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Sivamalar S, Gomathi S, Boobalan J, Balakrishnan P, Pradeep A, Devaraj CA, Solomonl SS, Nallusamy D, Nalini D, Sureka V, Saravanan S. Delayed identification of treatment failure causes high levels of acquired drug resistance and less future drug options among HIV-1-infected South Indians. Indian J Med Microbiol 2024; 47:100520. [PMID: 38052366 DOI: 10.1016/j.ijmmb.2023.100520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 06/21/2023] [Accepted: 11/28/2023] [Indexed: 12/07/2023]
Abstract
PURPOSE HIV-1 Drug Resistance Mutations (DRMs) among Immunological failure (IF) on NRTI based first-line regimens, Thymidine analogue (TA) - AZT & D4T and Non-Thymidine Analogue (NTA) -TDF; and predict viral drug susceptibility to gain vision about optimal treatment strategies for second-line. METHODS Cross-sectionally, 300 HIV-1 infected patients, failing first-line HAART were included. HIV-1 pol gene spanning 20-240 codons of RT was genotyped and mutation pattern was examined, (IAS-USA 2014 and Stanford HIV drug resistance database v7.0). RESULTS The median age of the participants was 35 years (IQR 29-40), CD4 T cell count of TDF failures was low at 172 cells/μL (IQR 80-252), and treatment duration was low among TDF failures (24 months vs. 61 months) (p < 0.0001). Majority of the TDF failures were on EFV based first-line (89 % vs 45 %) (p < 0.0001). Level of resistance for TDF and AZT shows, that resistance to TDF was about one-third (37 %) of TDF participants and onefourth (23 %) of AZT participants; resistance to AZT was 17 % among TDF participants and 47 % among AZT participants; resistance to both AZT and TDF was significantly high among AZT participants [21 % vs. 8 %, OR 3.057 (95 % CI 1.4-6.8), p < 0.0001]. CONCLUSION Although delayed identification of treatment failure caused high levels of acquired drug resistance in our study. Thus, we must include measures to regularize virological monitoring with integrated resistance testing in LMIC (Low and Middle Income Countries) like in India; this will help to preserve the effectiveness of ARV and ensure the success of ending AIDS as public health by 2030.
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Affiliation(s)
- Sathasivam Sivamalar
- Meenakshi Academy of Higher Education and Research (Deemed to be University), West K. K. Nagar, Chennai, 600 078, India; YR Gaitonde Centre for AIDS Research and Education, Voluntary Health Services, Hospital Campus, Taramani, Chennai, 600 113, India
| | - Selvamurthi Gomathi
- YR Gaitonde Centre for AIDS Research and Education, Voluntary Health Services, Hospital Campus, Taramani, Chennai, 600 113, India
| | - Jayaseelan Boobalan
- YR Gaitonde Centre for AIDS Research and Education, Voluntary Health Services, Hospital Campus, Taramani, Chennai, 600 113, India
| | - Pachamuthu Balakrishnan
- Centre for Infectious Diseases Saveetha Medical College & Hospitals [SMCH], Saveetha Institute of Medical and Technical Sciences [SIMATS], Saveetha University, Thandalam, Chennai, 602105, India
| | - Amrose Pradeep
- YR Gaitonde Centre for AIDS Research and Education, Voluntary Health Services, Hospital Campus, Taramani, Chennai, 600 113, India
| | - Chithra A Devaraj
- YR Gaitonde Centre for AIDS Research and Education, Voluntary Health Services, Hospital Campus, Taramani, Chennai, 600 113, India
| | - Sunil Suhas Solomonl
- YR Gaitonde Centre for AIDS Research and Education, Voluntary Health Services, Hospital Campus, Taramani, Chennai, 600 113, India; Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Duraisamy Nallusamy
- Meenakshi Academy of Higher Education and Research (Deemed to be University), West K. K. Nagar, Chennai, 600 078, India
| | - Devarajan Nalini
- Meenakshi Academy of Higher Education and Research (Deemed to be University), West K. K. Nagar, Chennai, 600 078, India
| | - Varalakshmi Sureka
- Meenakshi Academy of Higher Education and Research (Deemed to be University), West K. K. Nagar, Chennai, 600 078, India
| | - Shanmugam Saravanan
- Centre for Infectious Diseases Saveetha Medical College & Hospitals [SMCH], Saveetha Institute of Medical and Technical Sciences [SIMATS], Saveetha University, Thandalam, Chennai, 602105, India.
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Chatzidaki I, Curteis T, Luedke H, Mezzio DJ, Rhee MS, McArthur E, Eddowes LA. Indirect Treatment Comparisons of Lenacapavir Plus Optimized Background Regimen Versus Other Treatments for Multidrug-Resistant Human Immunodeficiency Virus. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:810-822. [PMID: 36566886 DOI: 10.1016/j.jval.2022.12.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 12/05/2022] [Accepted: 12/15/2022] [Indexed: 06/04/2023]
Abstract
BACKGROUND/AIMS Heavily treatment-experienced (HTE) people with human immunodeficiency virus (HIV) (PWH) may not achieve virologic suppression (VS) with combination antiretroviral therapy due to multidrug resistance (MDR), intolerance, and safety concerns. These PWH often receive highly individualized treatment regimens, but these regimens may not enable PWH to achieve VS, thereby halting disease progression. Novel medications are required for treating individuals with MDR HIV. Lenacapavir (LEN), a first-in-class HIV capsid inhibitor, is under investigation for the treatment of HTE individuals with MDR HIV in the phase 2/3 CAPELLA study. This study aimed to compare LEN plus optimized background regimen (OBR) with fostemsavir (FTR) + OBR, ibalizumab (IBA) + OBR, and OBR alone in terms of VS, CD4 cell count change from baseline, immunologic recovery, and discontinuation due to adverse events, using indirect treatment comparisons. METHODS A systematic review identified clinical evidence on HIV-1 treatments in HTE PWH. A feasibility assessment evaluated the identified studies for indirect treatment comparison analyses based on population characteristics, interventions, comparators, and outcomes of interest. Unanchored simulated treatment comparisons of LEN + OBR versus comparators were conducted. RESULTS LEN + OBR had 6.57 times higher odds of VS at weeks 24 to 28 than FTR + OBR (95% confidence interval [CI] 1.34-32.28), 8.93 times higher odds of VS than IBA + OBR (95% CI 2.07-38.46), and 12.74 times higher odds of VS than OBR alone (95% CI 1.70-95.37). Change from baseline in CD4 cell count was similar across LEN + OBR, FTR + OBR, and IBA + OBR. CONCLUSION LEN + OBR has statistically significantly greater odds of VS at weeks 24 to 28 than its comparators and represents a novel treatment for people with MDR HIV.
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Nyamankolly E, Bellecave P, Wittkop L, Le Marec F, Duffau P, Lazaro E, Vareil MO, Tumiotto C, Hessamfar M, Cazanave C, Perrier A, Leleux O, Bonnet F, Neau D. Long-term follow-up of HIV-1 multi-drug-resistant treatment-experienced participants treated with etravirine, raltegravir and boosted darunavir: towards drug-reduced regimen? ANRS CO3 Aquitaine Cohort 2007-2018. Int J Antimicrob Agents 2023; 61:106696. [PMID: 36470511 DOI: 10.1016/j.ijantimicag.2022.106696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 11/19/2022] [Accepted: 11/26/2022] [Indexed: 12/04/2022]
Abstract
OBJECTIVE To assess the efficacy of raltegravir, etravirine and darunavir/ritonavir (TRIO regimen) in treatment-experienced patients with human immunodeficiency virus-1 (HIV-1) infection by describing the proportion of patients who experienced virological failure (VF) at Week 24. The secondary objectives were to assess the HIV-1 plasma viral load (pVL) after Week 24, the proportion of patients who were receiving dual therapy or monotherapy at the last visit, and the number of deaths. METHODS Patients from the ANRS CO3 Aquitaine Cohort who were prescribed the TRIO regimen between February 2007 and September 2018 were classified into two groups based on their pVL at study inclusion: the virological failure group (VFG; pVL >50 copies/mL) and the virologically suppressed group (VSG; pVL <50 copies/mL). The impact of baseline pVL and genotypic susceptibility score (GSS) on VF was analysed. RESULTS In total, 184 patients were enrolled in this study, with 123 (66.8%) in the VFG and 61 (33.2%) in the VSG. The median length of follow-up was 7.5 (interquartile range 4.1-9.6) years, and 29 (15.8%) patients died. Thirty-seven (25.5%) patients experienced VF at Week 24, including 32/145 (32.7%) in the VFG and 5/47 (10.6%) in the VSG (P<0.01). Resistance-associated mutations were detected in integrase, reverse transcriptase and protease for 7/37 (18.9%), 3/37 (8.1%) and 1/37 (2.7%) patients, respectively. High pVL and GSS at baseline were independently associated with VF. At the last visit, 76/184 (41.3%) patients were still receiving the TRIO regimen, while 55/184 (29.9%) were receiving dual therapy and 1/184 (0.5%) was receiving protease inhibitor monotherapy. Among the 56 patients receiving dual therapy or monotherapy, 51 (96.2%) had pVL <50 copies/mL. CONCLUSION Despite a high level of mutation resistance at baseline, long-term virological follow-up was favourable and one-third of patients were eligible for drug-reducing strategies.
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Affiliation(s)
- Elsa Nyamankolly
- CHU de Bordeaux, Service des Maladies Infectieuses et Tropicales, Hôpital Pellegrin, Bordeaux, France.
| | | | - Linda Wittkop
- Bordeaux Population Health Research Center, INSERM U1219, CIC-EC 1401, Univ. Bordeaux - ISPED, 33076, Bordeaux, France; CHU de Bordeaux, Service d'information médicale, Bordeaux, France
| | - Fabien Le Marec
- Bordeaux Population Health Research Center, INSERM U1219, CIC-EC 1401, Univ. Bordeaux - ISPED, 33076, Bordeaux, France
| | - Pierre Duffau
- CHU de Bordeaux, COREVIH Nouvelle Aquitaine, Bordeaux, France; CHU de Bordeaux, Service de Médecine Interne, Hôpital Saint-André, Bordeaux, France
| | - Estibaliz Lazaro
- CHU de Bordeaux, COREVIH Nouvelle Aquitaine, Bordeaux, France; CHU de Bordeaux, Service de Médecine Interne et Maladies Infectieuses, Hôpital Haut-Lévêque, Pessac, France
| | - Marc-Olivier Vareil
- CHU de Bordeaux, COREVIH Nouvelle Aquitaine, Bordeaux, France; CH Bayonne Service des Maladies Infectieuses, Bayonne, France
| | - Camille Tumiotto
- CHU de Bordeaux, Virology Laboratory, Bordeaux, France; Université de Bordeaux, Fundamental Microbiology and Pathogenicity Laboratory, Bordeaux, France
| | - Mojgan Hessamfar
- Bordeaux Population Health Research Center, INSERM U1219, CIC-EC 1401, Univ. Bordeaux - ISPED, 33076, Bordeaux, France; CHU de Bordeaux, COREVIH Nouvelle Aquitaine, Bordeaux, France; CHU de Bordeaux, Service de Médecine Interne et Maladies Infectieuses, Hôpital Saint-André, Bordeaux, France
| | - Charles Cazanave
- CHU de Bordeaux, Service des Maladies Infectieuses et Tropicales, Hôpital Pellegrin, Bordeaux, France
| | - Adélaïde Perrier
- Bordeaux Population Health Research Center, INSERM U1219, CIC-EC 1401, Univ. Bordeaux - ISPED, 33076, Bordeaux, France
| | - Olivier Leleux
- Bordeaux Population Health Research Center, INSERM U1219, CIC-EC 1401, Univ. Bordeaux - ISPED, 33076, Bordeaux, France
| | - Fabrice Bonnet
- Bordeaux Population Health Research Center, INSERM U1219, CIC-EC 1401, Univ. Bordeaux - ISPED, 33076, Bordeaux, France; CHU de Bordeaux, COREVIH Nouvelle Aquitaine, Bordeaux, France; CHU de Bordeaux, Service de Médecine Interne et Maladies Infectieuses, Hôpital Saint-André, Bordeaux, France
| | - Didier Neau
- CHU de Bordeaux, Service des Maladies Infectieuses et Tropicales, Hôpital Pellegrin, Bordeaux, France; CHU de Bordeaux, COREVIH Nouvelle Aquitaine, Bordeaux, France
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Mocellin LP, Ziegelmann PK, Kuchenbecker R. A systematic review and meta-analysis assessing antiretroviral therapy for treatment-experienced HIV adult patients using an optimized background therapy approach: is there evidence enough for a standardized third-line strategy? Syst Rev 2022; 11:243. [PMID: 36397111 PMCID: PMC9673282 DOI: 10.1186/s13643-022-02102-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 10/16/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The World Health Organization (WHO) has identified the need for evidence on third-line antiretroviral therapy (ART) for adults living with HIV/AIDS, given that some controversy remains as to the best combinations of ART for experienced HIV-1-infected patients. Therefore, we conducted a systematic review and meta-analysis to (i) assess the efficacy of third-line therapy for adults with HIV/AIDS based on randomized controlled trials (RCT) that adopted the "new antiretroviral (ARV) + optimized background therapy (OBT)" approach and (ii) address the key issues identified in WHO's guidelines on the use of third-line therapy. METHODS MEDLINE, EMBASE, LILACS, ISI Web of Science, SCOPUS, and Cochrane Central Register of Controlled Trials were searched for RCTs assessing third-line ARV therapy that used an OBT approach between 1966 and 2015. Data was extracted using an Excel-structured datasheet based on the Consolidated Standards of Reporting Trials (CONSORT) recommendations. The primary outcome of this meta-analysis was the proportion of patients reaching undetectable HIV RNA levels (< 50 copies/mL) at 48 weeks of follow-up. Included studies were evaluated using the Cochrane's Risk of Bias assessment tool. Summarized evidence was rated according to the GRADE approach. RESULTS Eighteen trials assessing 9 new ARV + OBT combinations defined as third-line HIV therapy provided the efficacy data: 7 phase IIb trials and 11 phase III trials. Four of the 18 trials provided extension data, thus resulting in 14 trials providing 48-week efficacy data. In the meta-analysis, considering the outcome regarding the proportion of patients with a viral load below 50 copies/ml at 48 weeks, 9 out of 14 trials demonstrated the superiority of the new combination being studied (risk difference = 0.18, 95% CI 0.13-0.23). The same analysis stratified by the number of fully active ARVs demonstrated a risk difference of 0.29 (95% CI 0.12-0.46), 0.28 (95% CI 0.17-0.38) and 0.17 (95% CI 0.10-0.24) respectively from zero, one, and two or more active drugs strata. Nine of the 18 trials were considered to have a high risk of bias. CONCLUSIONS Efficacy results demonstrated that the groups of HIV-experienced patients receiving the new ARV + OBT were more likely to achieve viral suppression when compared to the control groups. However, most of these trials may be at a high risk of bias. Thus, there is still not enough evidence to stipulate which combinations are the most effective for therapeutic regimens that are to be used sequentially due to documented multi-resistance.
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Affiliation(s)
- Lucas Pitrez Mocellin
- Universidade Federal do Pampa - Campus Uruguaiana, Administrative Building, Collective Room No. 2, BR 472, Km 592 - Caixa Postal 118, Uruguaiana, RS, Brazil
| | - Patricia Klarmann Ziegelmann
- Statistics Department, Hospital de Clínicas de Porto Alegre, Universidade Federal Do Rio Grande Do Sul, Rua Ramiro Barcelos, Porto Alegre, RS, 2350, Brazil
| | - Ricardo Kuchenbecker
- Programa de Pós-Graduação Em Epidemiologia, Hospital de Clínicas de Porto Alegre, Universidade Federal Do Rio Grande Do Sul, Rua Ramiro Barcelos, Porto Alegre, RS, 2350, Brazil.
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Shchemelev AN, Semenov AV, Ostankova YV, Naidenova EV, Zueva EB, Valutite DE, Churina MA, Virolainen PA, Totolian AA. [Genetic diversity of the human immunodeficiency virus (HIV-1) in the Kaliningrad region]. Vopr Virusol 2022; 67:310-321. [PMID: 36097712 DOI: 10.36233/0507-4088-119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 09/12/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION As is currently known, the epidemic process in the Kaliningrad Region was mainly associated with the spread of the recombinant form of HIV-1 (CRF03_AB); however, regular HIV importations from other countries and continents has created favorable conditions for emergence and spread of various recombinant forms of the virus.The most complete information on the diversity of recombinant forms in the region is also necessary to understand the structure of drug resistance (DR). The aim of the study was to explore the HIV-1 genetic diversity in the Kaliningrad Region. MATERIALS AND METHODS We studied 162 blood plasma samples obtained from patients from the Kaliningrad Region, both with confirmed virological failure of antiretroviral therapy (ART) and with newly diagnosed HIV infection. For reverse transcription and amplification of HIV genome fragments, diagnostic «AmpliSense HIVResist-Seq». RESULTS AND DISCUSSION The various recombinants between subtypes A and B (74%) were predominant in study group: recombinant was between CRF03_AB and subtype A (33.95%) and CRF03_AB-like (13.58%) were the most common. Among the "pure" subtypes of the virus, subtype A6 (16.67%). The circulation of subtypes B (3.70%) and G (1.23%) was also noted.Ninety-six patients (59.26%) were identified with at least one mutation associated with antiretroviral (ARV) drug resistance. CONCLUSION The observed diversity of subtypes and recombinant forms of the virus implies that the new recombinants are actively emerging in the studied region, both between existing recombinant forms and "pure" subtypes, as well as between "pure" subtypes.
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Affiliation(s)
- A N Shchemelev
- FBSI «Saint Petersburg Pasteur Research Institute of Epidemiology and Microbiology» of the Federal Service for Surveillance of Consumer Rights Protection and Human Welfare (Rospotrebnadzor)
| | - A V Semenov
- Ekaterinburg Research Institute of Viral Infections of the Federal Research Institute, State Research Center for Virology and Biotechnology "Vector" of the Consumer Rights Protection and Human Welfare (Rospotrebnadzor)
| | - Yu V Ostankova
- FBSI «Saint Petersburg Pasteur Research Institute of Epidemiology and Microbiology» of the Federal Service for Surveillance of Consumer Rights Protection and Human Welfare (Rospotrebnadzor)
| | - E V Naidenova
- FSSI Russian Research Anti-Plague Institute «Microbe» of the Federal Service for Surveillance of Consumer Rights Protection and Human Welfare (Rospotrebnadzor)
| | - E B Zueva
- FBSI «Saint Petersburg Pasteur Research Institute of Epidemiology and Microbiology» of the Federal Service for Surveillance of Consumer Rights Protection and Human Welfare (Rospotrebnadzor)
| | - D E Valutite
- FBSI «Saint Petersburg Pasteur Research Institute of Epidemiology and Microbiology» of the Federal Service for Surveillance of Consumer Rights Protection and Human Welfare (Rospotrebnadzor)
| | - M A Churina
- St. Petersburg GBUZ «Botkin Clinical Infectious Diseases Hospital»
| | - P A Virolainen
- FBSI «Saint Petersburg Pasteur Research Institute of Epidemiology and Microbiology» of the Federal Service for Surveillance of Consumer Rights Protection and Human Welfare (Rospotrebnadzor)
| | - A A Totolian
- FBSI «Saint Petersburg Pasteur Research Institute of Epidemiology and Microbiology» of the Federal Service for Surveillance of Consumer Rights Protection and Human Welfare (Rospotrebnadzor)
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Tariq S, Kasadha B. HIV and women’s health: Where are we now? WOMEN'S HEALTH 2022; 18:17455065221076341. [PMID: 35107041 PMCID: PMC8814966 DOI: 10.1177/17455065221076341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Shema Tariq
- UCL Centre for Clinical Research in Infection and Sexual Health, Institute for Global Health, University College London, London, UK
- Mortimer Market Centre, CNWL NHS Foundation Trust, London, UK
| | - Bakita Kasadha
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Sluis-Cremer N. Retroviral reverse transcriptase: Structure, function and inhibition. Enzymes 2021; 50:179-194. [PMID: 34861936 DOI: 10.1016/bs.enz.2021.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Reverse transcriptase (RT) is a multifunctional enzyme that has RNA- and DNA-dependent DNA polymerase activity and ribonuclease H (RNase H) activity, and is responsible for the reverse transcription of retroviral single-stranded RNA into double-stranded DNA. The essential role that RT plays in the human immunodeficiency virus (HIV) life cycle is highlighted by the fact that multiple antiviral drugs-which can be classified into two distinct therapeutic classes-are routinely used to treat and/or prevent HIV infection. This book chapter provides detailed insights into the three-dimensional structure of HIV RT, the biochemical mechanisms of DNA polymerization and RNase H activity, and the mechanisms by which nucleoside/nucleotide and nonnucleoside RT inhibitors block reverse transcription.
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Affiliation(s)
- Nicolas Sluis-Cremer
- Department of Medicine, Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.
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Youssef M, Zani B, Olaiya O, Soliman M, Mbuagbaw L. Virological measures and factors associated with outcomes, and missing outcome data in HIV clinical trials: a methodological study. BMJ Open 2021; 11:e039462. [PMID: 34697107 PMCID: PMC8547356 DOI: 10.1136/bmjopen-2020-039462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND To evaluate the definition of HIV virological outcomes in the literature and factors associated with outcomes and missing outcome data. METHODS We conducted a methodological review of HIV RCTs using a search (2009-2019) of PubMed, Embase and the Cochrane Central Register of Controlled Trials.Only full-text, peer-reviewed, randomised controlled trials (RCTs) that measured virological outcomes in people living with HIV, and published in English were included.We extracted study details and outcomes. We used logistic regression to identify factors associated with a viral threshold ≤50 copies/mL and linear regression to identify factors associated with missing outcome data. RESULTS Our search yielded 5847 articles; 180 were included. A virological outcome was the primary outcome in 73.5% of studies. 89 studies (49.4%) used virological success. The remaining used change in viral load (VL) (33 studies, 18.3%); virological failure (59 studies, 32.8%); or virological rebound (9 studies, 5.0%). 96 studies (53.3%) set the threshold at ≤50 copies/mL; and 33.1% used multiple measures.Compared with government and privately funded studies, RCTs with industry funding (adjusted OR 6.39; 95% CI 2.15 to 19.00; p<0.01) were significantly associated with higher odds of using a VL threshold of ≤50 copies/mL. Publication year, intervention type, income level and number of patients were not associated with a threshold of ≤50 copies/mL. Trials with pharmacological interventions had less missing data (β=-11.04; 95% CI -20.02 to -1.87; p=0.02). DISCUSSION Country source of funding was associated with VL threshold choice and studies with pharmacological interventions had less missing data, which may in part explain heterogeneous virological outcomes across studies. Multiple measures of VL were not associated with missing data. The development of formal guidelines on virological outcome reporting in RCTs is needed.
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Affiliation(s)
- Mark Youssef
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Babalwa Zani
- Knowledge Translation Unit, University of Cape Town Lung Institute, Rondebosch, South Africa
| | - Oluwatobi Olaiya
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Michael Soliman
- Faculty of Science, University of Ottawa, Ottawa, Ontario, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, Ontario, Canada
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Anderson SJ, Murray M, Cella D, Grossberg R, Hagins D, Towner W, Wang M, Clark A, Pierce A, Llamoso C, Ackerman P, Lataillade M. Patient-Reported Outcomes in the Phase III BRIGHTE Trial of the HIV-1 Attachment Inhibitor Prodrug Fostemsavir in Heavily Treatment-Experienced Individuals. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2021; 15:131-143. [PMID: 34180035 PMCID: PMC8739158 DOI: 10.1007/s40271-021-00534-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/07/2021] [Indexed: 11/05/2022]
Abstract
Introduction Heavily treatment-experienced (HTE) people living with HIV-1 (PLWH) have limited viable antiretroviral regimens available because of multidrug resistance and safety concerns. The first-in-class HIV-1 attachment inhibitor fostemsavir demonstrated efficacy and safety in HTE participants in the ongoing phase III BRIGHTE trial. Objectives We describe patient-reported outcomes (PROs) through week 48. Methods Eligible participants for whom their current regimen was failing were assigned to the randomized cohort (RC; one to two fully active agents remaining) or the nonrandomized cohort (NRC; no fully active agents remaining). PRO assessments included the EQ-5D-3L, EQ-VAS, and Functional Assessment of HIV Infection (FAHI) instruments. Results Both cohorts achieved increases in EQ-5D-3L US- and UK-referenced utility score from baseline at week 24. Mean visual analog scale (VAS) scores in the RC and NRC increased from baseline by 8.7 (95% CI 6.2–11.2) and 5.6 points (95% CI 1.5–9.7) at week 24 and increased from baseline by 9.8 (95% CI 7.0–12.6) and 4.9 points (95% CI 0.6–9.2) at week 48, respectively. Mean increases in FAHI total score from baseline to weeks 24 and 48 in the RC were 6.9 (95% CI 4.2–9.7) and 5.8 (95% CI 2.7–9.0), respectively, whereas mean increases in physical and emotional well-being subscale scores were 2.7 (95% CI 1.9–3.6) and 2.4 (95% CI 1.3–3.4) and 3.2 (95% CI 2.2–4.2) and 2.6 (95% CI 1.6–3.7), respectively, with little to no change in other subscales. Conclusions Improvements in major domains of the EQ-VAS and FAHI through week 48, combined with efficacy and safety results, support the use of fostemsavir for HTE PLWH. Trial Registration Number and Date NCT02362503; February 13, 2015.
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Affiliation(s)
- Sarah-Jane Anderson
- GlaxoSmithKline, Brentford, UK. .,ViiV Healthcare, 980 Great West Road, Brentford, Middlesex, TW8 9GS, UK.
| | - Miranda Murray
- ViiV Healthcare, 980 Great West Road, Brentford, Middlesex, TW8 9GS, UK
| | - David Cella
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Debbie Hagins
- Georgia Department of Public Health, Coastal Health District, Chatham CARE Center, Savannah, GA, USA
| | - William Towner
- Southern California Kaiser Permanente Medical Group, Los Angeles, CA, USA
| | | | - Andrew Clark
- ViiV Healthcare, 980 Great West Road, Brentford, Middlesex, TW8 9GS, UK
| | - Amy Pierce
- ViiV Healthcare, Research Triangle Park, NC, USA
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High Detection Rate of HIV Drug Resistance Mutations among Patients Who Fail Combined Antiretroviral Therapy in Manaus, Brazil. BIOMED RESEARCH INTERNATIONAL 2021; 2021:5567332. [PMID: 34212033 PMCID: PMC8208851 DOI: 10.1155/2021/5567332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/10/2021] [Accepted: 05/27/2021] [Indexed: 02/08/2023]
Abstract
Virologic failure may occur because of poor treatment adherence and/or viral drug resistance mutations (DRM). In Brazil, the northern region exhibits the worst epidemiological scenarios for the human immunodeficiency virus (HIV). Thus, this study is aimed at investigating the genetic diversity of HIV-1 and DRM in Manaus. The cross-sectional study included people living with HIV on combined antiretroviral therapy and who had experienced virological failure during 2018-2019. Sequencing of the protease/reverse transcriptase (PR/RT) and C2V3 of the viral envelope gp120 (Env) regions was analyzed to determine subtypes/variants of HIV-1, DRMs, and tropism. Ninety-two individuals were analyzed in the study. Approximately 72% of them were male and 74% self-declared as heterosexual. Phylogenetic inference (PR/RT-Env) showed that most sequences were B subtype, followed by BF1 or BC mosaic genomes and few F1 and C sequences. Among the variants of subtype B at PR/RT, 84.3% were pandemic (BPAN), and 15.7% were Caribbean (BCAR). The DRMs most frequent were M184I/V (82.9%) for nucleoside reverse transcriptase inhibitors (NRTI), K103N/S (63.4%) for nonnucleoside reverse transcriptase inhibitor (NNRTI), and V82A/L/M (7.3%) for protease inhibitors (PI). DRM analysis depicted high levels of resistance for lamivudine and efavirenz in over 82.9% of individuals; although, low (7.7%) cross-resistance to etravirine was observed. A low level of resistance to protease inhibitors was found and included patients that take atazanavir/ritonavir (16.6%) and lopinavir (11.1%), which confirms that these antiretrovirals can be used—for most individuals. The thymidine analog mutations-2 (TAM-2) resistance pathway was higher in BCAR than in BPAN. Similar results from other Brazilian studies regarding HIV drug resistance were observed; however, we underscore a need for additional studies regarding subtype BCAR variants. Molecular epidemiology studies are an important tool for monitoring the prevalence of HIV drug resistance and can influence the public health policies.
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Abstract
Etravirine is a second-generation non-nucleoside reverse transcriptase inhibitor (NNRTI) for the treatment of human immunodeficiency virus type 1 infection. It is a potent inhibitor of HIV reverse transcriptase and retains activity against wild-type and most NNRTI-resistant HIV. The pharmacokinetic profile of etravirine and clinical data support twice-daily dosing, although once-daily dosing has been investigated in treatment-naïve and treatment-experienced persons. Despite similar pharmacokinetic and pharmacodynamic results compared with twice-daily dosing, larger studies are needed to fully support once-daily etravirine dosing in treatment-naïve individuals. Etravirine is reserved for use in third- or fourth-line antiretroviral treatment regimens, as recommended, for example, in treatment guidelines by the US Department of Health and Human Services-Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living with HIV. Etravirine exhibits the potential for bi-directional drug-drug interactions with other antiretrovirals and concomitant medications through its interactions with cytochrome P450 (CYP) isozymes: CYP3A4, CYP2C9, and CYP2C19. This review summarizes the pharmacokinetic and pharmacodynamic parameters of etravirine, with particular attention to information on drug-drug interactions and use in special patient populations, including children/adolescents, women, persons with organ dysfunction, and during pregnancy.
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Efficacy, pharmacokinetics and neurocognitive performance of dual, NRTI-sparing antiretroviral therapy in acute HIV-infection. AIDS 2020; 34:1923-1931. [PMID: 32773474 DOI: 10.1097/qad.0000000000002652] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate penetration of antiretrovirals into compartments and efficacy of a dual, NRTI-sparing regimen in acute HIV infection (AHI). DESIGN Single-arm, open-label pilot study of participants with AHI initiating ritonavir-boosted darunavir 800 mg once daily and etravirine 400 mg once daily or 200 mg twice daily within 30 days of AHI diagnosis. METHODS Efficacy was defined as HIV RNA less than 200 copies/ml by week 24. Optional sub-studies included pharmacokinetics analysis from genital fluids (weeks 0-4, 12, 48), cerebrospinal fluid (CSF) (weeks 2-4, 24 and 48) and endoscopic biopsies (weeks 4-12 and 36-48). Neuropsychological performance was assessed at weeks 0, 24 and 48. RESULTS Fifteen AHI participants were enrolled. Twelve (80%) participants achieved HIV RNA less than 200 copies/ml by week 24. Among 12 participants retained through week 48, nine (75%) remained suppressed to less than 50 copies/ml. The median time from ART initiation to suppression less than 200 and less than 50 copies/ml was 59 and 86 days, respectively. The penetration ratios for etravirine and darunavir in gut associated lymphoid tissue were 19.2 and 3.05, respectively. Most AHI participants achieving viral suppression experienced neurocognitive improvement. Of the three participants without overall improvement in neurocognitive functioning as measured by impairment ratings (more than two tests below 1 SD), two had virologic failure. CONCLUSION NRTI-sparing ART started during AHI resulted in rapid viral suppression similar to NRTI-based regimens. More novel and compact two-drug treatments for AHI should be considered. Early institution of ART during AHI appears to improve overall neurocognitive function and may reduce the risk of subsequent neurocognitive impairment. CLINICALTRIALS.GOV:: NCT00855413.
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Yu ZJ, Mosher EP, Bumpus NN. Pharmacogenomics of Antiretroviral Drug Metabolism and Transport. Annu Rev Pharmacol Toxicol 2020; 61:565-585. [PMID: 32960701 DOI: 10.1146/annurev-pharmtox-021320-111248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Antiretroviral therapy has markedly reduced morbidity and mortality for persons living with human immunodeficiency virus (HIV). Individual tailoring of antiretroviral regimens has the potential to further improve the long-term management of HIV through the mitigation of treatment failure and drug-induced toxicities. While the mechanisms underlying anti-HIV drug adverse outcomes are multifactorial, the application of drug-specific pharmacogenomic knowledge is required in order to move toward the personalization of HIV therapy. Thus, detailed understanding of the metabolism and transport of antiretrovirals and the influence of genetics on these pathways is important. To this end, this review provides an up-to-date overview of the metabolism of anti-HIV therapeutics and the impact of genetic variation in drug metabolism and transport on the treatment of HIV. Future perspectives on and current challenges in pursuing personalized HIV treatment are also discussed.
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Affiliation(s)
- Zaikuan J Yu
- Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA;
| | - Eric P Mosher
- Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA;
| | - Namandjé N Bumpus
- Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA;
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Valantin MA, Durand L, Wirden M, Assoumou L, Caby F, Soulié C, Nguyen TTT, Tubiana R, Kirstetter M, Junot H, Marcelin AG, Peytavin G, Tilleul P, Katlama C. Antiretroviral drug reduction in highly experienced HIV-infected patients receiving a multidrug regimen: the ECOVIR study. J Antimicrob Chemother 2020; 74:2716-2722. [PMID: 31273376 DOI: 10.1093/jac/dkz255] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 05/06/2019] [Accepted: 05/22/2019] [Indexed: 12/24/2022] Open
Abstract
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) <600 copies/mL and no emergence of resistance mutations. The DR strategy allowed a monthly cost saving of 36%. 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.
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Affiliation(s)
- Marc-Antoine Valantin
- AP-HP, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Service des Maladies Infectieuses, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, (IPLESP UMRS 1136), F-75013, Paris, France
| | - Lise Durand
- GH Pitié-Salpêtrière APHP, Pharmacy, Paris, France
| | - Marc Wirden
- INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), AP-HP, Hôpital Pitié-Salpêtrière, Laboratoire de virologie, F-75013, Paris, France
| | - Lambert Assoumou
- INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
| | - Fabienne Caby
- AP-HP, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Service des Maladies Infectieuses, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, (IPLESP UMRS 1136), F-75013, Paris, France
| | - Cathia Soulié
- INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), AP-HP, Hôpital Pitié-Salpêtrière, Laboratoire de virologie, F-75013, Paris, France
| | - Thi Thu-Thuy Nguyen
- INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), AP-HP, Hôpital Pitié-Salpêtrière, Laboratoire de virologie, F-75013, Paris, France
| | - Roland Tubiana
- AP-HP, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Service des Maladies Infectieuses, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, (IPLESP UMRS 1136), F-75013, Paris, France
| | - Myriam Kirstetter
- AP-HP, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Service des Maladies Infectieuses, Paris, France
| | - Helga Junot
- GH Pitié-Salpêtrière APHP, Pharmacy, Paris, France
| | - Anne-Geneviève Marcelin
- INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), AP-HP, Hôpital Pitié-Salpêtrière, Laboratoire de virologie, F-75013, Paris, France
| | - Gilles Peytavin
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, AP-HP, Laboratoire de Pharmacologie-Toxicologie, Hôpital Bichat Claude-Bernard, Paris, France
| | - Patrick Tilleul
- GH Pitié-Salpêtrière APHP, Pharmacy, Paris, France.,Paris Descartes Université, Pharmacie Clinique, Faculté de Pharmacie, Paris, France
| | - Christine Katlama
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, (IPLESP UMRS 1136), AP-HP, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Service des Maladies Infectieuses, F-75013, Paris, France
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Giacomelli A, Pezzati L, Rusconi S. The crosstalk between antiretrovirals pharmacology and HIV drug resistance. Expert Rev Clin Pharmacol 2020; 13:739-760. [PMID: 32538221 DOI: 10.1080/17512433.2020.1782737] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The clinical development of antiretroviral drugs has been followed by a rapid and concomitant development of HIV drug resistance. The development and spread of HIV drug resistance is due on the one hand to the within-host intrinsic HIV evolutionary rate and on the other to the wide use of low genetic barrier antiretrovirals. AREAS COVERED We searched PubMed and Embase on 31 January 2020, for studies reporting antiretroviral resistance and pharmacology. In this review, we assessed the molecular target and mechanism of drug resistance development of the different antiretroviral classes focusing on the currently approved antiretroviral drugs. Then, we assessed the main pharmacokinetic/pharmacodynamic of the antiretrovirals. Finally, we retraced the history of antiretroviral treatment and its interconnection with antiretroviral worldwide resistance development both in , and middle-income countries in the perspective of 90-90-90 World Health Organization target. EXPERT OPINION Drug resistance development is an invariably evolutionary driven phenomenon, which challenge the 90-90-90 target. In high-income countries, the antiretroviral drug resistance seems to be stable since the last decade. On the contrary, multi-intervention strategies comprehensive of broad availability of high genetic barrier regimens should be implemented in resource-limited setting to curb the rise of drug resistance.
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Affiliation(s)
- Andrea Giacomelli
- III Infectious Disease Unit, ASST-FBF-Sacco , Milan, Italy.,Department of Biomedical and Clinical Sciences DIBIC L. Sacco, University of Milan , Milan, Italy
| | - Laura Pezzati
- III Infectious Disease Unit, ASST-FBF-Sacco , Milan, Italy.,Department of Biomedical and Clinical Sciences DIBIC L. Sacco, University of Milan , Milan, Italy
| | - Stefano Rusconi
- III Infectious Disease Unit, ASST-FBF-Sacco , Milan, Italy.,Department of Biomedical and Clinical Sciences DIBIC L. Sacco, University of Milan , Milan, Italy
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Himmel DM, Arnold E. Non-Nucleoside Reverse Transcriptase Inhibitors Join Forces with Integrase Inhibitors to Combat HIV. Pharmaceuticals (Basel) 2020; 13:ph13060122. [PMID: 32545407 PMCID: PMC7345359 DOI: 10.3390/ph13060122] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/05/2020] [Accepted: 06/05/2020] [Indexed: 12/17/2022] Open
Abstract
In the treatment of acquired immune deficiency syndrome (AIDS), the diarylpyrimidine (DAPY) analogs etravirine (ETR) and rilpivirine (RPV) have been widely effective against human immunodeficiency virus (HIV) variants that are resistant to other non-nucleoside reverse transcriptase inhibitors (NNRTIs). With non-inferior or improved efficacy, better safety profiles, and lower doses or pill burdens than other NNRTIs in the clinic, combination therapies including either of these two drugs have led to higher adherence than other NNRTI-containing treatments. In a separate development, HIV integrase strand transfer inhibitors (INSTIs) have shown efficacy in treating AIDS, including raltegravir (RAL), elvitegravir (EVG), cabotegravir (CAB), bictegravir (BIC), and dolutegravir (DTG). Of these, DTG and BIC perform better against a wide range of resistance mutations than other INSTIs. Nevertheless, drug-resistant combinations of mutations have begun to emerge against all DAPYs and INSTIs, attributable in part to non-adherence. New dual therapies that may promote better adherence combine ETR or RPV with an INSTI and have been safer and non-inferior to more traditional triple-drug treatments. Long-acting dual- and triple-therapies combining ETR or RPV with INSTIs are under study and may further improve adherence. Here, highly resistant emergent mutations and efficacy data on these novel treatments are reviewed. Overall, ETR or RPV, in combination with INSTIs, may be treatments of choice as long-term maintenance therapies that optimize efficacy, adherence, and safety.
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Affiliation(s)
- Daniel M. Himmel
- Himmel Sci Med Com, L.L.C., Bala Cynwyd, PA 19004, USA
- Correspondence: ; Tel.: +1-848-391-5973
| | - Eddy Arnold
- Center for Advanced Biotechnology and Medicine (CABM), Department of Chemistry and Chemical Biology, Rutgers University, Piscataway, NJ 08854, USA;
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Discordance between Etravirine Phenotype and Genotype-Based Predicted Phenotype for Subtype C HIV-1 from First-Line Antiretroviral Therapy Failures in South Africa. Antimicrob Agents Chemother 2020; 64:AAC.02101-19. [PMID: 32071061 DOI: 10.1128/aac.02101-19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 02/12/2020] [Indexed: 12/25/2022] Open
Abstract
Etravirine (ETR) is a nonnucleoside reverse transcriptase inhibitor (NNRTI) used in treatment-experienced individuals. Genotypic resistance test-interpretation systems can predict ETR resistance; however, genotype-based algorithms are derived primarily from HIV-1 subtype B and may not accurately predict resistance in non-B subtypes. The frequency of ETR resistance among recombinant subtype C HIV-1 and the accuracy of genotypic interpretation systems were investigated. HIV-1LAI containing full-length RT from HIV-1 subtype C-positive individuals experiencing virologic failure (>10,000 copies/ml and >1 NNRTI resistance-associated mutation) were phenotyped for ETR susceptibility. Fold change (FC) was calculated against a composite 50% effective concentration (EC50) from treatment-naive individuals and three classifications were assigned: (i) <2.9-FC, susceptible; (ii) ≥2.9- to 10-FC, partially resistant; and (iii) >10-FC, fully resistant. The Stanford HIVdb-v8.4 was used for genotype predictions merging the susceptible/potential low-level and low-level/intermediate groups for 3 × 3 comparison. Fifty-four of a hundred samples had reduced ETR susceptibility (≥2.9-FC). The FC correlated with HIVdb-v8.4 (Spearman's rho = 0.62; P < 0.0001); however, 44% of samples were partially (1 resistance classification difference) and 4% completely discordant (2 resistance classification differences). Of the 34 samples with an FC of >10, 26 were HIVdb-v8.4 classified as low-intermediate resistant. Mutations L100I, Y181C, or M230L were present in 27/34 (79%) of samples with an FC of >10 but only in 2/46 (4%) of samples with an FC of <2.9. No other mutations were associated with ETR resistance. Viruses containing the mutation K65R were associated with reduced ETR susceptibility, but 65R reversions did not increase ETR susceptibility. Therefore, genotypic interpretation systems were found to misclassify ETR susceptibility in HIV-1 subtype C samples. Modifications to genotypic algorithms are needed to improve the prediction of ETR resistance for the HIV-1 subtype C.
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Wang Y, De Clercq E, Li G. Current and emerging non-nucleoside reverse transcriptase inhibitors (NNRTIs) for HIV-1 treatment. Expert Opin Drug Metab Toxicol 2019; 15:813-829. [PMID: 31556749 DOI: 10.1080/17425255.2019.1673367] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Introduction: Non-nucleoside reverse transcriptase inhibitors (NNRTIs) are essential components of highly active antiretroviral therapy against HIV-1 infections. Here, we provide a comprehensive overview of approved and emerging NNRTIs. Areas covered: This review covers the latest trend of NNRTIs regarding their pharmacodynamics, pharmacokinetics, mechanisms of drug action, drug resistance as well as new applications such as two-drug regimens and long-acting formulations. Expert opinion: Since the first NNRTI, nevirapine, was approved in 1996, antiviral drug discovery led to the approval of seven NNRTIs, including nevirapine, delavirdine (discontinued), etravirine, elsulfavirine, efavirenz, rilpivirine, and doravirine. The latter three compounds with favorable pharmacodynamic profiles and minimal adverse effects are often combined with one integrase inhibitor or two NRTIs in once-daily fixed-dose tablets. NNRTI-anchored regimens have been approved as initial therapies in treatment-naïve patients (efficacy: 72% to 86%) or maintaining therapies in virologically-suppressed patients (efficacy: 91% to 95%). Future development of NNRTIs includes: (i) better resistance and cross-resistance profiles; (ii) reduction of drug burden by optimizing two-drug or three-drug combinations; and (iii) improvement of patient adherence by novel long-acting formulations with weekly or monthly administration. Overall, NNRTIs play an important role in the management of HIV-1 infections, especially in resource-limited countries.
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Affiliation(s)
- Yali Wang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University , Changsha , Hunan , China
| | - Erik De Clercq
- KU Leuven, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research , Leuven , Belgium
| | - Guangdi Li
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University , Changsha , Hunan , China
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Abstract
Approximately 20% of people with HIV in the United States prescribed antiretroviral therapy are not virally suppressed. Thus, optimal management of virologic failure has a critical role in the ability to improve viral suppression rates to improve long-term health outcomes for those infected and to achieve epidemic control. This article discusses the causes of virologic failure, the use of resistance testing to guide management after failure, interpretation and relevance of HIV drug resistance patterns, considerations for selection of second-line and salvage therapies, and management of virologic failure in special populations.
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Affiliation(s)
- Suzanne M McCluskey
- Division of Infectious Diseases, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, GRJ5, Boston, MA 02114, USA.
| | - Mark J Siedner
- Division of Infectious Diseases, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, GRJ5, Boston, MA 02114, USA
| | - Vincent C Marconi
- Division of Infectious Diseases, Department of Global Health, Emory University School of Medicine, Rollins School of Public Health, Health Sciences Research Building, 1760 Haygood Dr NE, Room W325, Atlanta, GA 30322, USA
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Martìnez E, Pulido F. Introducción. Darunavir, cobicistat, emtricitabina y tenofovir alafenamida coformulados en el tratamiento de la infección por el VIH. Enferm Infecc Microbiol Clin 2019; 36 Suppl 2:1-2. [PMID: 30545465 DOI: 10.1016/s0213-005x(18)30384-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Esteban Martìnez
- Unidad de VIH, Servicio de Enfermedades Infecciosas, Institut d'Investigacions Biomèdiques Pi i Sunyer, Hospital ClÍnic, Universitat de Barcelona, Barcelona, España.
| | - Federico Pulido
- Unidad de VIH, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Universidad Complutense de Madrid, Madrid, España
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Abstract
Darunavir is the gold standard protease inhibitor in antiretroviral treatment. It has undergone complete development through randomised clinical trials throughout the entire spectrum of HIV infection, with 2 different dosages and clear indications of when to use each one of them. It has been studied in mono, dual and triple therapy. It can also be administered boosted with either ritonavir or cobicistat. The data indicate that it is the antiretroviral with the greatest barrier against resistance development and that it is the drug with the longest residence time bound to its receptor (protease), thus having the longest dissociation time. Its limited impact on selected mutations in the protease by other inhibitors and its high barrier against resistance have resulted in its widespread commercial use being associated with a steady decrease in the mutations circulating in the protease having an impact on its activity. Supplement information: This article is part of a supplement entitled "Co-formulated cobicistat-boosted darunavir, emtricitabine, and tenofovir alafenamide for the treatment of HIV infection", which is sponsored by Janssen.
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Hoosen K, Mosam A, Dlova NC, Grayson W. An Update on Adverse Cutaneous Drug Reactions in HIV/AIDS. Dermatopathology (Basel) 2019; 6:111-125. [PMID: 31700852 PMCID: PMC6827458 DOI: 10.1159/000496389] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 12/19/2018] [Indexed: 01/17/2023] Open
Abstract
Background The global mortality from HIV and the cutaneous burden of infective, inflammatory and malignant diseases in the setting of AIDS have significantly declined following the advent of highly active antiretroviral therapy. Regrettably, there has been a contemporaneous escalation in the incidence of adverse cutaneous drug reactions (ACDR), with studies attesting that HIV-positive individuals are a hundred times more susceptible to drug reactions than the general population, and advanced immunodeficiency portending an even greater risk. Several variables are accountable for this amplified risk in HIV. Summary Adverse reactions to trimethoprim-sulfamethoxazole are the most common, increasing from approximately 2–8% in the general population over to 43% amongst HIV-positive individuals to approximately 69% in subjects with AIDS. Antituberculosis drugs and antiretrovirals are also well-known instigators of ACDR. Cutaneous reactions range from mild morbilliform eruptions to severe, life-threatening manifestations in the form of Stevens-Johnson syndrome/toxic epidermal necrolysis. Histological features vary from vacuolar interface changes to full-thickness epidermal necrosis with subepidermal blister formation. A precipitous diagnosis of the ACDR, clinically and histologically if necessary, together with the isolation of the causative drug is critical. The identification process, however, is often complex and multifaceted due to polypharmacy and inconclusive data on which drugs are the most likely offending agents, especially against the background of tuberculosis co-infection. Key Messages Whilst milder cutaneous reactions are treated symptomatically, severe reactions mandate immediate treatment discontinuation without rechallenge. Further studies are required to establish safe rechallenge guidelines in resource-limited settings with a high HIV and tuberculosis prevalence.
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Affiliation(s)
- Koraisha Hoosen
- Department of Dermatology, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Anisa Mosam
- Department of Dermatology, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Ncoza Cordelia Dlova
- Department of Dermatology, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Wayne Grayson
- Division of Anatomical Pathology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Ampath National Laboratories, Johannesburg, South Africa
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Čechová L, Dejmek M, Baszczyňski O, Šaman D, Gao L, Hu E, Stepan G, Jansa P, Janeba Z, Šimon P. Synthesis and anti-human immunodeficiency virus activity of substituted ( o,o-difluorophenyl)-linked-pyrimidines as potent non-nucleoside reverse transcriptase inhibitors. Antivir Chem Chemother 2019; 27:2040206619826265. [PMID: 30788976 PMCID: PMC6376552 DOI: 10.1177/2040206619826265] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
With the worldwide number of human immunodeficiency virus positive patients stagnant and the increasing emergence of viral strains resistant to current treatment, the development of novel anti-human immunodeficiency virus drug candidates is a perpetual quest of medicinal chemists. Herein, we report a novel group of diarylpyrimidines, non-nucleoside reverse transcriptase inhibitors, which represents an important class of current anti-human immunodeficiency virus therapy. Series of diarylpyrimidines containing o,o-difluorophenyl (A-arm), 4-cyanophenylamino (B-arm), and a small substituent (e.g. NH2, OMe) at positions 2, 4, and 6 of the pyrimidine ring were prepared. The A-arm was modified in the para position (F or OMe) and linked to the central pyrimidine core with a variable spacer (CO, O, NH). Antiviral activities of 20 compounds were measured against wild type human immunodeficiency virus-1 and mutant reverse transcriptase strains (K103N, Y181C) using a cytoprotection assay. To the most promising structural motives belong the o,o-difluoro-p-methoxy A-arm in position 4, and the amino group in position 6 of pyrimidine. Single digit nanomolar activities with no significant toxicity (CC50 > 17,000 nM) were found for compounds 35 (EC50 = 2 nM), 37 (EC50 = 3 nM), and 13 (EC50 = 4 nM) having O, NH, and CO linkers, respectively.
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Affiliation(s)
- Lucie Čechová
- 1 Institute of Organic Chemistry and Biochemistry, Czech Academy of Sciences, Prague, Czech Republic
| | - Milan Dejmek
- 1 Institute of Organic Chemistry and Biochemistry, Czech Academy of Sciences, Prague, Czech Republic
| | - Ondřej Baszczyňski
- 1 Institute of Organic Chemistry and Biochemistry, Czech Academy of Sciences, Prague, Czech Republic
| | - David Šaman
- 1 Institute of Organic Chemistry and Biochemistry, Czech Academy of Sciences, Prague, Czech Republic
| | - Liping Gao
- 2 Gilead Sciences Inc., Foster City, USA
| | - Eric Hu
- 2 Gilead Sciences Inc., Foster City, USA
| | | | - Petr Jansa
- 2 Gilead Sciences Inc., Foster City, USA
| | - Zlatko Janeba
- 1 Institute of Organic Chemistry and Biochemistry, Czech Academy of Sciences, Prague, Czech Republic
| | - Petr Šimon
- 1 Institute of Organic Chemistry and Biochemistry, Czech Academy of Sciences, Prague, Czech Republic
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Abstract
INTRODUCTION Darunavir (DRV) was the last approved protease inhibitor (PI) and has been extensively used for the treatment of HIV in both naïve and experienced subjects due to its high genetic barrier and efficacy. The introduction in clinical practice of integrase strand transfer inhibitors limited its role in the management of naïve subjects and in antiretroviral treatment simplification strategies. However, recent data from trials that have investigated the new DRV/cobicistat/emtricitabine/tenofovir alafenamide (D/C/F/TAF) combination showed an excellent efficacy and tolerability of this coformulation both in naïve patients and in those with viral suppression, making D/C/F/TAF a new option for the treatment of HIV infection. Areas covered: The authors present and discuss the efficacy and safety data of DRV when used in antiretroviral-naïve, multiexperienced subjects and in the setting of treatment deintensification in subjects with viral suppression. Moreover, the authors evaluate the recent data from two different Phase III trials on D/C/F/TAF both in treatment-naïve and virologically suppressed subjects. Expert opinion: Although novel antiretroviral drugs may become available over time, DRV continues to represent a valuable option for multiexperienced subjects and has a role in simplification regimens. In addition, the convenience of D/C/F/TAF coformulation may be useful for the future management of HIV-infected subjects.
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Affiliation(s)
- Vincenzo Spagnuolo
- a Faculty of Medicine and Surgery , Vita-Salute San Raffaele University , Milan , Italy.,b Unit of Management and Antiretroviral Treatment of HIV Infection, Division of Immunology, Transplantation and Infectious Diseases , IRCCS San Raffaele Hospital , Milan , Italy
| | - Antonella Castagna
- a Faculty of Medicine and Surgery , Vita-Salute San Raffaele University , Milan , Italy.,b Unit of Management and Antiretroviral Treatment of HIV Infection, Division of Immunology, Transplantation and Infectious Diseases , IRCCS San Raffaele Hospital , Milan , Italy
| | - Adriano Lazzarin
- b Unit of Management and Antiretroviral Treatment of HIV Infection, Division of Immunology, Transplantation and Infectious Diseases , IRCCS San Raffaele Hospital , Milan , Italy
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25
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Valuev-Elliston VT, Kochetkov SN. Novel HIV-1 Non-nucleoside Reverse Transcriptase Inhibitors: A Combinatorial Approach. BIOCHEMISTRY (MOSCOW) 2018. [PMID: 29523068 DOI: 10.1134/s0006297917130107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Highly active antiretroviral therapy (HAART) is one of the most effective means for fighting against HIV-infection. HAART primarily targets HIV-1 reverse transcriptase (RT), and 14 of 28 compounds approved by the FDA as anti-HIV drugs act on this enzyme. HIV-1 non-nucleoside reverse transcriptase inhibitors (NNRTIs) hold a special place among HIV RT inhibitors owing to their high specificity and unique mode of action. Nonetheless, these drugs show a tendency to decrease their efficacy due to high HIV-1 variability and formation of resistant virus strains tolerant to clinically applied HIV NNRTIs. A combinatorial approach based on varying substituents within various fragments of the parent molecule that results in development of highly potent compounds is one of the approaches aimed at designing novel HIV NNRTIs. Generation of HIV NNRTIs based on pyrimidine derivatives explicitly exemplifies this approach, which is discussed in this review.
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Affiliation(s)
- V T Valuev-Elliston
- Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, Moscow, 119991, Russia.
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26
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Trottier B, Galanakis C, Longpré D, Dion H, Vézina S, Lavoie S, Boissonnault M, Costiniuk C, Jenabian MA, Machouf N, Thomas R. Removing inactive NRTIs in a salvage regimen is safe, maintains virological suppression and reduces treatment costs: results from the VERITAS study (TMC114HIV4054). HIV CLINICAL TRIALS 2018; 16:111-6. [PMID: 25997535 DOI: 10.1179/1528433614z.0000000015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Despite the benefit of maintaining inactive Nucleotide/side reverse transcriptase inhibitors (NRTIs) in salvage regimens, they are associated with increased toxicity and treatment costs. Current evidence suggests that NRTI-sparing regimens in patients failing ART are non-inferior to NRTI-including regimens. This study aimed to evaluate the impact of removing at least one inactive NRTI on virologic, safety, and financial outcomes. METHODS Drug-resistant, virologically suppressed patients with CD4 >250 cells/ml on a stable regimen of four or more antiretrovirals (ARVs) were enrolled in a 48-week prospective, open-label pilot trial. One inactive NRTI was removed at baseline. Patients taking over five ARVs had a second inactive NRTI removed at 24 weeks. Viral load, CD4 count, and adverse events were assessed at baseline, 24, and 48 weeks. RESULTS Thirty-one male patients participated. Twenty-nine (94%) patients had lamivudine (3TC) or emtricitabine (FTC) removed and four patients had an additional NRTI removed. One patient was excluded at week 26 for discontinuing an active NRTI. All patients maintained undetectable viral loads at weeks 24 (100%) and 48 [PP = 100%; Intent-to-treat (ITT) = 97%]. At 48 weeks, patients had a median gain of 20 CD4 (IQR: - 50, +133; mean +39) compared to baseline. Three patients exhibited Grade III bilirubin elevation (two Grade II and one Grade III at baseline), which returned to baseline levels. No serious adverse events were observed. Removal of one or two ARVs equated to a mean annual savings of $3319 CDN (11%) and $8630 CDN (24%), respectively. CONCLUSION Removing inactive NRTIs in patients with a controlled viral load appears to be safe, maintains virological suppression, and reduces treatment costs.
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27
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Olding M, Enns B, Panagiotoglou D, Shoveller J, Harrigan PR, Barrios R, Kerr T, Montaner JSG, Nosyk B. A historical review of HIV prevention and care initiatives in British Columbia, Canada: 1996-2015. J Int AIDS Soc 2017; 20:21941. [PMID: 28953322 PMCID: PMC5640311 DOI: 10.7448/ias.20.1.21941] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 08/22/2017] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION British Columbia has made significant progress in the treatment and prevention of HIV since 1996, when Highly Active Antiretroviral Therapy (HAART) became available. However, we currently lack a historical summary of HIV prevention and care interventions implemented in the province since the introduction of HAART and how they have shaped the HIV epidemic. Guided by a socio-ecological framework, we present a historical review of biomedical and health services, community and structural interventions implemented in British Columbia from 1996-2015 to prevent HIV transmission or otherwise enhance the cascade of HIV care. METHODS We constructed a historical timeline of HIV interventions implemented in BC between 1996 and 2015 by reviewing publicly available reports, guidelines and other documents from provincial health agencies, community organizations and AIDS service organizations, and by conducting searches of peer-reviewed literature through PubMed and Ovid MEDLINE. We collected further programmatic information by administering a data collection form to representatives from BC's regional health authorities and an umbrella agency representing 45 AIDS Service organizations. Using linked population-level health administrative data, we identified key phases of the HIV epidemic in British Columbia, as characterized by distinct changes in HIV incidence, HAART uptake and the provincial HIV response. RESULTS AND DISCUSSION In total, we identified 175 HIV prevention and care interventions implemented in BC from 1996 to 2015. We identify and describe four phases in BC's response to HIV/AIDS: the early HAART phase (1996-1999); the harm reduction and health service scale-up phase (2000-2005); the early Treatment as Prevention phase (2006-2009); and the STOP HIV/AIDS phase (2010-present). In doing so, we provide an overview of British Columbia's universal and centralized HIV treatment system and detail the role of community-based and provincial stakeholders in advancing innovative prevention and harm reduction approaches, as well as "seek, test, treat and retain" strategies. CONCLUSIONS The review provides valuable insight into British Columbia's HIV response, highlights emerging priorities, and may inform future efforts to evaluate the causal impact of interventions.
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Affiliation(s)
- Michelle Olding
- BC Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC, Canada
| | - Ben Enns
- BC Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC, Canada
| | | | - Jean Shoveller
- BC Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - P Richard Harrigan
- BC Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC, Canada
- Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Rolando Barrios
- BC Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC, Canada
- Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Thomas Kerr
- BC Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC, Canada
- Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Julio S. G. Montaner
- BC Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC, Canada
- Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Bohdan Nosyk
- BC Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
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28
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Cressey TR, Yogev R, Wiznia A, Hazra R, Jean-Philippe P, Graham B, Gonzalez A, Britto P, Carey VJ, Fletcher CV, Acosta EP. Pharmacokinetics of Darunavir/Ritonavir With Etravirine Both Twice Daily in Human Immunodeficiency Virus-Infected Adolescents and Young Adults. J Pediatric Infect Dis Soc 2017; 6:294-296. [PMID: 27103489 PMCID: PMC5907875 DOI: 10.1093/jpids/piw017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 03/04/2016] [Indexed: 11/13/2022]
Abstract
Data on the combination of darunavir/ritonavir and etravirine both given twice daily in adolescents/young adults are lacking. In this study, we assessed the pharmacokinetics of darunavir/ritonavir 600/100 mg with etravirine 200 mg twice daily in 36 treatment-experienced human immunodeficiency virus-infected adolescents and young adults and found that exposures were comparable to those reported in adults.
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Affiliation(s)
- Tim R Cressey
- Program for HIV Prevention and Treatment, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Thailand,,Correspondence: T. R. Cressey, PhD, Program for HIV Prevention and Treatment (PHPT-IRD174), Faculty of Associated Medical Sciences, 6th Floor, 110 Inthawaroros Road, Muang, Chiang Mai 50200, Thailand ()
| | - Ram Yogev
- Children's Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Rohan Hazra
- National Institutes of Health (NIH), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Maternal and Pediatric Infectious Disease Branch
| | - Patrick Jean-Philippe
- The Henry M. Jackson Foundation-Division of AIDS, a Division of The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Contractor to National Institute of Allergy and Infectious Diseases, NIH, US Department of Health and Human Services, Bethesda, Maryland
| | | | - Amy Gonzalez
- Frontier Science & Technology, Amherst, New York
| | - Paula Britto
- Harvard School of Public Health, Boston, Massachusetts
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29
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Flandre P, Marcelin AG, Calvez V. Addition of Etravirine Does Not Enhance the Initial Decline of HIV-1 RNA in Treatment-Experienced Patients Receiving Raltegravir. J Acquir Immune Defic Syndr 2017; 75:448-454. [PMID: 28653971 DOI: 10.1097/qai.0000000000001435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The importance of an early reduction of HIV-1 RNA as a marker for positive longer term outcome is still under debate. We investigate whether antiretroviral-experienced patients receiving raltegravir plus etravirine have a higher early reduction of HIV-1 RNA compared with patients receiving raltegravir. DESIGN An observational study of treatment-experienced patients. METHODS The objective is to investigate 349 patients included in a raltegravir resistance study. The early outcome is defined as a reduction of HIV-1 RNA at week 8. The crude method defines all measurements below the limit of quantification to be equal to the limit of quantification provides biased estimates. Such a reduction is censored by the limit of quantification and is subject to selection bias in observational studies. RESULTS The crude method showed a significant higher reduction in HIV-1 RNA reduction in patients receiving raltegravir plus etravirine compared with patients receiving raltegravir (mean reduction of 2.1 versus 1.8 log10 copies/mL). However, survival methods adjusted for both censoring, due to the limit of quantification, and confounding factors lead to a nonsignificant difference between the 2 treatment groups (mean reduction of 2.8 versus 2.7 log10 copies/mL). CONCLUSION Taking into account censoring and confounding factors, our study did not demonstrate a higher early reduction of HIV-1 RNA in patients receiving raltegravir with versus without etravirine.
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Affiliation(s)
- Philippe Flandre
- *Sorbonne Universités, UPMC Université, INSERM UMR-S 1136, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP), Paris, France; and†Laboratoire de Virologie AP-HP, Hôpital Pitié-Salpêtrière, INSERM UMR-S 1136, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP), Paris, France
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30
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Joyce VR, Sun H, Barnett PG, Bansback N, Griffin SC, Bayoumi AM, Anis AH, Sculpher M, Cameron W, Brown ST, Holodniy M, Owens DK. Mapping MOS-HIV to HUI3 and EQ-5D-3L in Patients With HIV. MDM Policy Pract 2017; 2:2381468317716440. [PMID: 30288427 PMCID: PMC6125043 DOI: 10.1177/2381468317716440] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 05/10/2017] [Indexed: 12/25/2022] Open
Abstract
Objectives: The Medical Outcomes Study HIV Health Survey (MOS-HIV)
is frequently used in HIV clinical trials; however, scores generated from the
MOS-HIV are not suited for cost-effectiveness analyses as they do not assign
utility values to health states. Our objective was to estimate and externally
validate several mapping algorithms to predict Health Utilities Index Mark 3
(HUI3) and EQ-5D-3L utility values from the MOS-HIV. Methods: We
developed and validated mapping algorithms using data from two HIV clinical
trials. Data from the first trial (n = 367) formed the estimation data set for
the HUI3 (4,610 observations) and EQ-5D-3L (4,662 observations) mapping
algorithms; data from the second trial (n = 168) formed the HUI3 (1,135
observations) and EQ-5D-3L (1,152 observations) external validation data set. We
compared ordinary least squares (OLS) models of increasing complexity with the
more flexible two-part, beta regression, and finite mixture models. We assessed
model performance using mean absolute error (MAE) and mean squared error (MSE).
Results: The OLS model that used MOS-HIV dimension scores along
with squared terms gave the best HUI3 predictions (mean observed 0.84; mean
predicted 0.80; MAE 0.0961); the finite mixture model gave the best EQ-5D-3L
predictions (mean observed 0.90; mean predicted 0.88; MAE 0.0567). All models
produced higher prediction errors at the lower end of the HUI3 and EQ-5D-3L
score ranges (<0.40). Conclusions: The proposed mapping
algorithms can be used to predict HUI3 and EQ-5D-3L utility values from the
MOS-HIV, although greater error may pose a problem in samples where a
substantial proportion of patients are in poor health. These algorithms may be
useful for estimating utility values from the MOS-HIV for cost-effectiveness
studies when HUI3 or EQ-5D-3L data are not available.
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Affiliation(s)
- Vilija R Joyce
- VA Palo Alto Health Care System, VA Cooperative Studies Program Coordinating Center, VA HSR&D Health Economics Resource Center, Menlo Park, California (VRJ, PGB).,Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada (HS, NB, AHA).,Canadian HIV Trials Network, Vancouver, British Columbia, Canada (HS).,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (NB, AHA).,Centre for Health Economics, University of York, York, UK (SCG, MS).,Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute and Division of General Internal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada (AMB).,Departments of Medicine and Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada (AMB).,Division of Infectious Diseases, University of Ottawa at The Ottawa Hospital, Ottawa, Ontario, Canada (WC).,James J. Peters VA Medical Center, Bronx, New York (STB).,VA Palo Alto Health Care System, Palo Alto, California (MH, DKO).,Center for Primary Care and Outcomes Research, Stanford University, Stanford, California (DKO)
| | - Huiying Sun
- VA Palo Alto Health Care System, VA Cooperative Studies Program Coordinating Center, VA HSR&D Health Economics Resource Center, Menlo Park, California (VRJ, PGB).,Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada (HS, NB, AHA).,Canadian HIV Trials Network, Vancouver, British Columbia, Canada (HS).,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (NB, AHA).,Centre for Health Economics, University of York, York, UK (SCG, MS).,Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute and Division of General Internal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada (AMB).,Departments of Medicine and Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada (AMB).,Division of Infectious Diseases, University of Ottawa at The Ottawa Hospital, Ottawa, Ontario, Canada (WC).,James J. Peters VA Medical Center, Bronx, New York (STB).,VA Palo Alto Health Care System, Palo Alto, California (MH, DKO).,Center for Primary Care and Outcomes Research, Stanford University, Stanford, California (DKO)
| | - Paul G Barnett
- VA Palo Alto Health Care System, VA Cooperative Studies Program Coordinating Center, VA HSR&D Health Economics Resource Center, Menlo Park, California (VRJ, PGB).,Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada (HS, NB, AHA).,Canadian HIV Trials Network, Vancouver, British Columbia, Canada (HS).,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (NB, AHA).,Centre for Health Economics, University of York, York, UK (SCG, MS).,Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute and Division of General Internal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada (AMB).,Departments of Medicine and Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada (AMB).,Division of Infectious Diseases, University of Ottawa at The Ottawa Hospital, Ottawa, Ontario, Canada (WC).,James J. Peters VA Medical Center, Bronx, New York (STB).,VA Palo Alto Health Care System, Palo Alto, California (MH, DKO).,Center for Primary Care and Outcomes Research, Stanford University, Stanford, California (DKO)
| | - Nick Bansback
- VA Palo Alto Health Care System, VA Cooperative Studies Program Coordinating Center, VA HSR&D Health Economics Resource Center, Menlo Park, California (VRJ, PGB).,Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada (HS, NB, AHA).,Canadian HIV Trials Network, Vancouver, British Columbia, Canada (HS).,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (NB, AHA).,Centre for Health Economics, University of York, York, UK (SCG, MS).,Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute and Division of General Internal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada (AMB).,Departments of Medicine and Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada (AMB).,Division of Infectious Diseases, University of Ottawa at The Ottawa Hospital, Ottawa, Ontario, Canada (WC).,James J. Peters VA Medical Center, Bronx, New York (STB).,VA Palo Alto Health Care System, Palo Alto, California (MH, DKO).,Center for Primary Care and Outcomes Research, Stanford University, Stanford, California (DKO)
| | - Susan C Griffin
- VA Palo Alto Health Care System, VA Cooperative Studies Program Coordinating Center, VA HSR&D Health Economics Resource Center, Menlo Park, California (VRJ, PGB).,Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada (HS, NB, AHA).,Canadian HIV Trials Network, Vancouver, British Columbia, Canada (HS).,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (NB, AHA).,Centre for Health Economics, University of York, York, UK (SCG, MS).,Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute and Division of General Internal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada (AMB).,Departments of Medicine and Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada (AMB).,Division of Infectious Diseases, University of Ottawa at The Ottawa Hospital, Ottawa, Ontario, Canada (WC).,James J. Peters VA Medical Center, Bronx, New York (STB).,VA Palo Alto Health Care System, Palo Alto, California (MH, DKO).,Center for Primary Care and Outcomes Research, Stanford University, Stanford, California (DKO)
| | - Ahmed M Bayoumi
- VA Palo Alto Health Care System, VA Cooperative Studies Program Coordinating Center, VA HSR&D Health Economics Resource Center, Menlo Park, California (VRJ, PGB).,Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada (HS, NB, AHA).,Canadian HIV Trials Network, Vancouver, British Columbia, Canada (HS).,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (NB, AHA).,Centre for Health Economics, University of York, York, UK (SCG, MS).,Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute and Division of General Internal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada (AMB).,Departments of Medicine and Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada (AMB).,Division of Infectious Diseases, University of Ottawa at The Ottawa Hospital, Ottawa, Ontario, Canada (WC).,James J. Peters VA Medical Center, Bronx, New York (STB).,VA Palo Alto Health Care System, Palo Alto, California (MH, DKO).,Center for Primary Care and Outcomes Research, Stanford University, Stanford, California (DKO)
| | - Aslam H Anis
- VA Palo Alto Health Care System, VA Cooperative Studies Program Coordinating Center, VA HSR&D Health Economics Resource Center, Menlo Park, California (VRJ, PGB).,Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada (HS, NB, AHA).,Canadian HIV Trials Network, Vancouver, British Columbia, Canada (HS).,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (NB, AHA).,Centre for Health Economics, University of York, York, UK (SCG, MS).,Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute and Division of General Internal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada (AMB).,Departments of Medicine and Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada (AMB).,Division of Infectious Diseases, University of Ottawa at The Ottawa Hospital, Ottawa, Ontario, Canada (WC).,James J. Peters VA Medical Center, Bronx, New York (STB).,VA Palo Alto Health Care System, Palo Alto, California (MH, DKO).,Center for Primary Care and Outcomes Research, Stanford University, Stanford, California (DKO)
| | - Mark Sculpher
- VA Palo Alto Health Care System, VA Cooperative Studies Program Coordinating Center, VA HSR&D Health Economics Resource Center, Menlo Park, California (VRJ, PGB).,Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada (HS, NB, AHA).,Canadian HIV Trials Network, Vancouver, British Columbia, Canada (HS).,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (NB, AHA).,Centre for Health Economics, University of York, York, UK (SCG, MS).,Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute and Division of General Internal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada (AMB).,Departments of Medicine and Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada (AMB).,Division of Infectious Diseases, University of Ottawa at The Ottawa Hospital, Ottawa, Ontario, Canada (WC).,James J. Peters VA Medical Center, Bronx, New York (STB).,VA Palo Alto Health Care System, Palo Alto, California (MH, DKO).,Center for Primary Care and Outcomes Research, Stanford University, Stanford, California (DKO)
| | - William Cameron
- VA Palo Alto Health Care System, VA Cooperative Studies Program Coordinating Center, VA HSR&D Health Economics Resource Center, Menlo Park, California (VRJ, PGB).,Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada (HS, NB, AHA).,Canadian HIV Trials Network, Vancouver, British Columbia, Canada (HS).,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (NB, AHA).,Centre for Health Economics, University of York, York, UK (SCG, MS).,Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute and Division of General Internal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada (AMB).,Departments of Medicine and Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada (AMB).,Division of Infectious Diseases, University of Ottawa at The Ottawa Hospital, Ottawa, Ontario, Canada (WC).,James J. Peters VA Medical Center, Bronx, New York (STB).,VA Palo Alto Health Care System, Palo Alto, California (MH, DKO).,Center for Primary Care and Outcomes Research, Stanford University, Stanford, California (DKO)
| | - Sheldon T Brown
- VA Palo Alto Health Care System, VA Cooperative Studies Program Coordinating Center, VA HSR&D Health Economics Resource Center, Menlo Park, California (VRJ, PGB).,Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada (HS, NB, AHA).,Canadian HIV Trials Network, Vancouver, British Columbia, Canada (HS).,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (NB, AHA).,Centre for Health Economics, University of York, York, UK (SCG, MS).,Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute and Division of General Internal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada (AMB).,Departments of Medicine and Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada (AMB).,Division of Infectious Diseases, University of Ottawa at The Ottawa Hospital, Ottawa, Ontario, Canada (WC).,James J. Peters VA Medical Center, Bronx, New York (STB).,VA Palo Alto Health Care System, Palo Alto, California (MH, DKO).,Center for Primary Care and Outcomes Research, Stanford University, Stanford, California (DKO)
| | - Mark Holodniy
- VA Palo Alto Health Care System, VA Cooperative Studies Program Coordinating Center, VA HSR&D Health Economics Resource Center, Menlo Park, California (VRJ, PGB).,Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada (HS, NB, AHA).,Canadian HIV Trials Network, Vancouver, British Columbia, Canada (HS).,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (NB, AHA).,Centre for Health Economics, University of York, York, UK (SCG, MS).,Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute and Division of General Internal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada (AMB).,Departments of Medicine and Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada (AMB).,Division of Infectious Diseases, University of Ottawa at The Ottawa Hospital, Ottawa, Ontario, Canada (WC).,James J. Peters VA Medical Center, Bronx, New York (STB).,VA Palo Alto Health Care System, Palo Alto, California (MH, DKO).,Center for Primary Care and Outcomes Research, Stanford University, Stanford, California (DKO)
| | - Douglas K Owens
- VA Palo Alto Health Care System, VA Cooperative Studies Program Coordinating Center, VA HSR&D Health Economics Resource Center, Menlo Park, California (VRJ, PGB).,Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada (HS, NB, AHA).,Canadian HIV Trials Network, Vancouver, British Columbia, Canada (HS).,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (NB, AHA).,Centre for Health Economics, University of York, York, UK (SCG, MS).,Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute and Division of General Internal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada (AMB).,Departments of Medicine and Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada (AMB).,Division of Infectious Diseases, University of Ottawa at The Ottawa Hospital, Ottawa, Ontario, Canada (WC).,James J. Peters VA Medical Center, Bronx, New York (STB).,VA Palo Alto Health Care System, Palo Alto, California (MH, DKO).,Center for Primary Care and Outcomes Research, Stanford University, Stanford, California (DKO)
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Saravanan S, Kausalya B, Gomathi S, Sivamalar S, Pachamuthu B, Selvamuthu P, Pradeep A, Sunil S, Mothi SN, Smith DM, kantor R. Etravirine and Rilpivirine Drug Resistance Among HIV-1 Subtype C Infected Children Failing Non-Nucleoside Reverse Transcriptase Inhibitor-Based Regimens in South India. AIDS Res Hum Retroviruses 2017; 33:567-574. [PMID: 27869478 DOI: 10.1089/aid.2016.0133] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
We have analyzed reverse transcriptase (RT) region of HIV-1 pol gene from 97 HIV-infected children who were identified as failing first-line therapy that included first-generation non-nucleoside RT inhibitors (Nevirapine and Efavirenz) for at least 6 months. We found that 54% and 65% of the children had genotypically predicted resistance to second-generation non-nucleoside RT inhibitors drugs Etravirine (ETR) and Rilpivirine, respectively. These cross-resistance mutations may compromise future NNRTI-based regimens, especially in resource-limited settings. To complement these investigations, we also analyzed the sequences in Stanford database, Monogram weighted score, and DUET weighted score algorithms for ETR susceptibility and found almost perfect agreement between the three algorithms in predicting ETR susceptibility from genotypic data.
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Affiliation(s)
- Shanmugam Saravanan
- Y.R. Gaitonde Centre for AIDS Research and Education (YRG CARE), Chennai, India
| | - Bagavathi Kausalya
- Y.R. Gaitonde Centre for AIDS Research and Education (YRG CARE), Chennai, India
| | - Selvamurthi Gomathi
- Y.R. Gaitonde Centre for AIDS Research and Education (YRG CARE), Chennai, India
| | | | | | | | - Amrose Pradeep
- Y.R. Gaitonde Centre for AIDS Research and Education (YRG CARE), Chennai, India
| | - Solomon Sunil
- Y.R. Gaitonde Centre for AIDS Research and Education (YRG CARE), Chennai, India
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Davey M. Smith
- University of California, San Diego, San Diego, California
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Arathoon E, Bhorat A, Silaghi R, Crauwels H, Lavreys L, Tambuyzer L, Van Baelen B, Vanveggel S, Opsomer M. Etravirine combined with antiretrovirals other than darunavir/ritonavir for HIV-1-infected, treatment-experienced adults: Week 48 results of a phase IV trial. SAGE Open Med 2017; 5:2050312116686482. [PMID: 28382208 PMCID: PMC5367767 DOI: 10.1177/2050312116686482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 12/01/2016] [Indexed: 11/21/2022] Open
Abstract
Objective: VIOLIN (TMC125IFD3002; NCT01422330) evaluated the safety, tolerability, and pharmacokinetics of etravirine with antiretrovirals other than darunavir/ritonavir in HIV-1-infected patients. Methods: In a 48-week, phase IV, single-arm, multicenter study, patients on prior antiretroviral therapy (⩾8 weeks) who needed to change regimen for virologic failure (viral load ⩾ 500 copies/mL) or simplification/adverse events (viral load < 50 copies/mL) received etravirine 200 mg bid with ⩾1 other active antiretroviral, excluding darunavir/ritonavir or only nucleoside/tide reverse transcriptase inhibitors. Results: Of 211 treated patients, 73% (n = 155) had baseline viral load ⩾ 50 copies/mL and 27% (n = 56) had baseline viral load < 50 copies/mL. Protease inhibitors were the most common background antiretrovirals (83%). Diarrhea was the most frequent adverse event (17%). Serious adverse events (no rash) occurred in 5% of patients; none were etravirine related. Overall, median etravirine AUC12h was 5390 ng h/mL and C0h was 353 ng/mL (N = 199). Week 48 virologic response rates (viral load < 50 copies/mL; Food and Drug Administration Snapshot algorithm) were 48% (74/155) (baseline viral load ⩾ 50 copies/mL) and 75% (42/56) (baseline viral load < 50 copies/mL). Virologic failure rates were 42% and 13%, respectively. The most frequently emerging etravirine resistance-associated mutations in virologic failures were Y181C, E138A, and M230L. Virologic response rates for patients with baseline viral load ⩾ 50 copies/mL were 38% (30/79) (non-adherent) versus 64% (44/69) (adherent subset). Conclusion: Etravirine 200 mg bid in combination with antiretrovirals other than darunavir/ritonavir was well tolerated in the studied treatment-experienced HIV-1-infected population. The overall etravirine safety and tolerability profile and pharmacokinetics (specifically in those patients who were adherent) were similar to those previously observed for etravirine in HIV-1-infected adults. The relatively high level of non-adherence, also observed in the pharmacokinetic assessments, negatively impacted virologic response, especially in patients with ⩾50 copies/mL at baseline.
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Affiliation(s)
- Eduardo Arathoon
- La Clinica Familiar de Luis Angel Garcia, Guatemala City, Guatemala
| | - Asad Bhorat
- Soweto Clinical Trials Centre, Johannesburg, South Africa
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Drugs for HIV Infection. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00152-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023] Open
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Belkhir L, Elens L, Zech F, Panin N, Vincent A, Yombi JC, Vandercam B, Haufroid V. Interaction between Darunavir and Etravirine Is Partly Mediated by CYP3A5 Polymorphism. PLoS One 2016; 11:e0165631. [PMID: 27788239 PMCID: PMC5082792 DOI: 10.1371/journal.pone.0165631] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 10/15/2016] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To assess the impact of the loss-of-function CYP3A5*3 allele (rs776746, 6986A>G SNP) on darunavir (DRV) plasma concentrations. METHODS 135 HIV-1 infected patients treated with DRV-based therapy were included in the study and plasma samples were obtained immediately before drug intake in order to determine DRV trough concentrations using an ultra performance liquid chromatography method (UPLC) with diode-array detection (DAD). Noteworthy is the fact that in 16 (11.9%) patients, etravirine (ETR) was combined with DRV. CYP3A5 genotypes were determined using real time PCR method (TaqMan® genotyping assay). The patients were then classified into CYP3A5 expressors (CYP3A5*1 allele carriers) and non-expressors (CYP3A5*3 homozygous). Subsequently, the association between DRV plasma trough concentration ([DRV]plasma) and CYP3A5 genotype-based expression status was analyzed. RESULTS 45% of the patients were classified as CYP3A5 expressors. In the whole cohort, mean [DRV]plasma was not different between CYP3A5 expressors and non-expressors (1894ng/ml [CI95%: 1566-2290] versus 1737ng/ml [CI95%: 1468-2057], p = 0.43). However, in the subgroup of the 16 patients receiving DRV combined with ETR, a significantly lower [DRV]plasma was observed for CYP3A5 expressors when compared to non-expressors (1385ng/ml [CI95%:886.3-2165] versus 3141ng/ml [CI95%:2042-4831], p = 0.007). CONCLUSIONS Interaction between DRV and ETR is partly mediated by CYP3A5 polymorphism with lower DRV plasma trough concentrations in CYP3A5 expressors suggesting a specific ETR-driven CYP3A5 activation only in CYP3A5 expressors. Consequently, these patients might be more at risk of infra-therapeutic [DRV]plasma. This potentially important observation is a good illustration of a genotype-based drug interaction, which could also have considerable consequences if translated to other CYP3A5-metabolized drugs. Further investigations are thus needed to confirm this association and to explore its clinical impact, mainly in the African population among whom CYP3A5 expressors are more frequent, before recommending systematic CYP3A5 pre-emptive genotyping for DRV-ETR co-administration.
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Affiliation(s)
- Leïla Belkhir
- AIDS Reference Center, Department of Internal Medicine, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
- Louvain centre for Toxicology and Applied Pharmacology, Institut de recherche expérimentale et clinique, Université catholique de Louvain, Brussels, Belgium
- * E-mail:
| | - Laure Elens
- Louvain centre for Toxicology and Applied Pharmacology, Institut de recherche expérimentale et clinique, Université catholique de Louvain, Brussels, Belgium
- Integrated PharmacoMetrics, PharmacoGenomics and PharmacoKinetics, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Francis Zech
- AIDS Reference Center, Department of Internal Medicine, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Nadtha Panin
- Louvain centre for Toxicology and Applied Pharmacology, Institut de recherche expérimentale et clinique, Université catholique de Louvain, Brussels, Belgium
| | - Anne Vincent
- AIDS Reference Center, Department of Internal Medicine, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Jean Cyr Yombi
- AIDS Reference Center, Department of Internal Medicine, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Bernard Vandercam
- AIDS Reference Center, Department of Internal Medicine, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Vincent Haufroid
- Louvain centre for Toxicology and Applied Pharmacology, Institut de recherche expérimentale et clinique, Université catholique de Louvain, Brussels, Belgium
- Department of Clinical Chemistry, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
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Novel (2,6-difluorophenyl)(2-(phenylamino)pyrimidin-4-yl)methanones with restricted conformation as potent non-nucleoside reverse transcriptase inhibitors against HIV-1. Eur J Med Chem 2016; 122:185-195. [DOI: 10.1016/j.ejmech.2016.06.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 06/01/2016] [Accepted: 06/15/2016] [Indexed: 01/26/2023]
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Vardhanabhuti S, Katzenstein D, Bartlett J, Kumarasamy N, Wallis CL. Human Immunodeficiency Virus-1 Sequence Changes and Drug Resistance Mutation Among Virologic Failures of Lopinavir/Ritonavir Monotherapy: AIDS Clinical Trials Group Protocol A5230. Open Forum Infect Dis 2016; 3:ofw154. [PMID: 27704010 PMCID: PMC5047431 DOI: 10.1093/ofid/ofw154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 07/17/2016] [Indexed: 12/12/2022] Open
Abstract
Background. The mechanism of virologic failure (VF) of lopinavir/ritonavir (LPV/r) monotherapy is not well understood. We assessed sequence changes in human immunodeficiency virus-1 reverse-transcriptase (RT) and protease (PR) regions. Methods. Human immunodeficiency virus-1 pol sequences from 34 participants who failed second-line LPV/r monotherapy were obtained at study entry (SE) and VF. Sequence changes were evaluated using phylogenetic analysis and hamming distance. Results. Human immunodeficiency virus-1 sequence change was higher over drug resistance mutation (DRM) sites (median genetic distance, 2.2%; Q1 to Q3, 2.1%–2.5%) from SE to VF compared with non-DRM sites (median genetic distance, 1.3%; Q1 to Q3, 1.0%–1.4%; P < .0001). Evolution over DRM sites was mainly driven by changes in the RT (median genetic distance, 2.7%; Q1 to Q3, 2.2%–3.2%) compared with PR (median genetic distance, 1.1%; Q1 to Q3, 0.0%–1.1%; P < .0001). Most RT DRMs present at SE were lost at VF. At VF, 19 (56%) and 26 (76%) were susceptible to efavirenz/nevirapine and etravirine (ETV)/rilpivirine (RPV), respectively, compared with 1 (3%) and 12 (35%) at SE. Participants who retained nonnucleoside reverse-transcriptase inhibitor (NNRTI) DRMs and those without evolution of LPV/r DRMs had significantly shorter time to VF. Conclusions. The selection of LPV/r DRMs in participants with longer time to VF suggests better adherence and more selective pressure. Fading NNRTI mutations and an increase in genotypic susceptibility to ETV and RPV could allow for the reuse of NNRTI. Further studies are warranted to understand mechanisms of PR failure.
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Affiliation(s)
| | | | - John Bartlett
- Duke University Medical Center , Durham, North Carolina
| | | | - Carole L Wallis
- Department of Molecular Pathology , Lancet Laboratories and BARC-SA , Johannesburg , South Africa
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Blakney AK, Jiang Y, Whittington D, Woodrow KA. Simultaneous measurement of etravirine, maraviroc and raltegravir in pigtail macaque plasma, vaginal secretions and vaginal tissue using a LC-MS/MS assay. J Chromatogr B Analyt Technol Biomed Life Sci 2016; 1025:110-8. [PMID: 27236000 DOI: 10.1016/j.jchromb.2016.04.048] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 04/21/2016] [Accepted: 04/30/2016] [Indexed: 11/16/2022]
Abstract
Etravirine (ETR), maraviroc (MVC) and raltegravir (RAL) are promising antiretroviral drugs being used in HIV treatment and may be interesting for prevention applications such as oral or topical pre-exposure prophylaxis. Here we describe a sensitive and accurate method for the simultaneous detection of ETR, MVC and RAL from pigtail macaque plasma, vaginal secretions, and vaginal tissue. This method is characterized by a straightforward precipitation extraction method, a limit of quantification <0.5ngmL(-1) for all three antiretrovirals bolstered by a corresponding internal standard for each drug analyte, and short run time. Quantification is performed using positive ion electrospray triple quadrupole mass spectrometry. This method was validated over clinically relevant ranges for the three ARV drugs in all three matrices: 0.1-100ngmL(-1) for ETR, 0.05-100ngmL(-1) for MVC and 1-100ngmL(-1) for RAL. Our method is accurate and precise, with measured mean inter-assay precision (%CV) and accuracy (% bias) of 5.08% and 1.96%, respectively, while the mean intra-assay precision and accuracy were 3.44% and 1.08%. The overall post-extraction recovery for ETR, MVC and RAL was >94% in all cases. We also show that extracted biological samples are stable after storage at room temperature or 4°C and after three freeze/thaw cycles. This is the first analytical method capable of quantifying ETR, MVC and RAL in biological matrices relevant for pre-clinical testing of oral or topical HIV prevention methods in pigtailed macaques.
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Affiliation(s)
- Anna K Blakney
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Yonghou Jiang
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Dale Whittington
- Department of Medicinal Chemistry, Mass Spectrometry Center, University of Washington, Seattle, WA, USA.
| | - Kim A Woodrow
- Department of Bioengineering, University of Washington, Seattle, WA, USA.
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Cresswell F, Waters L, Briggs E, Fox J, Harbottle J, Hawkins D, Murchie M, Radcliffe K, Rafferty P, Rodger A, Fisher M. UK guideline for the use of HIV Post-Exposure Prophylaxis Following Sexual Exposure, 2015. Int J STD AIDS 2016; 27:713-38. [PMID: 27095790 DOI: 10.1177/0956462416641813] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 02/18/2016] [Indexed: 11/15/2022]
Abstract
We present the updated British Association for Sexual Health and HIV guidelines for HIV post-exposure prophylaxis following sexual exposure (PEPSE). This document includes a review of the current data to support the use of PEPSE, considers how to calculate the risks of infection after a potential exposure, and provides recommendations on when PEPSE should and should not be considered. We also review which medications to use for PEPSE, provide a checklist for initial assessment, and make recommendations for monitoring individuals receiving PEPSE. Special scenarios, cost-effectiveness of PEPSE, and issues relating to service provision are also discussed. Throughout the document, the place of PEPSE within the broader context of other HIV prevention strategies is considered.
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Survival benefits of antiretroviral therapy in Brazil: a model-based analysis. J Int AIDS Soc 2016; 19:20623. [PMID: 27029828 PMCID: PMC4814587 DOI: 10.7448/ias.19.1.20623] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 01/29/2016] [Accepted: 02/22/2016] [Indexed: 01/05/2023] Open
Abstract
Objective In Brazil, universal provision of antiretroviral therapy (ART) has been guaranteed free of charge to eligible HIV-positive patients since December 1996. We sought to quantify the survival benefits of ART attributable to this programme. Methods We used a previously published microsimulation model of HIV disease and treatment (CEPAC-International) and data from Brazil to estimate life expectancy increase for HIV-positive patients initiating ART in Brazil. We divided the period of 1997 to 2014 into six eras reflecting increased drug regimen efficacy, regimen availability and era-specific mean CD4 count at ART initiation. Patients were simulated first without ART and then with ART. The 2014-censored and lifetime survival benefits attributable to ART in each era were calculated as the product of the number of patients initiating ART in a given era and the increase in life expectancy attributable to ART in that era. Results In total, we estimated that 598,741 individuals initiated ART. Projected life expectancy increased from 2.7, 3.3, 4.1, 4.9, 5.5 and 7.1 years without ART to 11.0, 17.5, 20.7, 23.0, 25.3, and 27.0 years with ART in Eras 1 through 6, respectively. Of the total projected lifetime survival benefit of 9.3 million life-years, 16% (or 1.5 million life-years) has been realized as of December 2014. Conclusions Provision of ART through a national programme has led to dramatic survival benefits in Brazil, the majority of which are still to be realized. Improvements in initial and subsequent ART regimens and higher CD4 counts at ART initiation have contributed to these increasing benefits.
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Scherrer AU, von Wyl V, Yang WL, Kouyos RD, Böni J, Yerly S, Klimkait T, Aubert V, Cavassini M, Battegay M, Furrer H, Calmy A, Vernazza P, Bernasconi E, Günthard HF, Aubert V, Battegay M, Bernasconi E, Böni J, Braun DL, Bucher HC, Burton-Jeangros C, Calmy A, Cavassini M, Dollenmaier G, Egger M, Elzi L, Fehr J, Fellay J, Furrer H, Fux CA, Gorgievski M, Günthard H, Haerry D, Hasse B, Hirsch HH, Hoffmann M, Hösli I, Kahlert C, Kaiser L, Keiser O, Klimkait T, Kouyos R, Kovari H, Ledergerber B, Martinetti G, Martinez de Tejada B, Marzolini C, Metzner K, Müller N, Nadal D, Nicca D, Pantaleo G, Rauch A, Regenass S, Rudin C, Schöni-Affolter F, Schmid P, Speck R, Stöckle M, Tarr P, Trkola A, Vernazza P, Weber R, Yerly S. Emergence of Acquired HIV-1 Drug Resistance Almost Stopped in Switzerland: A 15-Year Prospective Cohort Analysis. Clin Infect Dis 2016; 62:1310-1317. [PMID: 26962075 DOI: 10.1093/cid/ciw128] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 01/05/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Drug resistance is a major barrier to successful antiretroviral treatment (ART). Therefore, it is important to monitor time trends at a population level. METHODS We included 11 084 ART-experienced patients from the Swiss HIV Cohort Study (SHCS) between 1999 and 2013. The SHCS is highly representative and includes 72% of patients receiving ART in Switzerland. Drug resistance was defined as the presence of ≥1 major mutation in a genotypic resistance test. To estimate the prevalence of drug resistance, data for patients with no resistance test was imputed based on the patient's risk of harboring drug-resistant viruses. RESULTS The emergence of new drug resistance mutations declined dramatically from 401 to 23 patients between 1999 and 2013. The upper estimated prevalence limit of drug resistance among ART-experienced patients decreased from 57.0% in 1999 to 37.1% in 2013. The prevalence of 3-class resistance decreased from 9.0% to 4.4% and was always <0.4% for patients who initiated ART after 2006. Most patients actively participating in the SHCS in 2013 with drug-resistant viruses initiated ART before 1999 (59.8%). Nevertheless, in 2013, 94.5% of patients who initiated ART before 1999 had good remaining treatment options based on Stanford algorithm. CONCLUSIONS Human immunodeficiency virus type 1 drug resistance among ART-experienced patients in Switzerland is a well-controlled relic from the era before combination ART. Emergence of drug resistance can be virtually stopped with new potent therapies and close monitoring.
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Affiliation(s)
- Alexandra U Scherrer
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich.,Institute of Medical Virology
| | - Viktor von Wyl
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich
| | - Wan-Lin Yang
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich.,Institute of Medical Virology
| | - Roger D Kouyos
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich.,Institute of Medical Virology
| | | | - Sabine Yerly
- Laboratory of Virology, Division of Infectious Diseases
| | | | | | | | - Manuel Battegay
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel
| | - Hansjakob Furrer
- Department of Infectious Diseases, Berne University Hospital and University of Berne
| | - Alexandra Calmy
- HIV/AIDS Unit, Infectious Disease Service, Geneva University Hospital
| | - Pietro Vernazza
- Division of Infectious Diseases, Cantonal Hospital St Gallen
| | - Enos Bernasconi
- Division of Infectious Diseases, Regional Hospital Lugano, Switzerland
| | - Huldrych F Günthard
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich.,Institute of Medical Virology
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Allavena C, Katlama C, Cotte L, Roger PM, Delobel P, Cheret A, Duvivier C, Poizot-Martin I, Hoen B, Cabie A, Cheret A, Lahoulou R, Raffi F, Pugliese P. Long-term efficacy and safety of etravirine-containing regimens in a real-life cohort of treatment-experienced HIV-1-infected patients. Infect Dis (Lond) 2016; 48:392-8. [PMID: 26757613 DOI: 10.3109/23744235.2015.1133927] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Etravirine (ETR) was approved in France in September 2008 and is used in combination with a boosted protease inhibitor (bPI) and other anti-retrovirals (ART) in HIV-infected pre-treated patients. This study aimed to report in a real-life setting the efficacy and tolerability of ETR-based regimens and factors associated with virological response. METHODS The study population included all treatment-experienced patients who initiated an ETR-based regimen between September 2008 and July 2013 from the French Dat'AIDS cohort. Analyses were performed in ART-experienced patients starting ETR after virological failure (VF) or as a maintenance therapy (MT), with or without bPI. RESULTS A total of 2006 patients (VF, n = 1014 (51%); MT, n = 992 (49%)) were included. At M12, the proportion of patients with HIV RNA < 50 copies/ml was 71.7% (72.0% and 71.1% with or without bPI) in the VF group and 90.5% (85.0% and 92.3% with or without bPI) in the MT group, without significant differences regarding the use of bPI. ETR was discontinued in 8.8% of patients for adverse events in 23.9% of cases (21.5% in VF, 29.5% in MT), treatment failure in 15.2% (16.2% in VF, 7.4% in MT) or simplification in 5.4% (4.6% in VF, 7.4% in MT). In the VF group, factors associated with virological response were a longer duration of HIV infection (OR = 2.7; p < 0.001) and baseline HIV RNA < 5 log10 copies/mL (OR = 2.1; p = 0.002). CONCLUSION This study shows that in ART-experienced patients ETR is well tolerated with a high efficacy when combined with other active drugs, even when the regimen does not include a bPI.
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Affiliation(s)
- Clotilde Allavena
- a Infectious Diseases, CHU Hôtel Dieu University Hospital , Nantes , France
| | - Christine Katlama
- b Infectious Diseases, AP-HP Pitié Salpétrière Hospital , Paris , France
| | - Laurent Cotte
- c Infectious Diseases, Hôpital Croix-Rousse, Hospices Civils de Lyon , Lyon , France
| | | | | | | | - Claudine Duvivier
- g Infectious Diseases, AP-HP, Necker-Enfants Malades Hospital, Necker-Pasteur Infectious Diseases Center, Descartes University, Sorbonne Paris Cité , EA7327 , IHU Imagine , Paris , France
| | - Isabelle Poizot-Martin
- h Infectious Diseases, Aix-Marseille University , APHM Sainte-Marguerite, Department of Immuno-hematology , Inserm U912 (SESSTIM) , Marseille , France
| | - Bruno Hoen
- i Infectious Diseases, CHU Besançon , Besancon , France
| | - André Cabie
- j Infectious Diseases, CHU de Martinique , Inserm CIC1424 , France
| | | | | | - François Raffi
- a Infectious Diseases, CHU Hôtel Dieu University Hospital , Nantes , France
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Tambuyzer L, Thys K, Hoogstoel A, Nijs S, Tomaka F, Opsomer M, De Meyer S, Vingerhoets J. Assessment of etravirine resistance in HIV-1-infected paediatric patients using population and deep sequencing: final results of the PIANO study. Antivir Ther 2015; 21:317-27. [PMID: 26566161 DOI: 10.3851/imp3011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND We assessed etravirine resistance in treatment-experienced, HIV-1-infected children (n=41)/adolescents (n=60) who received twice-daily etravirine 5.2 mg/kg and a background regimen (boosted protease inhibitor plus nucleoside/nucleotide reverse transcriptase inhibitors, optional enfuvirtide/raltegravir) in a Phase II, open-label, multicentre trial (PIANO). METHODS In addition to phenotypes, viral genotypes were assessed by population and deep sequencing (PS and DS) in virological failures (VFs; baseline and end point) and responders (baseline). Minority resistance-associated mutations (RAMs) were defined as those with frequencies above 1% and not detected with PS. RESULTS By week 48, 41/101 (40.6%) patients experienced VF; 17/41 (41.5%) VFs and 22/54 (40.8%) responders had ≥1 baseline etravirine RAM by PS, mainly A98G, K101E, V106I and G190A. Baseline minority etravirine RAMs (n) were detected in 8/40 VFs (V90I [2], A98G [1], L100I [1], V106I [1], E138G [1] and Y181C [2]) and 5/38 responders (V90I [3], A98G [1], V106I [1] and E138G [1]). The most frequent emerging non-nucleoside reverse transcriptase inhibitor RAMs detected by PS (≥3 VFs; n) were the etravirine RAMs Y181C (8), V90I (3), L100I (3) and E138A (3). In 15 of 29 (51.7%) VFs with baseline DS/PS and end point PS data, ≥1 emerging etravirine RAM was detected by PS, which was not detected at baseline by DS in most cases (12/15 [80.0%]). In 10/26 (38.5%) VFs with baseline/end point DS data, ≥1 additional emerging minority etravirine RAM was detected. CONCLUSIONS Patterns of etravirine resistance in adults, adolescents and children experiencing VF are similar. The presence of minority etravirine RAMs at baseline was not consistently associated with treatment failure. ClinicalTrials.gov: NCT00665847.
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Floris-Moore MA, Mollan K, Wilkin AM, Johnson MA, Kashuba AD, Wohl DA, Patterson KB, Francis O, Kronk C, Eron JJ. Antiretroviral activity and safety of once-daily etravirine in treatment-naive HIV-infected adults: 48-week results. Antivir Ther 2015; 21:55-64. [PMID: 26263403 DOI: 10.3851/imp2982] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Etravirine (ETR), a non-nucleoside reverse transcriptase inhibitor approved for 200 mg twice-daily dosing in conjunction with other antiretrovirals (ARVs), has pharmacokinetic properties which support once-daily dosing. METHODS In this single-arm, open-label study, 79 treatment-naive HIV-infected adults were assigned to receive ETR 400 mg plus tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) 300/200 mg once daily to assess antiviral activity, safety and tolerability. ARV activity at 48 weeks was determined by proportion of subjects with HIV-1 RNA<50 copies/ml (intention-to-treat, missing = failure). RESULTS Of 79 eligible subjects, 90% were men, 62% African-American and 29% Caucasian. At baseline, median (Q1, Q3) age was 29 years (23, 44) and HIV-1 RNA 4.52 log10 copies/ml (4.07, 5.04). A total of 69 (87%) completed a week 48 visit and 61 (77%, 95% CI 66%, 86%) achieved HIV-1 RNA<50 copies/ml at week 48. At time of virological failure, genotypic resistance-associated mutations were detected in three participants, two with E138K (one alone and one with additional mutations). Median (95% CI) CD4(+) cell count increase was 163 (136, 203) cells/µl. Fifteen (19.0%) participants reported a new sign/symptom or lab abnormality ≥ Grade 3 and three participants (3.8%) permanently discontinued ETR due to toxicity. Two participants had psychiatric symptoms of any grade. There were no deaths. CONCLUSIONS In this study of ARV-naive HIV-positive adults, once-daily ETR with TDF/FTC had acceptable antiviral activity and was well-tolerated. Once-daily ETR may be a plausible option as part of a combination ARV regimen for treatment-naive individuals. ClinicalTrials.gov NCT00959894.
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Affiliation(s)
- Michelle A Floris-Moore
- Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
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Brochot A, Kakuda TN, Van De Casteele T, Opsomer M, Tomaka FL, Vermeulen A, Vis P. Model-Based Once-Daily Darunavir/Ritonavir Dosing Recommendations in Pediatric HIV-1-Infected Patients Aged ≥3 to <12 Years. CPT Pharmacometrics Syst Pharmacol 2015; 4:406-14. [PMID: 26312164 PMCID: PMC4544054 DOI: 10.1002/psp4.44] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 04/10/2015] [Indexed: 01/02/2023] Open
Abstract
An existing population pharmacokinetic model of darunavir in adults was updated using pediatric data from two studies evaluating weight-based, once-daily dosing of darunavir/ritonavir (ARIEL, NCT00919854 and DIONE, NCT00915655). The model was then used to provide once-daily dosing recommendations for darunavir/ritonavir in pediatric patients aged ≥3 to <12 years. The final model comprised two compartments with first-order absorption and apparent clearance dependent on the concentration of α1-acid glycoprotein. The recommended darunavir/ritonavir once-daily dosing regimens in children aged ≥3 to <12 years are: 35/7 mg/kg from 10 to <15 kg, 600/100 mg from 15 to <30 kg, 675/100 mg from 30 to <40 kg, and 800/100 mg for ≥40 kg. These doses should result in exposures similar to the adult exposure after treatment with darunavir/ritonavir 800/100 mg once daily, while minimizing pill burden and allowing a switch from suspension to tablet(s) as early as possible.
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Affiliation(s)
- A Brochot
- Janssen Research & DevelopmentBeerse, Belgium
| | - TN Kakuda
- Janssen Research & DevelopmentTitusville, New Jersey, USA
| | | | - M Opsomer
- Janssen Infectious Diseases BVBABeerse, Belgium
| | - FL Tomaka
- Janssen Research & DevelopmentTitusville, New Jersey, USA
| | - A Vermeulen
- Janssen Research & DevelopmentBeerse, Belgium
| | - P Vis
- Janssen Infectious Diseases BVBABeerse, Belgium
- LAP&P Consultants BVLeiden, The Netherlands
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Kabbara WK, Ramadan WH. Emtricitabine/rilpivirine/tenofovir disoproxil fumarate for the treatment of HIV-1 infection in adults. J Infect Public Health 2015; 8:409-17. [PMID: 26001757 DOI: 10.1016/j.jiph.2015.04.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 03/19/2015] [Accepted: 04/03/2015] [Indexed: 11/18/2022] Open
Abstract
This paper reviews the current literature and information on the combination drug Complera(™) (rilpivirine/emtricitabine/tenofovir disoproxil fumarate) that was approved by the Food and Drug Administration (FDA) in August 2011. PubMed, Cochrane and Embase (2001-2014) were searched for primary and review articles on rilpivirine, emtricitabine, and tenofovir disoproxil fumarate, individually or in combination. Data from drug manufacturer and product label was also used. Clinical trial reports were selected, extracted and analyzed to include relevant and recent ones. Selected English-language trials were limited to those with human subjects and included both safety and efficacy outcomes. Results from two phase 3 randomized double blind trials (ECHO and THRIVE) showed that rilpivirine is non-inferior to efavirenz in suppressing viral load below 50 copies/mL in anti-retroviral therapy (ART) naïve human immunodeficiency virus (HIV) infected patients. In addition, psychiatric disturbances, rash and increase in lipid levels occurred less frequently with rilpivirine when compared to efavirenz. However, virological failure and drug resistance were higher with rilpivirine in patients with baseline viral load >100,000 copies/mL. Rilpivirine showed cross resistance to efavirenz and etravirine. Efavirenz, on the other hand, did not demonstrate cross resistance to rilpivirine and etravirine, leaving the latter drugs as options for use in case of virological failure with efavirenz. Complera(™) remains an acceptable alternative treatment to Atripla(™) in ART naïve patients who have a pre-ART plasma HIV RNA <100,000 copies/mL and CD4 count >200 cells/mm(3) with non-inferior efficacy and better safety and tolerability.
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Affiliation(s)
- Wissam K Kabbara
- Department of Pharmacy Practice, School of Pharmacy, Lebanese American University (LAU), P.O. Box: 36/F-53, Byblos, Lebanon.
| | - Wijdan H Ramadan
- Department of Pharmacy Practice, School of Pharmacy, Lebanese American University (LAU), P.O. Box: 36/F-53, Byblos, Lebanon.
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Abstract
Supplemental Digital Content is Available in the Text. Objective: HIV genotype-resistance testing can help identify more effective antiretroviral treatment (ART) regimens for patients, substantially increasing the likelihood of viral suppression and immune recovery. We sought to evaluate the cost-effectiveness of genotype-resistance testing before first-line ART initiation in Brazil. Design: We used a previously published microsimulation model of HIV disease (CEPAC-International) and data from Brazil to compare the clinical impact, costs, and cost-effectiveness of initial genotype testing (Genotype) with no initial genotype testing (No genotype). Methods: Model parameters were derived from the HIV Clinical Cohort at the Evandro Chagas Clinical Research Institute and from published data, using Brazilian sources whenever possible. Baseline patient characteristics included 69% male, mean age of 36 years (SD, 10 years), mean CD4 count of 347 per microliter (SD, 300/µL) at ART initiation, annual ART costs from 2012 US $1400 to US $13,400, genotype test cost of US $230, and primary resistance prevalence of 4.4%. Life expectancy and costs were discounted 3% per year. Genotype was defined as “cost-effective” compared with No Genotype if its incremental cost-effectiveness ratio was less than 3 times the 2012 Brazilian per capita GDP of US $12,300. Results: Compared with No genotype, Genotype increased life expectancy from 18.45 to 18.47 years and reduced lifetime cost from US $45,000 to $44,770; thus, in the base case, Genotype was cost saving. Genotype was cost-effective at primary resistance prevalence as low as 1.4% and remained cost-effective when subsequent-line ART costs decreased to 30% of baseline value. Cost-inefficient results were observed only when simultaneously holding multiple parameters to extremes of their plausible ranges. Conclusions: Genotype-resistance testing in ART-naive individuals in Brazil will improve survival and decrease costs and should be incorporated into HIV treatment guidelines in Brazil.
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Pharmacokinetics of Etravirine Combined with Atazanavir/Ritonavir and a Nucleoside Reverse Transcriptase Inhibitor in Antiretroviral Treatment-Experienced, HIV-1-Infected Patients. AIDS Res Treat 2015; 2015:938628. [PMID: 25664185 PMCID: PMC4312629 DOI: 10.1155/2015/938628] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 11/26/2014] [Accepted: 12/09/2014] [Indexed: 01/10/2023] Open
Abstract
Objectives. TEACH (NCT00896051) was a randomized, open-label, two-arm Phase II trial to investigate the pharmacokinetic interaction between etravirine and atazanavir/ritonavir and safety and efficacy in treatment-experienced, HIV-1-infected patients. Methods. After a two-week lead-in of two nucleoside reverse transcriptase inhibitors (NRTIs) and atazanavir/ritonavir 300/100 mg, 44 patients received etravirine 200 mg bid with one NRTI, plus atazanavir/ritonavir 300/100 mg or 400/100 mg qd (n = 22 each group) over 48 weeks. Results. At steady-state etravirine with atazanavir/ritonavir 300/100 mg qd or 400/100 mg qd decreased atazanavir C min by 18% and 9%, respectively, with no change in AUC24 h or C max versus atazanavir/ritonavir 300/100 mg qd alone (Day -1). Etravirine AUC12 h was 24% higher and 16% lower with atazanavir/ritonavir 300/100 or 400/100 mg qd, respectively, versus historical controls. At Week 48, no significant differences were seen between the atazanavir/ritonavir groups in discontinuations due to adverse events (9.1% each group) and other safety parameters, the proportion of patients with viral load <50 copies/mL (intent-to-treat population, noncompleter = failure) (50.0%, atazanavir/ritonavir 300/100 mg qd versus 45.5%, 400/100 mg qd), and virologic failures (31.8% versus 27.3%, resp.). Conclusions. Etravirine 200 mg bid can be combined with atazanavir/ritonavir 300/100 mg qd and an NRTI in HIV-1-infected, treatment-experienced patients without dose adjustment.
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Vingerhoets J, Calvez V, Flandre P, Marcelin AG, Ceccherini-Silberstein F, Perno CF, Mercedes Santoro M, Bateson R, Nelson M, Cozzi-Lepri A, Grarup J, Lundgren J, Incardona F, Kaiser R, Sonnerborg A, Clotet B, Paredes R, Günthard HF, Ledergerber B, Hoogstoel A, Nijs S, Tambuyzer L, Lavreys L, Opsomer M. Efficacy of etravirine combined with darunavir or other ritonavir-boosted protease inhibitors in HIV-1-infected patients: an observational study using pooled European cohort data. HIV Med 2015; 16:297-306. [PMID: 25585664 DOI: 10.1111/hiv.12218] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES This observational study in antiretroviral treatment-experienced, HIV-1-infected adults explored the efficacy of etravirine plus darunavir/ritonavir (DRV group; n = 999) vs. etravirine plus an alternative boosted protease inhibitor (other PI group; n = 116) using pooled European cohort data. METHODS Two international (EuroSIDA; EUResist Network) and five national (France, Italy, Spain, Switzerland and UK) cohorts provided data (collected in 2007-2012). Stratum-adjusted (for confounding factors) Mantel-Haenszel differences in virological responses (viral load < 50 HIV-1 RNA copies/mL) and odds ratios (ORs) with 95% confidence intervals (CIs) were derived. RESULTS Baseline characteristics were balanced between groups except for previous use of antiretrovirals (≥ 10: 63% in the DRV group vs. 49% in the other PI group), including previous use of at least three PIs (64% vs. 53%, respectively) and mean number of PI resistance mutations (2.3 vs. 1.9, respectively). Week 24 responses were 73% vs. 75% (observed) and 49% vs. 43% (missing = failure), respectively. Week 48 responses were 75% vs. 73% and 32% vs. 30%, respectively. All 95% CIs around unadjusted and adjusted differences encompassed 0 (difference in responses) or 1 (ORs). While ORs by cohort indicated heterogeneity in response, for pooled data the difference between unadjusted and adjusted for cohort ORs was small. CONCLUSIONS These data do not indicate a difference in response between the DRV and other PI groups, although caution should be applied given the small size of the other PI group and the lack of randomization. This suggests that the efficacy and virology results from DUET can be extrapolated to a regimen of etravirine with a boosted PI other than darunavir/ritonavir.
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Cohen C. Low-Level Viremia in HIV-1 Infection: Consequences and Implications for Switching to a New Regimen. HIV CLINICAL TRIALS 2015; 10:116-24. [DOI: 10.1310/hct1002-116] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Boffito M, Miralles D, Hill A. Pharmacokinetics, Efficacy, and Safety of Darunavir/Ritonavir 800/100 mg Once-Daily in Treatment-Naïve and -Experienced Patients. HIV CLINICAL TRIALS 2015; 9:418-27. [DOI: 10.1310/hct0906-418] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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