Simplification to dual antiretroviral therapy including a ritonavir-boosted protease inhibitor in treatment-experienced HIV-1-infected patients
Por:
Burgos, J, Crespo, M, Falco, V, Curran, A, Navarro, J, Imaz, A, Domingo, P, Podzamczer, D, Mateo, MG, Villar, S, Van den Eynde, E, Ribera, E, Pahissa, A
Publicada:
1 oct 2012
Resumen:
To assess the effectiveness of simplification to a dual antiretroviral regimen containing a ritonavir-boosted protease inhibitor (PI/r) in treatment-experienced HIV-1-infected patients.
Retrospective analysis of 131 HIV-1-infected patients on suppressive antiretroviral treatment (HIV-RNA 50 copies/mL) who switched to a maintenance dual antiretroviral regimen, containing a PI/r, in three hospitals in Spain. Virological failure was defined as confirmed HIV-RNA 50 copies/mL. The percentage of patients remaining free of therapeutic failure was estimated using the time-to-loss-of-therapeutic-response algorithm, by intent-to-treat analysis.
Median baseline characteristics of the patients were 14 years on antiretroviral therapy, five prior HAART regimens and 10 different drugs, 24 months on a suppressive regimen and 522 CD4 cells/mL. Reasons for simplification to dual therapy were nucleoside reverse transcriptase inhibitor-related toxicity (46.6), removal of lamivudine/emtricitabine due to resistance (16.8), simplification from regimens containing a dual PI, enfuvirtide or tipranavir (20.6) and simplification from other complex regimens (16.0). Darunavir (58.0), lopinavir (16.8) or atazanavir (13.0) were the preferred PIs, used in combination with tenofovir (50.4), raltegravir (22.1) or etravirine (12.2). At the end of follow-up (median 14 months), 90.1 of patients remained free of therapeutic failure; corresponding data at treatment weeks 24, 48 and 96 were 93.6 (95 CI, 89.397.9), 90.9 (95 CI, 84.995.9) and 87.4 (95 CI, 80.794.1), respectively. Two (1.5) patients had virological failure and 11 (8.4) discontinued treatment due to side effects or were lost to follow-up.
Simplification to a dual-therapy regimen including a PI/r might be useful to enhance convenience and/or diminish toxicity in selected treatment-experienced patients.
Filiaciones:
Burgos, J:
Univ Autonoma Barcelona, Hosp Univ Vall dHebron, Dept Infect Dis, E-08193 Barcelona, Spain
Crespo, M:
Univ Autonoma Barcelona, Hosp Univ Vall dHebron, Dept Infect Dis, E-08193 Barcelona, Spain
Falco, V:
Univ Autonoma Barcelona, Hosp Univ Vall dHebron, Dept Infect Dis, E-08193 Barcelona, Spain
Curran, A:
Univ Autonoma Barcelona, Hosp Univ Vall dHebron, Dept Infect Dis, E-08193 Barcelona, Spain
Navarro, J:
Univ Autonoma Barcelona, Hosp Univ Vall dHebron, Dept Infect Dis, E-08193 Barcelona, Spain
Imaz, A:
Univ Barcelona, Hosp Univ Bellvitge, Dept Infect Dis, Barcelona, Spain
Domingo, P:
Univ Autonoma Barcelona, Infect Dis Unit, Hosp Santa Creu & St Pau, E-08193 Barcelona, Spain
Podzamczer, D:
Univ Barcelona, Hosp Univ Bellvitge, Dept Infect Dis, Barcelona, Spain
Mateo, MG:
Univ Autonoma Barcelona, Infect Dis Unit, Hosp Santa Creu & St Pau, E-08193 Barcelona, Spain
Villar, S:
Univ Autonoma Barcelona, Hosp Univ Vall dHebron, Dept Infect Dis, E-08193 Barcelona, Spain
Van den Eynde, E:
Univ Autonoma Barcelona, Hosp Univ Vall dHebron, Dept Infect Dis, E-08193 Barcelona, Spain
Ribera, E:
Univ Autonoma Barcelona, Hosp Univ Vall dHebron, Dept Infect Dis, E-08193 Barcelona, Spain
Pahissa, A:
Univ Autonoma Barcelona, Hosp Univ Vall dHebron, Dept Infect Dis, E-08193 Barcelona, Spain
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