Impact of antiretroviral regimens containing integrase inhibitors on achieving viral suppression at ultra-low levels compared to other antiretroviral therapy strategies.

BACKGROUND

Despite effective antiretroviral therapy (ART), residual low-level HIV viremia may persist. Integrase inhibitor (INSTI)-based regimens have become preferred treatments, but their impact on controlling residual viral replication remains unclear.

OBJECTIVE

To evaluate the impact of integrase inhibitor-based regimens on achieving target not detected (TND) rates compared to other antiretroviral strategies.

METHODS

This retrospective cohort study assessed 131 virologically suppressed people with HIV (PWH) categorized into four treatment groups: Group 1, treated with protease inhibitor or nonnucleoside reverse transcriptase inhibitor (NNRTI) based regimens ( n  = 30); Group 2, treated with INSTI-based regimens ( n  = 30); Group 3, initially treated with protease inhibitor/NNRTI regimens who switched to INSTI-based therapy ( n  = 26); and Group 4, initially treated with INSTI triple therapy who switched to dual therapy ( n  = 30). The primary endpoint was the proportion of "target not detected" (TND) HIV-1 RNA measurements.

RESULTS

INSTI-based regimens showed significantly higher TND rates compared to PI/NNRTI-therapies (difference: 18.5%, P  < 0.001). Switching from PI/NNRTI to INSTI-based therapies increased TND rates from 52.6 to 92%. Multivariate analysis identified shorter time to viral suppression and absence of HCV co-infection as factors associated with higher TND rates. No significant differences were observed when switching from INSTI-based triple therapy to INSTI-based dual therapy.

CONCLUSION

INSTI-based regimens, whether triple or dual therapy, achieve better control of residual viremia compared to other treatment strategies. This improved virological control was maintained during follow-up and was independent of the number of drugs.