Document Detail

Impact of lopinavir/ritonavir use on antiretroviral resistance in recent clinical practice.
MedLine Citation:
PMID:  22733652     Owner:  NLM     Status:  Publisher    
OBJECTIVES: This observational study was requested by French health authorities to determine the impact of lopinavir/ritonavir (Kaletra(®)) on antiretroviral resistance in clinical practice. Virological failures of lopinavir/ritonavir and their effects on the resistance to protease inhibitors and reverse transcriptase inhibitors were evaluated in protease inhibitor-experienced patients. PATIENTS AND METHODS: Virological failure was defined as an HIV-1 plasma viral load >50 copies/mL after at least 3 months of lopinavir/ritonavir-containing antiretroviral therapy. For all patients, a resistance genotypic test was available at failure and before lopinavir/ritonavir treatment. Data from 72 patients with inclusion criteria were studied. RESULTS: The mean viral load at baseline was 4 log(10) copies/mL (1.6-6.5). Mutations in the protease gene significantly selected between baseline and failure were L10V, K20R, L33F, M36I, I47V, I54V, A71V and I85V (P < 0.05). Patients who had more than seven protease inhibitor mutations at baseline showed a significantly increased risk of occurrence of protease inhibitor mutations. The proportion of viruses susceptible to atazanavir, fosamprenavir and darunavir decreased significantly between baseline and failure (P < 0.05). Among patients with a virus susceptible to atazanavir at day 0, 26% (n = 14) exhibited a virus resistant or possibly resistant at the time of failure. This proportion was 32% (n = 16) for fosamprenavir and 16% (n = 7) for darunavir. CONCLUSIONS: A darunavir-based regimen appears to be a sequential option in the case of lopinavir/ritonavir failure. To compare and determine the best treatment sequencing, similar studies should be performed for darunavir/ritonavir and atazanavir/ritonavir.
Sidonie Lambert-Niclot; Bernard Masquelier; Isabelle Cohen Codar; Cathia Soulie; Constance Delaugerre; Laurence Morand-Joubert; Charlotte Charpentier; Virginie Ferre; Jean-Christophe Plantier; Brigitte Montes; Sophie Carret; Valerie Perrot; Gilles Peytavin; Dominique Costagliola; Vincent Calvez; Anne-Geneviève Marcelin;
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-6-25
Journal Detail:
Title:  The Journal of antimicrobial chemotherapy     Volume:  -     ISSN:  1460-2091     ISO Abbreviation:  -     Publication Date:  2012 Jun 
Date Detail:
Created Date:  2012-6-26     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7513617     Medline TA:  J Antimicrob Chemother     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
AP-HP, Pitié-Salpêtrière Hospital, INSERM U943 and Pierre et Marie Curie University, Paris, France.
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MeSH Terms
A-G Marcelin / ; C Soulie / ; S Lambert-Niclot / ; C Delamare / ; I De Mandela / ; D Descamps / ; E Dussaix / ; D Dubois / ; D Schneider / ; M Segondy / ; B Montes / ; F Simon / ; J M Sire / ; J C Plantier / ; A Depatureau / ; C Poggi / ; A Signori-Schmuck / ; A Ruffault / ; M J Carles / ; A Vabret / ; J Izopet / ; F Nicot / ; S Gaba / ; L Bocket / ; L Morand-Joubert / ; J Cottalorda / ; B Masquelier / ; V Ferre / ; H Le Guillou Guillemette / ; A Si-Mohamed /

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