Initiation of antiretroviral therapy with integrase strand-transfer inhibitor-based regimens and reduction of the risk of horizontal transmission of HIV-1

Abstract

We read with interest the modeling study published by Zhu J t al. showing that initiating antiretroviral therapy (ART) with inegrase strand-transfer inhibitor (INSTI)-based regimens can potenially reduce HIV transmission risk significantly when compared to on-INSTI regimens [1] . Our group found similar results, first presented in July 2017 at he 9th IAS Conference [2] , and now published in July 2019 in PLoS NE [3] . We too performed a modeling study that showed that iniial use of INSTI-based regimens has the potential to impact HIVhorizontal transmission following initiation of ART in treatment aïve men who have sex with men (MSM). In brief, we used disrete event simulation modeling to estimate transmission events uring the first eight weeks after initiation of ART as first line therpy for MSM. Simulated transmission events were modeled using nputs from meta-analyses [4] and sexual behavior inputs for MSM erived from those found in the START trial [5] . HIV RNA decay in SM was modeled from the databases of three clinical trials Sinle (dolutegravir [DTG] vs. efavirenz [EFV]), Spring-2 (DTG vs. ralegravir [RAL]) and Flamingo (DTG vs. darunavir/ritonavir [DRV/r]).