Document Detail


Antiretroviral Therapy and Efficacy after Virologic Failure on First-line Boosted Protease Inhibitor Regimens.
MedLine Citation:
PMID:  24842909     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND:  Virologic failure (VF) on first-line ritonavir-boosted protease inhibitor (PI/r) is associated with low rates of resistance, but optimal management after failure is unknown.
METHODS:  The analysis included participants in randomized trials who experienced VF on a first-line PI/r plus two reverse-transcriptase inhibitors (NRTIs) and had at least 24 weeks follow-up after VF. Antiretroviral management and virologic suppression (HIV-1 RNA <400 copies/mL) after VF were assessed.
RESULTS:  Of 209 participants, only one had major PI-associated treatment-emergent mutations at first-line VF. The most common treatment approach after VF (66%) was to continue the same regimen. The virologic suppression rate 24 weeks after VF was 64% for these participants, compared to 72% for those who changed regimens (P=0.19). Participants remaining on the same regimen had lower NRTI resistance rates (11% versus 30%, P=0.003) and higher CD4+ cell counts (median 275 versus 213 cells/mm(3), P=0.005) at VF than those who changed. Among participants remaining on their first-line regimen, factors at or before VF significantly associated with subsequent virologic suppression were: achieving HIV-1 RNA <400 copies/mL before VF (OR[95%CI]: 3.39[1.32,8.73]) and lower HIV-1 RNA at VF (OR for <10,000 versus ≥10,000 copies/mL: 3.35[1.40,8.01]). Better adherence after VF was also associated with subsequent suppression (OR for <100% versus 100%: 0.38[0.15,0.97]). For participants who changed regimens, achieving HIV-1 RNA <400 copies/mL before VF also predicted subsequent suppression.
CONCLUSIONS:  For participants failing first-line PI/r with no or limited drug resistance, remaining on the same regimen is a reasonable approach. Improving adherence is important to subsequent treatment success.
Authors:
Yu Zheng; Michael D Hughes; Shahin Lockman; Constance A Benson; Mina C Hosseinipour; Thomas B Campbell; Roy M Gulick; Eric S Daar; Paul E Sax; Sharon A Riddler; Richard Haubrich; Robert A Salata; Judith S Currier
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-5-19
Journal Detail:
Title:  Clinical infectious diseases : an official publication of the Infectious Diseases Society of America     Volume:  -     ISSN:  1537-6591     ISO Abbreviation:  Clin. Infect. Dis.     Publication Date:  2014 May 
Date Detail:
Created Date:  2014-5-20     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9203213     Medline TA:  Clin Infect Dis     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.
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