Document Detail


Low rate of virological failure and maintenance of susceptibility to HIV-1 protease inhibitors with first-line lopinavir/ritonavir-based antiretroviral treatment in clinical practice.
MedLine Citation:
PMID:  20981785     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
Protease inhibitor (PI)-resistant HIV-1 has hardly ever been detected at failed boosted PI-based first-line antiretroviral regimens in clinical trials. However, this phenomenon has not been investigated in clinical practice. To address this gap, data from patients starting a first-line lopinavir/ritonavir (LPV/rtv)-based therapy with available baseline HIV-1 RNA load, a viral genotype and follow-up viral load after 3 and 6 months of treatment were extracted from the Italian Antiretroviral Resistance Cohort Analysis (ARCA) observational database. Based on survival analysis, 39 (7.1%) and 43 (7.8%) of the 548 examined patient cases had an HIV-1 RNA >500 and >50 copies/ml, respectively, after 6 months of treatment. Cox proportional hazard models detected baseline HIV-1 RNA (RH 1.79, 95%CI 1.10-2.92 per 1-log(10) increase, P=0.02) and resistance to the nucleoside backbone (RH 1.04, 95%CI 1.02-1.06 per 10-point increase using the Stanford HIVdb algorithm, P<0.001) as independent predictors of HIV-1 RNA at >500 copies/ml, but not at the >50 copies/ml cutoff criteria. Higher baseline viral load, older patient age, heterosexual route of infection and use of tenofovir/emtricitabine were predictors of failure at month 3 using the 50-copy and/or 500-copy threshold. Resistance to LPV/rtv did not occur or increase in any of the available 36 follow-up HIV-1 genotypes. Resistance to the nucleoside backbone (M184V) developed in four cases. Despite the likely differences in patient population and adherence, both the low rate of virological failure and the lack of development of LPV/rtv resistance documented in clinical trials are thus confirmed in clinical practice.
Authors:
Mattia C F Prosperi; Maurizio Zazzi; Grazia Punzi; Laura Monno; Grazia Colao; Paola Corsi; Simona Di Giambenedetto; Genny Meini; Valeria Ghisetti; Stefano Bonora; Monica Pecorari; Maria Rita Gismondo; Patrizia Bagnarelli; Tiziana Carli; Andrea De Luca;
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of medical virology     Volume:  82     ISSN:  1096-9071     ISO Abbreviation:  J. Med. Virol.     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2010-10-28     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7705876     Medline TA:  J Med Virol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1996-2003     Citation Subset:  IM    
Affiliation:
Clinic of Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy. ahnven@yahoo.it
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MeSH Terms
Descriptor/Qualifier:
Investigator
Investigator/Affiliation:
Andrea Giacometti / ; Luca Butini / ; Romana del Gobbo / ; Stefano Menzo / ; Danilo Tacconi / ; Giovanni Corbelli / ; Stefania Zanussi / ; Laura Monno / ; Grazia Punzi / ; Franco Maggiolo / ; Annapaola Callegaro / ; Leonardo Calza / ; Maria Carla Re / ; Pristerà Raffaele / ; Paola Turconi / ; Antonella Mandas / ; Sauro Tini / ; Alessia Zoncada / ; Elisabetta Paolini / ; Giorgio Amadio / ; Laura Sighinolfi / ; Giuliano Zuccati / ; Massimo Morfini / ; Roberto Manetti / ; Paola Corsi / ; Luisa Galli / ; Massimo Di Pietro / ; Filippo Bartalesi / ; Grazia Colao / ; Andrea Tosti / ; Antonio Di Biagio / ; Maurizio Setti / ; Bianca Bruzzone / ; Giovanni Penco / ; Michele Trezzi / ; Anna Orani / ; Riccardo Pardelli / ; Michele De Gennaro / ; Alessandro Chiodera / ; Alfredo Scalzini / ; Loredana Palvarini / ; Paolo Almi / ; Giovanni Todaro / ; Antonella d'Arminio Monforte / ; Paola Cicconi / ; Stefano Rusconi / ; Maria Rita Gismondo / ; Maria Rita Gismondo / ; Valeria Micheli / ; Maria Luisa Biondi / ; Nicola Gianotti / ; Amedeo Capetti / ; Paola Meraviglia / ; Enzo Boeri / ; Cristina Mussini / ; Monica Pecorari / ; Alessandro Soria / ; Laura Vecchi / ; Maurizio Santirocchi / ; Diego Brustia / ; Paolo Ravanini / ; Federico Dal Bello / ; Nino Romano / ; Salvatrice Mancuso / ; Carlo Calzetti / ; Renato Maserati / ; Gaetano Filice / ; Fausto Baldanti / ; Daniela Francisci / ; Giustino Parruti / ; Ennio Polilli / ; Daria Sacchini / ; Chiara Martinelli / ; Rita Consolini / ; Linda Vatteroni / ; Angela Vivarelli / ; Daniele Dionisio / ; Alessandro Nerli / ; Lucia Lenzi / ; Giacomo Magnani / ; Patrizia Ortolani / ; Massimo Andreoni / ; Guido Palamara / ; Caterina Fimiani / ; Lucia Palmisano / ; Andrea De Luca / ; Simona Di Giambenedetto / ; Vincenzo Vullo / ; Ombretta Turriziani / ; Marco Montano / ; Giovanni Cenderello / ; Angela Gonnelli / ; Maurizio Zazzi / ; Michele Palumbo / ; Valeria Ghisetti / ; Stefano Bonora / ; Palma Delle Foglie / ; Cristina Rossi / ; Federica Poletti / ; Vincenzo Mondino / ; Marina Malena / ; Emanuela Lattuada /

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