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Boosted protease inhibitor monotherapy as a maintenance strategy: an observational study in the FHDH-ANRS CO4 cohort.
MedLine Citation:
PMID:  22695301     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVES:: We aimed to determine the effectiveness of boosted protease inhibitor monotherapy (BPIMT) initiated as a maintenance strategy in routine care and identify predictive factors of failure. DESIGN:: Observational study in the FHDH-ANRS CO4 cohortMethods: 529 virologically suppressed individuals switched to BPIMT in the period 2006-2010, 75% had at least 12 and 49% at least 24 months of follow-up. Virological failure (VF) (2 consecutive HIV-RNA>50 copies/ml or one HIV-RNA>50 copies/ml followed by BPIMT discontinuation), and treatment failure (TF) (VF, antiretroviral reintensification, or death) were analysed separately. RESULTS:: At baseline, 11% were PI-naïve, median duration on CART was 84 months and median duration of suppressed viremia was 38 months. 9% had an history of VF while on a PI-containing regimen and rates of VF were higher among those individuals (adjusted HR, 1.6; 95%CI, 0.9- 2.9). Compared to individuals with less than one year of sustained virological suppression before the switch to BPIMT, those with longer duration were less likely to experience VF (HR, 0.7; 95%CI, 0.4 - 1.2), and 0.6 (95%CI, 0.4-0.9) for a duration of 12-23 months and 24 months or more, respectively. Rates of failure were similar for BPIMT with LPV/RTV or DRV/RTV, but increased for BPIMT with ATV/RTV. Same risk factors were associated with TF. CONCLUSION:: The safety and efficacy of a maintenance strategy with BPIMT in a routine care setting matched the results of randomized clinical trials. A longer duration since last virological rebond before switching to BPIMT was associated with a decreased risk of subsequent failure.
Authors:
Marguerite Guiguet; Jade Ghosn; Claudine Duvivier; Jean-Luc Meynard; Guillaume Gras; Marialuisa Partisani; Elina Teicher; Aba Mahamat; Franck Rodenbourg; Odile Launay; Dominique Costagliola;
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-6-12
Journal Detail:
Title:  AIDS (London, England)     Volume:  -     ISSN:  1473-5571     ISO Abbreviation:  -     Publication Date:  2012 Jun 
Date Detail:
Created Date:  2012-6-14     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8710219     Medline TA:  AIDS     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
aINSERM, U943, Paris F-75013, France bUPMC Université Paris 06, UMR S943, Paris F-75013, France cAP-HP, Hôpital Bicêtre, Service de médecine interne, Le Kremlin-Bicêtre F-94270, France dUniversité Paris Descartes, EA 3620, Faculté de Médecine site Necker, Paris F-75015, France. eAP-HP, Hôpital Necker-Enfants Malades, Service des maladies infectieuses et tropicales, Centre d'Infectiologie Necker-Pasteur, Paris F-75015, France fInstitut Pasteur, Centre Médical de l'Institut Pasteur, Centre d'Infectiologie Necker-Pasteur, Paris F-75015, France gAP-HP, Hopital Saint Antoine, Service des maladies infectieuses et tropicales, Paris F-75012, France hHopital Bretonneau, Service des maladies infectieuses, Tours F-37000 France iHopitaux Universitaires de Strasbourg, Le Trait d'Union - Centre de soins de l'infection par le VIH, Strasbourg, F-67000 France jCentre Hospitalier Andrée Rosemon, Service des maladies infectieuses et tropicales, Cayenne F-97300, France kGroupe Interassociatif Traitements & recherche thérapeutique (TRT-5), Pantin F-93500, France lUniversité Paris Descartes, AP-HP, Hopital Cochin, Paris F-75014, France mAP-HP, Groupe hospitalier Pitié-Salpétrière, Service des maladies infectieuses et tropicales, Paris F-75013, France. 1Members are listed at http://www.ccde.fr/main.php?main_file=fl-1171464013-677.html.
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