Predictors of virological failure and time to viral suppression of first line integrase inhibitor based antiretroviral treatment.

Pyngottu, Ashima; Scherrer, Alexandra U; Kouyos, Roger; Huber, Michael; Hirsch, Hans; Perreau, Matthieu; Yerly, Sabine; Calmy, Alexandra; Cavassini, Matthias; Stöckle, Marcel; Furrer, Hansjakob; Vernazza, Pietro; Bernasconi, Enos; Günthard, Huldrych F (2021). Predictors of virological failure and time to viral suppression of first line integrase inhibitor based antiretroviral treatment. Clinical infectious diseases, 73(7), e2134-e2141. Oxford University Press 10.1093/cid/ciaa1614

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Integrase strand transfer inhibitors (InSTIs) are recommended for first-line treatment of HIV-infection. We identified risk factors, including baseline minor InSTI resistance mutations, for treatment failure of InSTI-based regimens.


We studied time to treatment failure and time to viral suppression among 1419 drug-naive patients in the Swiss HIV Cohort Study.We performed Cox regression models adjusted for demographic factors, baseline HIV RNA/CD4 cell counts, AIDS defining events and the type of InSTI.In 646 patients with a baseline genotypic resistance test of the integrase, we studied the impact of minor integrase resistance mutations.


We observed 121 virological failures during 18'447 person-years of follow-up. A baseline viral load ≥100'000 cps/mL (multivariable Hazard Ratio (mHR): 2.2, 95% CI: 1.3-3.6) and an AIDS defining event (mHR: 1.8, 95% CI: 1.1-3.0) were associated with treatment failure. CD4 counts between 200-500 cells/µL (mHR: 0.5, 95% CI: 0.3-0.8) and >500 cells/µL (mHR: 0.4, 95% CI: 0.2-0.7) were protective. Median [IQR] time to viral suppression was 50 [29,107] days. Time to suppression was shorter in lower viral load strata (mHR: 0.7, 95% CI: 0.6-0.8) and in dolutegravir-based therapy (mHR: 1.2, 95% CI: 1.0-1.4). Minor resistance mutations were found at baseline in 104/646 (16%) patients with no effect on treatment outcome.


Among drug-naïve HIV-infected individuals treated with InSTI-based regimens, factors associated with treatment failure, in particular high viral load and low CD4 counts remain similar to older treatments. Minor InSTI resistance mutations had no impact in this large observational cohort.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Infectiology

UniBE Contributor:

Furrer, Hansjakob


600 Technology > 610 Medicine & health




Oxford University Press




Annelies Luginbühl

Date Deposited:

07 Dec 2020 09:40

Last Modified:

23 Jan 2024 15:26

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

HIV drug resistance integrase strand transfer inhibitors minor drug resistance mutations treatment outcome




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