Share
Title
24 week efficacy and safety of efavirenz- and dolutegravir-based antiretroviral therapy with isoniazid and rifapentine for tuberculosis preventive therapy (1HP and 3HP) in Thai people living with HIV
Presenter
Anchalee Avihingsanon
Authors
A. Avihingsanon1,2, S. Jirajariyavet3, P. Treebupachatsakul4, T.P.N. Ayuthaya5, S. Gatechompol1,2, J. Sophonphan1, P. Danpornprasert6, W. Imsanguan7, J. Visuthranukul8, S. Wiwatrojanagul9, V. Klinbuayaem10, P. Noopetch,11, C. Fujitnirun12, P. Panarat13, N. Saetiew14, S. Mekviwattanawong15, H.M.S. Lwin1, W.M. Han1,2, S.J. Kerr1,16,17, G. Suwanpimolkul2,18, P. Chetchotisakd19
Institutions
1HIV-NAT, Thai Red Cross - AIDS Research Centre, Bangkok, Thailand, 2Center of Excellence in Tuberculosis, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand, 3Infectious Disease Taksin Hospital, Bangkok, Thailand, 4Infectious Disease Buddhachinaraj Phitsanulok Hospital, Phitsanulok, Thailand, 5Health Center 28 (Krung Thon Buri), Krung Thon Buri, Thailand, 6Klang Hospital, Bangkok, Thailand, 7Infectious Disease Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand, 8Police General Hospital, Department of Medicine, Bangkok, Thailand, 9Maharat Nakhon Ratchasima Hospital, Department of Medicine,, Nakhon Ratchasima, Thailand, 10Sanpatong Hospital, Chiangmai, Thailand, 11Hatyai Hospital, Department of Medicine,, Songkla, Thailand, 12Bhumibol Adulyadej Hospital, Department of Medicine, Bangkok, Thailand, 13Queen Savang Vadhana Memorial Hospital, Department of Medicine, Chonburi, Thailand, 14Sisaket Hospital, Department of Medicine, Sisaket, Thailand, 15Pranangklao Hospital, Department of Medicine, Nonthaburi, Thailand, 16Biostatistics Excellence Centre, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand, 17The Kirby Institute, University of New South Wales, Sydney, Australia, 18Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand, 19Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand

BACKGROUND: Limited data inform evidence-based co-administration of DTG/TDF/3TC (TLD) with daily isoniazid (H) and rifapentine (P) for 1 month (1HP) or weekly HP for 3 months (3HP) for tuberculosis preventive therapy (TPT) in people living with HIV (PWH), particularly from Asia.
METHODS: A randomized control trial of 1 HP or 3 HP for TPT among PWH in 15 HIV clinics in Thailand is ongoing study from 2019 to present. At the beginning, only EFV/TDF/FTC was allowed. After the A5372 study demonstrated high DTG plasma concentrations among Thai PWH, TLD once daily was initiated from March 2022 onward. We reported the 24 weeks efficacy and safety of TLD and EFV/TDF/FTC with either 1 HP or 3HP.
RESULTS: Of 1070 participants analysed (59% male, median body weight 62.6 kg) , 804 (75%) took EFV/TDF/FTC and 266 (25%) received TLD; 546 (51%) participants received 1HP. Median ART duration prior to TPT was 1.2 (IQR:0.6-7.2) years; the majority of participants started TPT within 3 months of TLD or EFV/TDF/FTC initiation (66%), especially in the TLD group (84%). At week 24, viral suppression (HIV VL =50 copies/mL) was high in both EFV/TDF/FTC (92.2% 1HP and 91% 3HP) and TLD (92.8% 1HP and 94.7% 3HP) (Figure1). Hepatotoxicity >grade 2, that was mainly asymptomatic and self-limited, developed in 8.8% of 1 HP and 6.4% 3HP groups. Only 0.4% and 0.2% of 1070 participants prematurely discontinued 1 HP and 3 HP, respectively, due to hepatotoxicity or hypersensitivity reactions. Only 0.8% TLD group participants prematurely discontinued TPT.

Figure. 1A-C represent median CD4 change, HIV VL suppression and grading of hepatotoxicity in each treatment group



CONCLUSIONS: Similar efficacy and safety was observed for PWH receiving dolutegravir and efavirenz based ART, co-administered with 1 HP or 3HP, suggesting once daily DTG doses are appropriate with 1 HP or 3 HP.

Download the e-Poster (PDF)