559. Efficacy and Tolerability of Integrase Inhibitors: Experiences From a Nationwide Real-Life Cohort

Abstract

BackgroundThe integrase strand transfer inhibitors (INSTIs) are widely used in first-line and alternative antiretroviral therapy. Observational studies have documented a 2–12% incidence of adverse drug reactions sometimes leading to INSTI discontinuation.MethodsProspectively collected cohort data of INSTI use were analyzed between January 2008 and March 2017, in Hungary, a Central-European country with centralized HIV care. Efficacy of viral suppression and reasons for discontinuation were evaluated for available INSTIs (raltegravir (RAL) and dolutegravir (DTG)).ResultsThere were 2,232 patients registered in the national HIV Center in 2017 March 31. Six hundred seventeen patients received during the study period RAL (259 patients—41.9%) or DTG (358—58.1%). There were 55 cases (9%) of switch within class (39 patients for simplification, 13 due to toxicity, two virological failures, and one other reason). Sixteen cases (3%) changed INSTI to another class (eight virological failures, four due to toxicity, and four other reasons). Ten cases of virological failure occurred in patients taking RAL, whereas none of those taking DTG, but in patients on DTG higher rates of side effects were observed compared with patients on RAL (11—3.1% vs. 6—2.3%, respectively).ConclusionLarge and homogenous, nationwide cohort of patients taking INSTIs confirm good tolerability and excellent efficacy of the class with slight differences between RAL and DTG.Disclosures All authors: No reported disclosures.