https://orcid.org/0009-0008-2032-4148
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Cathia Soulie, Aliou Balde, Djeneba Fofana, Charlotte Charpentier, Pascale Bonnafous, Justine Sourice, Anne De Monte, Véronique Avettand-Fenoel, Hélène Le Guillou-Guillemette, Laurence Bocket, Stéphanie Raymond, Stéphanie Marque Juillet, Mary-Anne Trabaud, Brigitte Montes, Anne Maillard, Cédric Hartard, Elodie Alessandri-Gradt, Etienne Brochot, Anne Signori-Schmuck, Lambert Assoumou, Anne-Geneviève Marcelin, DORAVIR: a French national survey of people with HIV-1 treated with an antiretroviral regimen including doravirine, Journal of Antimicrobial Chemotherapy, Volume 79, Issue 8, August 2024, Pages 1974–1984, https://doi.org/10.1093/jac/dkae194
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Abstract
Doravirine is the latest NNRTI to be approved for the treatment of HIV-1 and has a different resistance profile from first-generation NNRTIs. Our aim was to investigate the virological efficacy of antiretroviral treatment including doravirine in people living with HIV-1 (PLWHIV), the factors associated with virological failure (VF) and those associated with the emergence of reverse transcriptase (RT) mutations in the case of VF.
A retrospective national survey of PLWHIV who were either naive or experienced on antiretroviral treatment including doravirine was conducted. VF was defined as two consecutive plasma viral loads (VLs) of ≥50 copies/mL or one VL of ≥200 copies/mL. Genotypic resistance tests were interpreted using the Stanford (v9.4.1) and ANRS (v33) algorithms.
Of the 589 PLWHIV treated with a doravirine-containing regimen, 8.5% were naive and 91.5% had prior antiretroviral experience; 56.9% were infected with HIV-1 B subtype. Overall, 88.3% and 85.1% of participants were virologically controlled at Month (M)3 and M6 of doravirine treatment, respectively. In multivariable analysis, CRF02_AG subtype, higher zenith plasma HIV-1 RNA VL, doravirine initiation in the context of failure and baseline V179D mutation presence were associated with VF. Among 88 PLWHIV who experienced virological failure at M6, 15.9% had a median of 2 (IQR 1–3) HIV RT mutations. In multivariable analysis, the only factor associated with the occurrence of mutations was a genotypic sensitivity score that was not fully sensitive.
This study is one of the largest to characterize the virological efficacy of doravirine-containing regimens in clinical practice and to identify factors associated with VF or emergence of resistance mutations that should be considered in clinical management.
