Efficacy and safety of dolutegravir plus boosted-darunavir dual therapy among highly treatment-experienced patients
| Autor: | José L. Casado, María Fontecha, Aurora M Rojo, Marta Monsalvo, María J Vivancos, Pilar Vizcarra |
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| Rok vydání: | 2019 |
| Předmět: |
Oncology
Adult Male medicine.medical_specialty Pyridones HIV Infections Drug resistance Treatment experienced Piperazines chemistry.chemical_compound Internal medicine Antiretroviral Therapy Highly Active Drug Resistance Viral Oxazines Medicine Humans Pharmacology (medical) Dual therapy Darunavir Aged Pharmacology business.industry Middle Aged Viral Load Antiretroviral therapy Infectious Diseases Treatment Outcome chemistry Toxicity Dolutegravir HIV-1 Female business Viral load Heterocyclic Compounds 3-Ring medicine.drug |
| Zdroj: | Antiviral therapy. 24(6) |
| ISSN: | 2040-2058 |
| Popis: | Background Dual therapies decrease toxicity, pill-burden and treatment-associated cost. The combination of high genetic barrier drugs such as dolutegravir plus boosted-darunavir may be suitable as simplification regimen for patients harbouring multidrug-resistant virus. Methods Patients switched to a once-daily regimen consisting of dolutegravir plus darunavir, boosted with cobicistat or ritonavir, were included in this cohort study. The primary end point was the proportion of patients with HIV RNA viral load Results Overall, 51 patients were enrolled. At baseline, all patients had failed to ≥2 antiretroviral classes. Genotypic resistance profiles showed a mean of primary mutations of 1.2 for non-nucleoside reverse transcriptase inhibitors, 2.4 for nucleoside/nucleotide reverse transcriptase inhibitors and 3.5 for protease inhibitors (PIs), but they were virologically suppressed for a median of 33 months (IQR 12–60). Only five patients had reduced sensitivity to darunavir and mean genotypic susceptibility score of dual therapy was 1.95 over 2. At week 48, there were no virological failures, three patients discontinued the regimen due to neuropsychiatric adverse events, two were lost to follow-up, and therefore the efficacy was 90% (95% CI, 82, 99%, intention-to-treat analysis). Mean estimated glomerular filtration rate decreased by 8.8 ml/min/1.73 m2, though kidney tubular parameters, high density lipoprotein-cholesterol and triglycerides levels improved after switching to dual therapy. Conclusions In highly treatment-experienced patients who were virologically suppressed, switching to the combination of dolutegravir plus boosted-darunavir dual therapy was effective and well tolerated, improving lipid and renal parameters. |
| Databáze: | OpenAIRE |
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