Effectiveness of boosted darunavir plus rilpivirine in patients with long-lasting HIV-1 infection: DARIL study
Por:
Navarro, J, Gonzalez-Cordon, A, Casado, JL, Bernardino, JI, Domingo, P, Portilla, J, Llibre, JM, Colomer, J, Rial-Crestelo, D, Vizcarra, P, Curran, A, Martinez, E, Ribera, E
Publicada:
1 jul 2020
Resumen:
Background: The combination of boosted darunavir plus rilpivirine, once daily, could be a convenient, effective and well-tolerated two-drug regimen to achieve HIV suppression in HIV-infected patients.
Methods: Multicentre, retrospective cohort study in nine hospitals in Spain. All HIV-infected subjects starting boosted darunavir plus rilpivirine were included, irrespective of their viral load (VL). The primary objective was the percentage of patients with VL <50 copies/mL at 48 weeks. Secondary objectives included changes in CD4+ cell count, lipid profile and renal function.
Results: Eighty-one of 84 patients reached Week 48. Fifty-nine (70.2%) patients had VL <50 copies/mL at baseline and the rest had a median VL of 202 (IQR 98-340) copies/mL. Subjects had a median of 21 years of infection with six prior regimens. The main reasons for starting boosted darunavir plus rilpivirine were simplification (44%), kidney or bone toxicity (28.6%) and virological failure (17.9%). Historical genotypes from 47 patients showed 41 (87.2%) patients with NRTI RAMs, 21 (44.7%) with NNRTI RAMs, 12 (25.5%) with primary PI RAMs and 7 (14.9%) with integrase strand transfer inhibitor (INSTI) RAMs. One patient had low-level resistance to boosted darunavir and five patients had some resistance to rilpivirine. At 48 weeks, 71 (87.7%) patients had VL <50 copies/mL. According to undetectable or detectable baseline VL, effectiveness was 91.1% or 80%, respectively. There were four virological failures with no emergence of new RAMs. Three of these patients resuppressed viraemia while maintaining the same regimen.
Conclusions: The combination of boosted darunavir plus rilpivirine has shown good effectiveness and tolerability in this cohort of pretreated patients with a long-lasting HIV infection, exposure to multiple antiretroviral regimens and prior HIV resistance.
Filiaciones:
Navarro, J:
Hosp Univ Vall dHebron, Dept Infect Dis, Barcelona, Spain
Vall dHebron Res Inst, Barcelona, Spain
Gonzalez-Cordon, A:
Hosp Clin IDIBAPS, Dept Infect Dis, Barcelona, Spain
Casado, JL:
Hosp Ramon & Cajal, Dept Infect Dis, Madrid, Spain
Bernardino, JI:
Hosp Univ La Paz, HIV Unit, Madrid, Spain
Domingo, P:
Hosp Santa Creu & Sant Pau, Dept Infect Dis, Barcelona, Spain
Portilla, J:
Hosp Gen Univ Alicante, Dept Infect Dis, Alicante, Spain
Llibre, JM:
Hosp Badalona Germans Trias & Pujol, Dept Infect Dis, Badalona, Spain
Colomer, J:
Hosp Santa Caterina, Dept Internal Med, Salt, Spain
Rial-Crestelo, D:
Hosp 12 Octubre, HIV Unit, Imas12, Madrid, Spain
Vizcarra, P:
Hosp Ramon & Cajal, Dept Infect Dis, Madrid, Spain
Curran, A:
Hosp Univ Vall dHebron, Dept Infect Dis, Barcelona, Spain
Vall dHebron Res Inst, Barcelona, Spain
Martinez, E:
Hosp Clin IDIBAPS, Dept Infect Dis, Barcelona, Spain
Ribera, E:
Hosp Univ Vall dHebron, Dept Infect Dis, Barcelona, Spain
Vall dHebron Res Inst, Barcelona, Spain
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