael, Grinsztejn, Beatriz, Mwelase, Noluthando, Sued, Omar, Angelis, Konstantinos, Lacerda, Marcus

2020

Overview

Abstract Background The concurrent treatment of tuberculosis and human immunodeficiency virus (HIV) is challenging, owing to drug interactions, overlapping toxicities, and immune reconstitution inflammatory syndrome (IRIS). The efficacy and safety of dolutegravir (DTG) were assessed in adults with HIV and drug-susceptible tuberculosis. Methods International Study of Patients with HIV on Rifampicin ING is a noncomparative, active-control, randomized, open-label study in HIV-1–infected antiretroviral therapy–naive adults (CD4+ ≥50 cells/mm3). Participants on rifampicin-based tuberculosis treatment ≤8 weeks were randomized (3:2) to receive DTG (50 mg twice daily both during and 2 weeks after tuberculosis therapy, then 50 mg once daily) or efavirenz (EFV; 600 mg daily) with 2 nucleoside reverse transcriptase inhibitors for 52 weeks. The primary endpoint was the proportion of DTG-arm participants with plasma HIV-1-RNA <50 copies/mL (responders) by the Food and Drug Administration Snapshot algorithm (intent-to-treat exposed population) at Week 48. The study was not powered to compare arms. Results For DTG (n = 69), the baseline HIV-1 RNA was >100 000 copies/mL in 64% of participants, with a median CD4+ count of 208 cells/mm3; for EFV (n = 44), 55% of participants had HIV-1 RNA >100 000 copies/mL, with a median CD4+ count of 202 cells/mm3. The Week 48 response rates were 75% (52/69, 95% confidence interval [CI] 65–86%) for DTG and 82% (36/44, 95% CI 70–93%) for EFV. The DTG nonresponses were driven by non–treatment related discontinuations (n = 10 lost to follow-up). There were no deaths or study drug switches. There were 2 discontinuations for toxicity (EFV). There were 3 protocol-defined virological failures (2 DTG, no acquired resistance; 1 EFV, emergent resistance to nucleoside reverse transcriptase inhibitors and nonnucleoside reverse transcriptase inhibitors). The tuberculosis treatment success rate was high. Tuberculosis-associated IRIS was uncommon (4/arm), with no discontinuations for IRIS. Conclusions Among adults with HIV receiving rifampicin-based tuberculosis treatment, twice-daily DTG was effective and well tolerated. Clinical Trials Registration NCT02178592. Dolutegravir (given at a dose of 50 mg twice daily) demonstrated rapid virologic and immunologic response among human immunodeficiency virus treatment-naive individuals with drug-sensitive tuberculosis. Dolutegravir with rifampicin-containing tuberculosis treatments was well tolerated, with no deaths or discontinuations for toxicity.

• Publisher: Oxford University Press
• Subject: Adult / Anti-HIV Agents - therapeutic use / ARTICLES AND COMMENTARIES / CD4 Lymphocyte Count / Coinfection - drug therapy / Heterocyclic Compounds, 3-Ring - adverse effects / HIV Infections - complications / HIV Infections - drug therapy / Humans / Oxazines / Piperazines / Pyridones / RNA, Viral / Treatment Outcome / Tuberculosis - complications / Tuberculosis - drug therapy / Viral Load