Contemporary Management of HIV 2021: Modifying ART in Virologically Suppressed Patients

In this episode, David Malebranche, MD, MPH, discusses modifying ART in virologically suppressed patients, including switching ART in a patient with daily pill fatigue, switching ART to avoid comorbidities and simplifying ART in the context of known multidrug resistance. The overview will include analyses from:

• The ATLAS and FLAIR studies in which long-acting intramuscular CAB + RPV was initiated after initial virologic suppression with oral therapy
• D:A:D study data that found cumulative use of RTV-boosted DRV, but not RTV-boosted ATV, was independently associated with a small but progressively increasing risk of CVD events
• The SWORD-1 and -2 evaluating the switch to DTG + RPV vs continuation of baseline ART in virologically suppressed adults
• The TANGO study that compared switching to DTG/3TC vs continuing a TAF-based 3-drug regimen
• The DAWNING study that showed favorable outcomes for treatment-experienced patients switched to DTG containing regimens with an M184V mutation, whether the regimen contained emtricitabine or lamivudine or not
• Study 380-4030 that showed noninferiority in maintenance of viral suppression when switching to BIC/FTC/TAF from DTG + FTC/(TAF or TDF)
• BRAAVE 2020 that evaluated the impact of baseline resistance on outcomes following a switch to BIC/FTC/TAF in Black PWH

In addition, Dr. Malebranche reviews current recommendations by the DHHS regarding considerations when switching regimens in virologically suppressed patients and switching regimens in patients with viral suppression and drug resistance.