by Jeffrey T. Kirchner, DO, AAHIVS, AAHIVM Chief Medical Officer
July 28, 2020
For those of us who have been treating HIV patients since the days of AZT monotherapy and then dual nucleoside therapy (which ultimately failed), it remains cognitively challenging to use only 2 drugs to treat patients. However, the data continues to become increasingly compelling and we will soon have IM cabotegravir/rilpivirine as another dual therapy option.
The TANGO study showed that switching to the 2-drug regimen of DTG/3TC from a 3-drug regimen was non-inferior in regards to maintaining viral suppression (VL< 50c/ml). This study of patients from TANGO used the Abbott RealTime PCR assay which measures HIV-1 viral loads from 40 copies to 10 million copies/mL. The assay also provides a qualitative target detected (TD) or target not detected (TND) outcome for those with a VL<40 copies/mL. This study assessed the number of subjects with TD or TND through Week-48 in Tango – comparing the DTG/3T patients with those taking 3-drugs. At week-48, 79% of subjects in the 2-drug arm and 76% in the 3-drug arm had TND for a VL < 40 c/mL. Of participants with TND at baseline, the proportion with TND at all follow-up visits through week-48 was 53% in 2-drug and 46% in the 3-drug arm. This study concludes that post-baseline incident viremia (>=40c/mL) was more often associated with baseline TD than baseline TND. However, when using the strict TND threshold there was NO difference in the number of subjects with detectable viremia at week-48 of TANGO whether they were taking 2-drugs or 3-drugs.
Primary outcomes from the TANGO study demonstrated that switching to DTG/3TC is non-inferior at 48 weeks to continuing a 3 or 4-drug TAF-based regimen in suppressed patients. However, switching from TDF to TAF or using boosting agents has been associated with weight gain and dyslipidemia. This study of TANGO participants summarizes changes over 48 weeks in regards to fasting glucose and insulin levels, A1C, lipid levels, the prevalence of metabolic syndrome, and weight gain. Most participants were male (92%) with a median age of 40 years. Changes in fasting glucose and A1C levels were minimal across arms although changes in fasting insulin favored the DTG/3TC arm. Changes in lipids, including TC:HDL ratio, favored the DTG/3TC group compared to those on a TAF or a boosted ART regimen. Those diagnosed with metabolic syndrome included 11% in the DTG/3TC and 12% in the TAF-based patients. Regarding weight gain, this was similar at 0.81kg (DTG/3TC) and 0.76 kg (3-drug). The authors conclude that switching from 3 or 4-drug TAF-based regimens to DTG/3TC led to similar increases in weight, but with improvements in other metabolic parameters that are clinically important.
The author has no conflicts of interest to disclose.
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