Antiretroviral drug reduction in highly experienced HIV-infected patients receiving a multidrug regimen: the ECOVIR study
| Autor: | Fabienne Caby, Anne-Geneviève Marcelin, Helga Junot, Cathia Soulié, Marc-Antoine Valantin, Marc Wirden, Roland Tubiana, Lise Durand, Patrick Tilleul, Christine Katlama, Lambert Assoumou, Gilles Peytavin, Myriam Kirstetter, Thi Thu-Thuy Nguyen |
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| Rok vydání: | 2019 |
| Předmět: |
0301 basic medicine
Microbiology (medical) Adult Male medicine.medical_specialty Efavirenz Nevirapine Anti-HIV Agents 030106 microbiology HIV Infections Emtricitabine 03 medical and health sciences chemistry.chemical_compound Young Adult 0302 clinical medicine Abacavir Internal medicine Antiretroviral Therapy Highly Active Drug Resistance Viral medicine Humans Pharmacology (medical) 030212 general & internal medicine Prospective Studies Aged Pharmacology business.industry Lamivudine Middle Aged Viral Load Raltegravir Atazanavir CD4 Lymphocyte Count Regimen Infectious Diseases Treatment Outcome chemistry HIV-1 Female business medicine.drug |
| Zdroj: | The Journal of antimicrobial chemotherapy. 74(9) |
| ISSN: | 1460-2091 |
| Popis: | Objectives In a context of life-long therapy, we asked whether it could be possible to reduce the number of antiretroviral drugs without jeopardizing viral suppression. Methods ECOVIR was a prospective study aiming to assess whether in patients on combination ART with ≥4 antiretrovirals for ≥24 weeks and virally suppressed for ≥48 weeks, a drug-reduced (DR) regimen could be proposed. The intervention consisted of discontinuing genotypically less susceptible drugs to reach a DR regimen with ≤3 antiretrovirals. The primary endpoint was the proportion of patients maintaining viral suppression at week (W) 24. Results From 89 eligible individuals for the study, a DR regimen was proposed in 86 (97%) patients, of whom 71 were switched to a DR regimen. Baseline characteristics [median (IQR)] were: age 58 (53–65) years, duration of treatment 24 (21–26) years and viral suppression 8 (6–11) years. The cumulative resistance profile showed full resistance to lamivudine/emtricitabine (91%), abacavir (74%), efavirenz/nevirapine (70%), rilpivirine (56%), darunavir (q24h/q12h) (42%/29%), lopinavir (69%), atazanavir (71%) and raltegravir (24%). The final DR regimen consisted of a two-drug or three-drug regimen in 54 patients (76%) and in 17 patients (24%), respectively. The success rate of a DR regimen at W24 was 93.9% (95% CI 84.4–97.6, Kaplan–Meier estimate). Four patients experienced virological failure (at W4, W8 and W12), all with plasma viral load (pVL) Conclusions In experienced patients with high-level resistance, individualized strategies based on expert advice can offer DR regimen options with fewer drug–drug interactions and a significant economic impact while ensuring virological success. |
| Databáze: | OpenAIRE |
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