Treatment responses to integrase strand-transfer inhibitor-containing antiretroviral regimens in combination with short-course rifapentine-based regimens for latent tuberculosis infection among people with HIV

Kuan-Yin Lin; Hsin-Yun Sun; Chia-Jui Yang; Po-Liang Lu; Yuan-Ti Lee; Nan-Yao Lee; Bo-Huang Liou; Hung-Jen Tang; Mei-Hui Lee; Ning-Chi Wang; Tun-Chieh Chen; Ing-Moi Hii; Sung-Hsi Huang; Chi-Ying Lin; Chin-Shiang Tsai; Chien-Yu Cheng; Chien-Ching Hung; Taiwan HIV Study Group

doi:10.1093/cid/ciad730

Treatment responses to integrase strand-transfer inhibitor-containing antiretroviral regimens in combination with short-course rifapentine-based regimens for latent tuberculosis infection among people with HIV

Clin Infect Dis. 2023 Dec 5:ciad730. doi: 10.1093/cid/ciad730. Online ahead of print.

Authors

Kuan-Yin Lin¹, Hsin-Yun Sun¹, Chia-Jui Yang^{2

3}, Po-Liang Lu^{4

5

6}, Yuan-Ti Lee^{7

8}, Nan-Yao Lee⁹, Bo-Huang Liou¹⁰, Hung-Jen Tang¹¹, Mei-Hui Lee¹², Ning-Chi Wang¹³, Tun-Chieh Chen^{4

5

14}, Ing-Moi Hii¹⁵, Sung-Hsi Huang^{16

17}, Chi-Ying Lin¹⁸, Chin-Shiang Tsai^{9

19}, Chien-Yu Cheng^{20

21}, Chien-Ching Hung^{1

17

18}; Taiwan HIV Study Group

Collaborators

Taiwan HIV Study Group:
Chien-Ching Hung, Sui-Yuan Chang, Hsin-Yun Sun, Yu-Shan Huang, Kuan-Yin Lin, Guan-Jhou Chen, Pei-Ying Wu, Ling-Ya Chen, Hsi-Yen Chang, Wen-Chun Liu, Yi-Ching Su, Ning-Chi Wang, Te-Yu Lin, Chia-Jui Yang, Mao-Song Tsai, Mei-Hui Lee, Yi-Chieh Lee, Shu-Hsing Cheng, Chien-Yu Cheng, Bo-Huang Liou, Sung-Hsi Huang, Yi-Chia Huang, An-Ting Peng, Yuan-Ti Lee, Yu-Lin Lee, Chia-Chun Lin, Shih-Ping Lin, Chia-Yin Hsieh, Hsiu-Wen Wang, Mao-Wang Ho, Chun-Eng Liu, Ing-Moi Hii, Chi-Ying Lin, Hung-Jen Tang, Nan-Yao Lee, Chin-Shiang Tsai, Tung-Che Hung, Yen-Hsu Chen, Po-Liang Lu, Chun-Yuan Lee, Tun-Chieh Chen, Hung-Chin Tsai, Hsi-Hsun Lin, Chen-Hsiang Lee

Affiliations

¹ Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
² Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
³ School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
⁴ Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
⁵ College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁶ Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁷ School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
⁸ Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.
⁹ Department of Internal Medicine, National Cheng Kung University College of Medicine and Hospital, Tainan, Taiwan.
¹⁰ Department of Internal Medicine, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan.
¹¹ Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan.
¹² Department of Internal Medicine, Shuang Ho Hospital, Taipei, Taiwan.
¹³ Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
¹⁴ Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.
¹⁵ Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan.
¹⁶ Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan.
¹⁷ Department of Tropical Medicine and Parasitology, National Taiwan University College of Medicine, Taipei, Taiwan.
¹⁸ Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan.
¹⁹ Department of Internal Medicine, National Cheng Kung University Hospital Dou-Liou Branch, Yunlin, Taiwan.
²⁰ Department of Infectious Diseases, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan.
²¹ School of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan.

PMID: 38051646
DOI: 10.1093/cid/ciad730

Abstract

Background: Real-world experience with combinations of short-course rifapentine-based regimens and integrase strand-transfer inhibitor (InSTI)-containing antiretroviral therapy (ART) in management of latent tuberculous infection (LTBI) is limited among people with HIV (PWH).

Methods: From August 2019 to October 2022, PWH receiving 3 months of weekly rifapentine plus isoniazid (3HP) or 1 month of daily rifapentine plus isoniazid (1HP) in combination with ART were included. The primary outcome was virologic response within 12 months after LTBI treatment, and the secondary outcomes included treatment completion rate and safety of LTBI regimens.

Results: During the study period, 479 PWH (94.6% male; median age, 43 years) were included: 142 received 1HP and bictegravir (BIC)-containing regimens (1HP/BIC group), 46 1HP and dolutegravir (DTG)-containing regimens (1HP/DTG group), 38 3HP and BIC-containing regimens (3HP/BIC group), 214 3HP and DTG-containing regimens (3HP/DTG group), 17 1HP and other ART regimens (1HP/others group), and 22 3HP/other ART regimens (3HP/others group). In the intention-to-treat analysis, the proportions of PWH maintaining plasma HIV-1 RNA <200 copies/mL within 12 months after LTBI treatment completion were 96.5% (1HP/BIC), 100% (1HP/DTG), 100% (3HP/BIC), 95.8% (3HP/DTG), 100% (1HP/others), and 100% (3HP/others). The overall completion rates were >80% for all treatment groups, whereas >50% of the included PWH experienced any adverse event. LTBI regimens and ART combinations were not associated with virologic response and completion rate.

Conclusion: Combinations of short-course rifapentine-based regimens and InSTI-containing ART maintained viral suppression for most PWH within 12 months of LTBI treatment completion with low rates of grade 3 or higher adverse events.

Keywords: drug interaction; integrase strand-transfer inhibitor; interferon-gamma release assay; isoniazid; rifamycin.