{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T00:13:27Z","timestamp":1784852007254,"version":"3.55.0"},"reference-count":28,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,8,24]],"date-time":"2025-08-24T00:00:00Z","timestamp":1755993600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Viruses"],"abstract":"<jats:p>Background: Data on the use of dolutegravir (DTG) plus boosted darunavir (DRV\/b) in people with 4-class drug-resistant HIV (4DR-PWH) are limited. This study assessed the virological effectiveness of DTG + DRV\/b in this population using real-world data from the PRESTIGIO Registry. Methods: We compared three regimen groups: dual DTG + DRV\/b (DODA), DTG + DRV\/b plus an additional antiretroviral drug (DODA + Other), and regimens excluding DTG + DRV\/b (NO-DODA). Virological failure (VF) was defined as \u22652 HIV-RNA values \u2265 50 copies\/mL or 1 \u2265 1000 copies\/mL. Mixed-effects logistic regression was used to assess VF, adjusting for antiretroviral therapy (ART) duration, age, number of fully active drugs, sex at birth, and nadir CD4+. Individuals could switch regimens during follow-up. Results: Among 249 4DR-PWH (median follow-up: 8.7 years), 844 ART regimens were analyzed: 72 (8.5%) DODA, 264 (31.3%) DODA + Other, and 508 (60.2%) NO-DODA. Compared to NO-DODA, the odds of VF were 77% and 35.9% lower with DODA and DODA + Other, respectively. Notably, in the DODA group, DTG and DRV\/b were fully active in only 63.9% and 47.2% of the cases, respectively. Conclusions: DTG + DRV\/b regimens were associated with a significantly lower risk of virological failure, even when drug activity was partial. This strategy remains a valuable option for managing multi-drug-resistant HIV.<\/jats:p>","DOI":"10.3390\/v17091158","type":"journal-article","created":{"date-parts":[[2025,8,25]],"date-time":"2025-08-25T00:09:32Z","timestamp":1756080572000},"page":"1158","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Virological Effectiveness of Dolutegravir Plus Darunavir in People with Multi-Drug-Resistant HIV: Data from the PRESTIGIO Registry"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0999-6070","authenticated-orcid":false,"given":"Filippo","family":"Lagi","sequence":"first","affiliation":[{"name":"Infectious and Tropical Diseases Unit, Careggi University Hospital, 50134 Florence, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Bellomo","sequence":"additional","affiliation":[{"name":"Infectious Diseases, IRCCS San Raffaele Scientific Institute, 20127 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2447-6498","authenticated-orcid":false,"given":"Riccardo","family":"Lolatto","sequence":"additional","affiliation":[{"name":"Infectious Diseases, IRCCS San Raffaele Scientific Institute, 20127 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Filippo","family":"Ducci","sequence":"additional","affiliation":[{"name":"Infectious and Tropical Diseases Unit, Careggi University Hospital, 50134 Florence, Italy"},{"name":"Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9687-0734","authenticated-orcid":false,"given":"Seble Tekle","family":"Kiros","sequence":"additional","affiliation":[{"name":"Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincenzo","family":"Spagnuolo","sequence":"additional","affiliation":[{"name":"Infectious Diseases, IRCCS San Raffaele Scientific Institute, 20127 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecka Papaioannu","family":"Borjesson","sequence":"additional","affiliation":[{"name":"Infectious Diseases, IRCCS San Raffaele Scientific Institute, 20127 Milan, Italy"},{"name":"IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, 20127 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6548-3427","authenticated-orcid":false,"given":"Tommaso","family":"Clemente","sequence":"additional","affiliation":[{"name":"Infectious Diseases, IRCCS San Raffaele Scientific Institute, 20127 Milan, Italy"},{"name":"IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, 20127 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonardo","family":"Calza","sequence":"additional","affiliation":[{"name":"Unit of Infectious Diseases, Department of Medical and Surgical Sciences, S. Orsola Hospital, \u201cAlma Mater Studiorum\u201d University of Bologna, 40126 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcello","family":"Feasi","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, E.O. Ospedali Galliera, 16128 Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4395-5379","authenticated-orcid":false,"given":"Emanuele","family":"Foc\u00e0","sequence":"additional","affiliation":[{"name":"Unit of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, University of Brescia and ASST Spedali Civili Hospital, 25123 Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Giacomelli","sequence":"additional","affiliation":[{"name":"Department of Biomedical and Clinical Sciences, Universit\u00e0 Degli Studi di Milano, 20122 Milan, Italy"},{"name":"III Infectious Diseases Unit, ASST Fatebenefratelli Sacco, 20157 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Gulminetti","sequence":"additional","affiliation":[{"name":"Fondazione IRCCS Policlinico San Matteo, University of Pavia, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Menzaghi","sequence":"additional","affiliation":[{"name":"Unit of Infectious Diseases, ASST della Valle Olona, 21052 Busto Arsizio, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonella","family":"Castagna","sequence":"additional","affiliation":[{"name":"Infectious Diseases, IRCCS San Raffaele Scientific Institute, 20127 Milan, Italy"},{"name":"IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, 20127 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of the PRESTIGIO Study Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"E207954","DOI":"10.1001\/jamanetworkopen.2020.7954","article-title":"Comparison of Overall and Comorbidity-Free Life Expectancy between Insured Adults with and Without HIV Infection, 2000-2016","volume":"3","author":"Marcus","year":"2020","journal-title":"JAMA Netw. 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