Open AccessImpact of Integrase Inhibition Compared With Nonnucleoside Inhibition on HIV Reservoirs in Lymphoid Tissues
Author(s) -
Meghan K Rothenberger,
Krystelle Nganou-Makamdop,
Cissy Kityo,
Francis Ssali,
Jeffrey G. Chipman,
Gregory J. Beilman,
Torfi Hoskuldsson,
Jodi Anderson,
Jake Jasurda,
Thomas Schmidt,
Samuel P. Calisto,
Hope Pearson,
Thomas Reimann,
Caitlin David,
Katherine Perkey,
Peter J. Southern,
Stephen W. Wietgrefe,
Erika S. Helgeson,
Cavan Reilly,
Ashley T. Haase,
Daniel C. Douek,
Courtney V. Fletcher,
Timothy W. Schacker
Publication year - 2019
Publication title -
journal of acquired immune deficiency syndromes
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.162
H-Index - 157
eISSN - 1944-7884
pISSN - 1525-4135
DOI - 10.1097/qai.0000000000002026
Subject(s) - raltegravir , viremia , efavirenz , viral load , integrase inhibitor , virology , lymph node , integrase , virus , antiretroviral therapy , pharmacokinetics , biology , medicine , pharmacology , chemistry , human immunodeficiency virus (hiv) , immunology
Background: HIV is produced in lymphoid tissues (LT) and stored on the follicular dendritic cell network in LT. When antiretroviral therapy is started, plasma viremia decays in 2 phases; the first within days of starting therapy and the second over weeks. Raltegravir (RAL), an integrase inhibitor, has been associated with only a single rapid phase of decay, and we speculated this may be due to higher intracellular concentration (IC) of RAL in LT. We have previously measured suboptimal ICs of antiretroviral therapy agents in LT, which were associated with slower decay of both vRNA+ cells and the follicular dendritic cell network pool. Setting: Outpatient clinic at the Joint Clinical Research Center in Kampala, Uganda. Methods: We compared the rate of decay in LT in people starting RAL with those starting efavirenz (EFV). Results: There was no difference in the rate of virus decay in LT. The ratio of the ICs of RAL and EFV in lymph node to the concentration of drug that inhibits 95% of virus in blood was 1 log lower in lymph node for EFV and >3 logs lower for RAL. Conclusion: These data further highlight the challenges of drug delivery to LT in HIV infection and demonstrate that RAL is not superior to EFV as judged by direct measurements of the source of virus in LT.