Abstract:
Introduction: ACTG A5288 was a strategy trial conducted in diverse populations from multiple continents of people living
with HIV (PLWH) failing second-line protease inhibitor (PI)-based antiretroviral therapy (ART) from 10 low- and middle-income
countries (LMICs). Participants resistant to lopinavir (LPV) and/or multiple nucleotide reverse transcriptase inhibitors started
on third-line regimens that included raltegravir (RAL), darunavir/ritonavir (DRV/r) and/or etravirine (ETR) according to their
resistance profiles. At 48 weeks, 87% of these participants achieved HIV-1 RNA ≤200 copies/ml. We report here long-term
outcomes over 144 weeks.
Methods: Study participants were enrolled from 2013 to 2015, prior to the availability of dolutegravir in LMICs. “Extended
Follow-up” of the study started after the last participant enrolled had reached 48 weeks and included participants still on
antiretroviral (ARV) regimens containing RAL, DRV/r and/or ETR at that time. RAL, DRV/r and ETR were provided for an
additional 96 weeks (giving total follow-up of ≥144 weeks), with HIV-1 RNA measured at 48 and 96 weeks and CD4 count
at 96 weeks after entry into Extended Follow-up. Proportion of participants with HIV-1 RNA ≤200 copies/ml was estimated
every 24 weeks, using imputation if necessary to handle the different measurement schedule in Extended Follow-up; mean
CD4 count changes were estimated using loess regression.
Results and Discussion: Of 257 participants (38% females), at study entry, median CD4 count was 179 cells/mm3, and HIV-1
RNA was 4.6 log10 copies/ml. Median follow-up was 168 weeks (IQR: 156–204); 15 (6%) participants were lost to follow-up
and 9 (4%) died. 27/246 (11%), 26/246 (11%) and 13/92 (14%) of participants who started RAL, DRV/r and ETR, respectively,
discontinued these drugs; only three due to adverse events. 87%, 86%, 83% and 80% of the participants had HIV-1 RNA
≤200 copies/ml at weeks 48, 96, 144 and 168 (95% CI at week 168: 74–85%), respectively. Mean increase from study entry
in CD4 count at week 168 was 265 cells/mm3 (95% CI 247–283).
Conclusions: Third-line regimens comprising of RAL, DRV/r and/or ETR were very well tolerated and had high rates of durable
virologic suppression among PLWH in LMICs who were failing on second-line PI-based ART prior to the availability of dolutegravir
