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Title
Short-course rifapentine-based regimens for latent tuberculosis infection among people living with HIV who received integrase inhibitor-based antiretroviral therapy
Presenter
Kuan-Yin Lin
Authors
K.-Y. Lin1, H.-Y. Sun1, C.-J. Yang2, P.-L. Lu3, N.-Y. Lee4, Y.-T. Lee5, H.-J. Tang6, B.-H. Liou7, N.-C. Wang8, I.-M. Hii9, T.-C. Chen3, A.-T. Peng10, C.-Y. Lin11, C.-Y. Cheng12, C.-C. Hung1, Taiwan HIV Study Group
Institutions
1National Taiwan University Hospital, Taipei, Taiwan, Republic of China, 2Far Eastern Memorial Hospital, New Taipei City, Taiwan, Republic of China, 3Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, Republic of China, 4National Cheng Kung University Hospital, Tainan, Taiwan, Republic of China, 5Chung Shan Medical University Hospital, Taichung, Taiwan, Republic of China, 6Chi Mei Medical Center, Tainan, Taiwan, Republic of China, 7Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan, Republic of China, 8Tri-Service General Hospital, Taipei, Taiwan, Republic of China, 9Changhua Christian Hospital, Changhua, Taiwan, Republic of China, 10National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan, Republic of China, 11National Taiwan University Hospital Yu-Lin Branch, Yunlin, Taiwan, Republic of China, 12Taoyuan General Hospital, Taoyuan, Taiwan, Republic of China

BACKGROUND: Rifapentine-based regimens have been shown to have a high completion rate for latent tuberculosis infection (LTBI) treatment; however, rifapentine reduces plasma concentrations of co-administered ART among PLWH. This study aimed to retrospectively evaluate the outcomes of short-course rifapentine-based regimens among PLWH who received integrase strand-transfer inhibitor (InSTI)-based ART.
METHODS: During August 2019 to October 2022, PLWH testing positive or indeterminate for interferon-gamma release assay (IGRA) were advised to receive directly-observed therapy for LTBI after excluding active tuberculosis. Those receiving 3-month once-weekly rifapentine plus isoniazid (3HP) or 1-month daily rifapentine plus isoniazid (1HP) combined with INSTI-based ART were included. The primary outcome was maintenance of virologic response (PVL<200 copies/mL) at months 3-6 after completion of LTBI treatment.
RESULTS: During the study period, 456 PLWH were included; they were mostly male (94.3%) with a median age of 43 years, and 91.9% received InSTI-based ART with a median CD4 count of 651 cells/mm3 and 97.6% having achieved PVL<200 copies/mL. Among those receiving InSTI-based ART, 142 PLWH received 1HP and bictegravir (BIC)-containing regimens (1HP/BIC group), 46 received 1HP and dolutegravir (DTG)-containing regimens (1HP/DTG group), 28 received 3HP and BIC-containing regimens and (3HP/BIC group), and 203 received 3HP and DTG-containing regimens (3HP/DTG group). In the per-protocol analysis, the proportions of PLWH who maintained PVL <200 copies/ml at months 3-6 after the completion of LTBI treatment in the 4 study groups were 100% (125/125), 100% (44/44), 100% (17/17), and 96.7% (178/184), respectively. The completion rates were similar in the 1HP and 3HP groups (92.7% vs 90.0%). None of the PLWH discontinued INSTI-based ART that had been taking before combinations with rifapentine-based LTBI treatment. The rates of PLWH experiencing any adverse event (AE) were also similar in the 1HP and 3HP groups (60.9% vs 57.4%), and the AEs were mainly of grade 1 (40.1%) or 2 (13.4%) in severity. While the most commonly reported AEs were flu-like symptoms (40.1%), more dermatologic AEs were observed in the 1HP group compared with the 3HP group (17.8% vs 9.6%).
CONCLUSIONS: Combinations of InSTI-containing regimens and short-course rifapentine-based regimens had a good safety profile and maintained higher rates of viral suppression.