Prolactin (PRL) exerts numerous effects in the brain including induction of maternal behaviour, increased food intake, and inhibition of GnRH secretion. Knowledge about the distribution of PRL receptors (PRL-R) in the brain will be critical for investigating mechanisms of PRL-brain interactions during lactation. The present study aimed to investigate the distribution of PRL-R in specific hypothalamic nuclei of lactating rats by immunohistochemistry and to compare this distribution with that in dioestrous rats. Rats were perfused with 2% paraformaldehyde and brains were cut into coronal sections (18 microm) for immunostaining. Immunoreactivity was detected by the avidin biotin complex method using mouse monoclonal antibody U5. In dioestrous rats, PRL-R immunoreactivity was observed in the choroid plexus, three hypothalamic nuclei: medial preoptic, periventricular and arcuate, and in the median eminence. The number of labelled profiles per section in the medial preoptic and arcuate nuclei increased significantly (P<0.05) in lactating rats (days 7-10 to post partum) when compared with dioestrous rats. Furthermore, in lactating rats, PRL-R immunoreactive neurons were identified in the cerebral cortex, substantia nigra and numerous additional hypothalamic nuclei including the ventromedial preoptic, ventrolateral preoptic, lateroanterior hypothalamic, ventrolateral hypothalamic, paraventricular hypothalamic, supraoptic, suprachiasmatic, and ventromedial hypothalamic nuclei. These observations assist our understanding of the multiple sites of PRL effects on brain function during lactation.

Background: We investigated the efficacy of a switch to dolutegravir plus lamivudine in aviremic individuals without evidence of persistent lamivudine resistance-associated mutations in baseline proviral DNA population sequencing. Methods: Open-label, single-arm, 48-week pilot trial. HIV-1 infected adults, naïve to integrase inhibitors, with CD4+ above 350 cell/mL and fewer than 50 HIV-1 RNA copies per mL the year prior to study entry switched to dolutegravir plus lamivudine. Participants were excluded if baseline proviral DNA population genotyping detected lamivudine resistance-associated mutations. To detect resistance minority variants, proviral DNA next-generation sequencing was retrospectively performed from baseline samples. Primary efficacy endpoint was proportion of participants with fewer than 50 HIV-1 RNA copies per mL at week 48. Safety and tolerability outcomes were incidence of adverse events and treatment discontinuations. ART-PRO is registered with ClinicalTrials.gov, NCT03539224. Findings: 41 participants switched to dolutegravir plus lamivudine, 21 with lamivudine resistance mutations in historical plasma genotypes. Baseline next-generation sequencing detected lamivudine resistance mutations (M184V/I and/or K65R/E/N) over a 5% threshold in 15/21 (71¢4%) and 3/20 (15%) of participants with and without history of lamivudine resistance, respectively. At week 48, 92¢7% of participants (38/41) had fewer than 50 HIV-1 RNA copies per mL. There were no cases of virologic failure. Three participants with historical lamivudine resistance were prematurely discontinued from the study (2 protocol violations, one adverse event). Ten participants (4 in the group with historical lamivudine resistance) had a transient viral rebound, all resuppressed on dolutegravir plus lamivudine. There were 28 drug-related adverse events, only one leading to discontinuation. Interpretation: In this pilot trial, dolutegravir plus lamivudine was effective in maintaining virologic control despite past historical lamivudine resistance and presence of archived lamivudine resistance-associated mutations detected by next generation sequencing. Further studies are needed to confirm our results.

Background In the ART-PRO pilot trial there were no virological failures through 48 weeks of treatment with dolutegravir plus lamivudine in suppressed individuals with and without archived lamivudine resistance-associated mutations (RAMs) detected through next-generation sequencing (NGS) but without evidence of lamivudine RAMs in baseline proviral DNA population sequencing. Objectives To present 96 week results from ART-PRO. Methods Open-label, single-arm pilot trial. At baseline, all participants switched to dolutegravir plus lamivudine. Participants were excluded if proviral DNA population genotyping detected lamivudine RAMs. To detect resistance minority variants, proviral DNA NGS was retrospectively performed from baseline samples. For this analysis the efficacy endpoint was the proportion of participants with &lt;50 HIV-1 RNA copies/mL at week 96. Safety and tolerability outcomes were incidence of adverse events and treatment discontinuations. Results Forty-one participants were included, 21 with lamivudine RAMs in historical plasma RNA genotypes. Baseline proviral DNA NGS detected lamivudine RAMs (M184V/I and/or K65R/E/N) above a 5% threshold in 71.4% (15/21) and 15% (3/20) of participants with and without history of lamivudine resistance, respectively. At 96 weeks, 90.2% of participants achieved the efficacy endpoint. Between week 48 and 96 there was one discontinuation due to consent withdrawal and no discontinuations related to adverse events. Two participants had a transient viral rebound, both re-suppressed on dolutegravir plus lamivudine. Through week 96, there were no virological failures. Conclusions In this pilot trial, dolutegravir plus lamivudine maintained virological suppression at 96 weeks despite historical lamivudine resistance and persisting archived minority lamivudine RAMs.

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