title: Dolutegravir monotherapy in HIV-infected patients with sustained viral suppression.
abstract: We reviewed the 24 week outcomes of HIV-infected patients from our hospital who had their ART switched to dolutegravir monotherapy on an individual clinical basis.
  
  
  
  Retrospective hospital database assessment of virally suppressed patients in whom the treating physician had switched to 50 mg of dolutegravir once daily due to one or more of the following reasons: antiretroviral-related adverse effects; comorbidities; risk of interactions; or archived resistance. Patients had ≥24 weeks of follow-up. Population, virological and immunological responses and safety and tolerability are described.
  
  
  
  Thirty-three (22 on PIs, of whom 18 had ritonavir-boosted PI monotherapy) patients were identified: median (IQR) age of 56 (50-62) years, 55% women, median (IQR) of 19 (17-23) years of known HIV infection, 39% prior AIDS events, median (IQR) of 8 (4-13) years with undetectable plasma HIV-1 RNA and median (IQR) CD4 cell count of 596 (420-843) cells/mm(3). Twenty-five (76%) patients had antiretroviral-related adverse effects, 32 (97%) patients had comorbidities, 28 (85%) patients had risk of interactions and 16 (48%) patients had archived resistance. One patient with suboptimal adherence had low-level virological failure through weeks 4-24. HIV RNA genotypic resistance tests detected no integrase mutations at weeks 4 and 24, but 118R was detected in 7% of the integrated HIV DNA at 24 weeks. Patients had significant median decreases in triglycerides (-117 mg/dL), total cholesterol (-36 mg/dL), the total cholesterol/HDL cholesterol ratio (-0.7) and high-sensitivity C-reactive protein (-0.05 mg/dL) (P ≤ 0.007), although the Chronic Kidney Disease Epidemiology Collaboration equation also decreased (-7.1 mL/min) (P < 0.0001).
  
  
  
  These data suggest the efficacy of dolutegravir monotherapy as a maintenance strategy to be further confirmed in randomized clinical trials.
authors.affiliation: Hospital Clínic-IDIBAPS, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Jhon
authors.initials: J
authors.lastname: Rojas
authors.affiliation: Hospital Clínic-IDIBAPS, Universitat de Barcelona, Barcelona, Spain.
authors.forename: José L
authors.initials: JL
authors.lastname: Blanco
authors.affiliation: Hospital Clínic-IDIBAPS, Universitat de Barcelona, Barcelona, Spain.
authors.forename: María A
authors.initials: MA
authors.lastname: Marcos
authors.affiliation: Hospital Clínic-IDIBAPS, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Lonca
authors.affiliation: Hospital Clínic-IDIBAPS, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Amparo
authors.initials: A
authors.lastname: Tricas
authors.affiliation: Hospital Clínic-IDIBAPS, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Moreno
authors.affiliation: Hospital Clínic-IDIBAPS, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Gonzalez-Cordon
authors.affiliation: Hospital Clínic-IDIBAPS, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Berta
authors.initials: B
authors.lastname: Torres
authors.affiliation: Hospital Clínic-IDIBAPS, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Mallolas
authors.affiliation: Hospital Universitario San Cecilio, Granada, Spain.
authors.forename: Federico
authors.initials: F
authors.lastname: Garcia
authors.affiliation: Hospital Clínic-IDIBAPS, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Jose M
authors.initials: JM
authors.lastname: Gatell
authors.affiliation: Hospital Clínic-IDIBAPS, Universitat de Barcelona, Barcelona, Spain esteban@fundsoriano.es.
authors.forename: Esteban
authors.initials: E
authors.lastname: Martinez
mesh_terms: D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology*; D019428:HIV Integrase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D006575:Heterocyclic Compounds, 3-Ring / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D060046:Maintenance Chemotherapy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010078:Oxazines; D010879:Piperazines; D011728:Pyridones; D012189:Retrospective Studies; D000072230:Sustained Virologic Response; D016896:Treatment Outcome; D000099226:Dolutegravir
chemical_list: D019428:HIV Integrase Inhibitors; D006575:Heterocyclic Compounds, 3-Ring; D010078:Oxazines; D010879:Piperazines; D011728:Pyridones; D000099226:Dolutegravir