Clinical Outcomes Following the Use of Archived Proviral HIV-1 DNA Genotype to Guide Antiretroviral Therapy Adjustment

Kristen E Ellis; George T Nawas; Connie Chan; Lawrence York; Julia Fisher; Elizabeth Connick; Tirdad T Zangeneh

doi:10.1093/ofid/ofz533

Clinical Outcomes Following the Use of Archived Proviral HIV-1 DNA Genotype to Guide Antiretroviral Therapy Adjustment

Open Forum Infect Dis. 2019 Dec 14;7(1):ofz533. doi: 10.1093/ofid/ofz533. eCollection 2020 Jan.

Authors

Kristen E Ellis^{1

2}, George T Nawas³, Connie Chan^{1

2}, Lawrence York¹, Julia Fisher⁴, Elizabeth Connick¹, Tirdad T Zangeneh¹

Affiliations

¹ Division of Infectious Diseases, Department of Medicine, University of Arizona College of Medicine, Tucson, Arizona, USA.
² Department of Pharmacy Practice and Science, University of Arizona College of Pharmacy, Tucson, Arizona, USA.
³ Division of Clinical and Administrative Sciences, Xavier University of Louisiana College of Pharmacy, New Orleans, Louisiana, USA.
⁴ Statistics Consulting Laboratory, BIO5 Institute, University of Arizona, Tucson, Arizona, USA.

Abstract

Background: Evidence regarding the safety of using proviral HIV-1 DNA genotype (DNA GT) to guide antiretroviral therapy (ART) is limited. We hypothesized that HIV RNA would not increase following ART adjustment guided by DNA GT in a university HIV clinic.

Methods: Data were obtained from electronic medical records of adult persons living with HIV-1 (PWH) who underwent DNA GT testing and changed ART between October 2014 and November 2017. Logistic regression was used to evaluate the effect of ART switch on HIV RNA over time.

Results: Eighty-three PWH had DNA GT performed, 66 (80%) switched ART, and 59 had postswitch follow-up. Data were analyzed pre-/postswitch for these 59 PWH (median age, 54 years; 71% LWH ≥10 years; 46% ≥2 previous regimens; 36% recent low-level viremia; 34% unknown medication history). On DNA GT, 58% had ≥1-class ART resistance, 34% ≥2-class, and 10% 3-class. Median follow-up (range) was 337 (34-647) days. There was no change in probability of HIV RNA ≥50 copies/mL over time (P > .05). At baseline, 76% had HIV RNA <50 vs 88% at last postswitch follow-up (P = .092). Protease inhibitor use decreased from 58% to 24% (P < .001). Average daily pills and dosing frequency decreased from 3.48 to 2.05 (P < .001) and 1.39 to 1.09 (P < .001), respectively; ART cost did not change.

Conclusions: DNA GT facilitated changes in ART in a treatment-experienced population without increases in HIV RNA. Decreased pill burden occurred without increased ART cost. Further studies to identify optimal use of DNA GT are needed.

Keywords: HIV; antiretroviral therapy; archived proviral HIV DNA genotype; genotypic antiretroviral resistance testing; peripheral blood mononuclear cell DNA.