Background Antiretroviral monotherapy presents several significant benefits, such as reduction of toxicity, and drug and cost saving, as well as preserving future options with other classes of antiretrovirals and improved adherence.
Purpose To assess the effectiveness and safety of simplification to a monotherapy with dolutegravir (DTG) in experienced HIV patients and to evaluate the economic impact.
Material and methods A retrospective observational study was carried out. We included all patients who presented in the last 48 weeks with viral load (VL) undetectable and CD4 cell count >250, and who switched to DTG as monotherapy in 2015. Demographic and clinical characteristics were recorded at weeks 0, 12 and 24: sex, age, VL, CD4 cell count, fasting lipid profile (low density lipoprotein (LDL)/high density lipoprotein (HDL), total cholesterol (TC), triglycerides (TG)) and glomerular filtration rate (GFR).
We evaluated the saving strategy by the average cost difference of previous treatments in comparison with monotherapy with DTG for 1 year.
Results 38 patients were included: 31 (82%) were men with a median age of 52 years. No patient failed or was switched for another reason. 19 (50%) patients are at <24 weeks in the study period. Only 1 (2.6%) patient had VL 45 copies/mL at week 12, but VL was undetectable at week 24.
All values are expressed as median, unless otherwise indicated.
Regarding previous treatments, patients were divided as follows: 14 (37%) patients were switched from 2 nucleoside reverse transcriptase inhibitors (NRTIs) + 1 non-nucleoside reverse transcriptase inhibitors (NNRTIs), 13 (34%) patients from 2 NRTIs + 1 protease inhibitor (PI), 11 (29%) patients from 1 NNRTIs +1 integrase strand transfer inhibitors (INSTIs).
Conclusion Switching to monotherapy with DTG proved safe (significantly improved lipid profile and GFR), effective (maintained levels of VL and CD4) and more economical. It is necessary to carry out more studies to corroborate this strategy.
No conflict of interest
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