Evidence map›Paper›PMID 40426337›Full record

SynthesisHIV medicine2025

Comparison of treatment-emergent resistance-associated mutations and discontinuation due to adverse events among integrase strand transfer inhibitor-based single-tablet regimens and cabotegravir + rilpivirine for the treatment of virologically suppressed people with HIV: A systematic literature review and network meta-analysis.

Ishfaq Rashid, Nathan R Unger, Connor Willis, Teerapon Dhippayom, Moti Ramgopal, Elizabeth M Sherman, Nicholas Yared, Rachel Safran, Edwin Swiatlo, Amy R Weinberg and 3 more

Abstract readComparative StudyNetwork Meta-AnalysisSystematic Review
In one paragraph

Synthesis in HIV medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Observational
  3. Article
  4. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Ishfaq RashidDepartment of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, Utah, USA.
Nathan R UngerGilead Sciences, Inc., Foster City, California, USA.
Connor WillisDepartment of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, Utah, USA.
Teerapon DhippayomDepartment of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, Utah, USA.ORCID https://orcid.org/0000-0001-6222-6476
Moti RamgopalMidway Specialty Care Center, Fort Pierce, Florida, USA.
Elizabeth M ShermanDepartment of Pharmacy Practice, Barry and Judy Silverman College of Pharmacy, Nova Southeastern University, Fort Lauderdale, Florida, USA.ORCID https://orcid.org/0000-0002-6559-0684
Nicholas YaredDepartment of Medicine, Division of Infectious Diseases, Henry Ford Health, Detroit, Michigan, USA.
Rachel SafranDepartment of Internal Medicine, MultiCare Health System INW, Spokane, Washington, USA.
Edwin SwiatloSection of Infectious Diseases, Southeast Louisiana Veterans Health Care System, New Orleans, Louisiana, USA.
Amy R WeinbergGilead Sciences, Inc., Foster City, California, USA.
Soodi NavadehGilead Sciences, Inc., Foster City, California, USA.
Howard Weston SchmutzDepartment of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, Utah, USA.
Nathorn ChaiyakunaprukDepartment of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, Utah, USA.ORCID https://orcid.org/0000-0003-4572-8794

Funding

Gilead Sciences, Inc.
6 · The paper itself

Abstract

objectiveThis study evaluated rates of treatment-emergent resistance-associated mutations (TE-RAMs) and discontinuation due to adverse events (DC-AEs) across integrase strand transfer inhibitor (INSTI)-based single-tablet regimens and injectable cabotegravir + rilpivirine (CAB + RPV) in virologically suppressed people with HIV.

methodsA systematic literature review was conducted for phase 2-4 randomized controlled trials with ≥48 weeks of follow-up involving virologically suppressed people with HIV aged ≥12 years and published January 2003-March 2024. A random-effects network meta-analysis estimated comparative rates of TE-RAMs and DC-AEs among regimens at 48 weeks. Risk of bias and strength of evidence were assessed using Cochrane RoB and CINeMA, respectively.

resultsFourteen (7509 participants) and nine (4656 participants) studies were included in the TE-RAMs and DC-AEs analyses, respectively. No significant differences in rates of TE-RAMs were observed; risk ratios (RRs) for TE-RAMs for bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF), dolutegravir/abacavir/lamivudine (DTG/ABC/3TC) and CAB + RPV every 4 weeks (Q4W) versus CAB + RPV every 8 weeks (Q8W) were 0.22 (95% CI, 0.02-2.04), 0.22 (95% CI, 0.00-19.85) and 0.40 (95% CI, 0.14-1.09). Compared with CAB + RPV Q4W and Q8W, DC-AEs were significantly lower with B/F/TAF (RR, 0.15 [95% CI, 0.03-0.75] and RR, 0.16 [95% CI, 0.04-0.67], respectively) and DTG/ABC/3TC (RR, 0.05 [95% CI, 0.01-0.48] and RR, 0.05 [95% CI, 0.01-0.46], respectively).

conclusionsIn virologically suppressed people with HIV, switching to CAB + RPV Q8W yielded a non-significant increased risk of TE-RAMs compared with INSTI-based 2- and 3-drug regimens and CAB + RPV Q4W. Both CAB + RPV Q4W and Q8W had significantly higher risks of DC-AEs than B/F/TAF and DTG/ABC/3TC. Findings highlight the importance of considering both resistance and tolerability when switching regimens.

Indexed as

Anti-HIV AgentsDrug Resistance, ViralHIV InfectionsHIV Integrase InhibitorsPyridonesRilpivirineDiketopiperazinesHIV-1HumansMutationRandomized Controlled Trials as TopicTabletsAnti-HIV AgentscabotegravirDiketopiperazinesHIV Integrase InhibitorsPyridonesRilpivirineTabletsantiretroviral therapydrug resistanceHIVintegrase inhibitorsingle‐tablet regimen

Identifiers

PMID40426337
PMCPMC12315059

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.