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Dubé K, Barr E, Philbin M, Perez-Brumer A, Minalga B, Peterson B, Averitt D, Picou B, Martel K, Chung C, Mejía M, Cameron M, Graham G, Dee L, Diallo DD, Gordon E, Korolkova A, Dyer T, Auerbach JD, Scully E, Dong KL, Gianella S. Increasing the meaningful involvement of women in HIV cure-related research: a qualitative interview study in the United States. HIV Res Clin Pract 2023; 24:2246717. [PMID: 37608645 PMCID: PMC10454980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
BACKGROUND Cisgender women represent over half of people living with HIV globally. However, current research efforts toward a cure for HIV focus predominantly on cisgender men. The under-representation of women in HIV cure clinical studies is particularly problematic given data suggesting that sex-dependent phenotypes limit scientific discovery. OBJECTIVE We aimed to generate considerations to increase the meaningful involvement of women in HIV cure-related research. MATERIALS AND METHODS We conducted in-depth interviews with biomedical researchers and community members to better understand factors that could increase the meaningful involvement of women in HIV cure clinical trials. Participants were affiliated with academia, industry, community advisory boards, and community-based organizations, and were identified using listings from the AIDS Clinical Trials Group and the Martin Delaney Collaboratories. We used conventional content analysis to analyze the qualitative data. RESULTS We recruited 27 participants, of whom 11 were biomedical researchers and 16 were community members. Participants included 25 cisgender women, 1 transgender woman, and 1 cisgender man. Key considerations emerged, including the need to ensure that HIV cure studies reflect HIV epidemiologic trends and having accurate representation by sex and gender in HIV cure research. To increase the meaningful involvement of women, recommendations included instituting intentional enrollment goals, frequent and mandatory reporting on enrollment, and incentives for sites to enroll women. Additional themes included the need for agency and self-determination, attention to lived experiences, trauma and healing, and adequate support for women (e.g. logistical, psychosocial, mental, emotional, and physical). Participants noted that women would be willing to participate in HIV cure trials, related procedures (e.g. biopsies), and analytical treatment interruptions. They also expressed a desired for women-centered and holistic clinical trial designs that account for intersectionality. CONCLUSIONS Our empirical inquiry extends recent calls to action to increase diversity of people involved in HIV cure research. Redressing the under-inclusion of women in HIV cure research is an urgent imperative. The entire field must mobilize and reform to achieve this goal. Meaningfully involving women across the gender spectrum in HIV cure research is needed to ensure that interventions are safe, effective, scalable, and acceptable for all people with HIV.
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Affiliation(s)
- Karine Dubé
- University of California San Diego (UCSD), School of Medicine, Division of Infectious Diseases and Global Public Health (IDGPH), 9500 Gilman Drive MC 0507, San Diego, CA, 92093-0507, USA
- University of North Carolina (UNC) Gillings School of Global Public Health, Department of Health Policy and Management, 135 Dauer Drive, Chapel Hill, NC, 27599-7411, USA
| | - Elizabeth Barr
- National Institutes of Health (NIH) Office of Research on Women’s Health (ORWH), 6707 Democracy Boulevard, Suite 400, Bethesda, MD, 20817, USA
| | - Morgan Philbin
- Center for Vulnerable Populations, Department of Medicine, University of California San Francisco (UCSF), 2789 25 Street, Suite 350, San Francisco, CA, 94110, USA
| | - Amaya Perez-Brumer
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Room 500, Toronto, Ontario, M5T 3M7, Canada
| | - Brian Minalga
- Office of HIV/AIDS Network Coordination (HANC), Fred Hutchinson Cancer Center, 1100 Fairview Avenue North, Seattle, WA, 98109, USA
| | - Beth Peterson
- Wistar Institute and BEAT-HIV Delaney Collaboratory Towards an HIV-1 Cure, 3601 Spruce Street, Philadelphia, PA, 19104, USA
| | - Dawn Averitt
- The Well Project and Women’s Research Initiative on HIV/AIDS (WRI), Nationwide, USA
| | - Bridgette Picou
- The Well Project and Women’s Research Initiative on HIV/AIDS (WRI), Nationwide, USA
| | - Krista Martel
- The Well Project and Women’s Research Initiative on HIV/AIDS (WRI), Nationwide, USA
| | - Cecilia Chung
- Transgender Law Center, PO Box 70976, Oakland, CA, 94612-0976, USA
| | - María Mejía
- The Well Project Community Advisory Board (CAB), Nationwide, USA
| | - Martha Cameron
- International Community of Women Living with HIV (ICW), North America
| | - Gail Graham
- University of Maryland PATIENTS Program, 20 North Pine Sreet, Maryland, MD, 21201, USA
| | - Lynda Dee
- AIDS Action Baltimore, 14 East Street, Baltimore, MD, 21202, USA
- Delaney AIDS Research Enterprise (DARE) Community Advisory Board, 995 Potrero Avenue, San Francisco, CA, 94110, USA
| | | | - Ebony Gordon
- Delaney AIDS Research Enterprise (DARE) Community Advisory Board, 995 Potrero Avenue, San Francisco, CA, 94110, USA
- San Francisco AIDS Foundation (SFAF), 1035 Market Street, 4 Floor, San Francisco, CA, 94103, USA
| | - Anastasia Korolkova
- University of California San Diego (UCSD), School of Medicine, Division of Infectious Diseases and Global Public Health (IDGPH), 9500 Gilman Drive MC 0507, San Diego, CA, 92093-0507, USA
| | - Typhanye Dyer
- University of Maryland, School of Public Health, 4200 Valley Drive, Suite 2242, College Park, MD, 20742-2611, USA
| | - Judith D. Auerbach
- Division of Prevention Science, Department of Medicine, UCSF, 550 16 Street, 3 Floor, San Francisco, CA, 94158, USA
| | - Eileen Scully
- Johns Hopkins School of Medicine, 733 North Broadway, Baltimore, MD, 21205, USA
| | - Krista L. Dong
- Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
- Ragon Institute of MGH, MIT and Harvard, 400 Technology Square, Cambridge, MA, 02139-3583, USA
- Massachusetts General Hospital (MGH), 55 Fruit Street, Boston, MD, 02114, USA
| | - Sara Gianella
- University of California San Diego (UCSD), School of Medicine, Division of Infectious Diseases and Global Public Health (IDGPH), 9500 Gilman Drive MC 0507, San Diego, CA, 92093-0507, USA
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Abstract
The latest HIV-1 protease inhibitor (PI) darunavir (Prezista™) has a high genetic barrier to resistance development and is active against wild-type HIV and HIV strains no longer susceptible to some older PIs. Ritonavir-boosted darunavir, as a component of antiretroviral therapy (ART), is indicated for the treatment of HIV-1 infection in adult and paediatric patients (aged ≥3 years), with or without treatment experience (details vary depending on region of approval). Several open-label or partially-blinded trials have evaluated the efficacy of ritonavir-boosted darunavir ART regimens for up to 192 weeks in these settings. In treatment-naïve adults, once-daily boosted darunavir was no less effective in establishing virological suppression than once- or twice-daily boosted lopinavir, yet was more effective at maintaining suppression long term. Moreover, treatment-experienced adults with no darunavir resistance-associated mutations (RAMs) had no less effective viral load suppression with once-daily than with twice-daily boosted darunavir. In treatment-experienced adults, including some with multiple major PI RAMs, twice-daily boosted darunavir was more effective than twice-daily boosted lopinavir or boosted control PIs in reducing viral load, and provided virological benefit as part of a salvage regimen in those with few remaining treatment options. Boosted darunavir also reduced viral load when administered once-daily in treatment-naïve adolescents or twice-daily in treatment-experienced children and adolescents. Boosted darunavir is generally well tolerated, with gastrointestinal disturbances and lipid abnormalities among the most common tolerability issues. It has a lipid profile more favourable than that of boosted lopinavir in terms of total cholesterol and triglyceride changes and, when administered once daily, its lipid effects are generally similar to those of boosted atazanavir. Thus, boosted darunavir is a useful option for the ART regimens of adult and paediatric patients with HIV-1 infection.
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Abstract
PURPOSE OF REVIEW This review considers the evidence available to guide clinicians in their choice of optimal antiretroviral therapy (ART) for women with HIV. RECENT FINDINGS Cohort and clinical trial data indicate that ART is as efficacious in women as men, although women are more likely to discontinue therapy, which compromises effectiveness. For many drugs, women have higher plasma levels than men, although whether this is secondary to differing metabolism in women or because on average women have a lower body mass than men is not clear. For many drugs, women experience more adverse events secondary to ART. Opinion on the use of efavirenz in pregnancy differs between countries. The average age of women with HIV is increasing. Although virological responses to ART are not affected by age, immunological responses may be poorer. Older women with HIV face issues such as neurocognitive impairment, early menopause, osteoporosis and polypharmacy, which will have the potential to impact on their use of ART. SUMMARY When planning ART regimes with women, clinicians need to be mindful of the woman's social situation and stage in the life course, as well as the scientific data on individual drug effectiveness according to sex.
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Srinivasa S, Grinspoon SK. Metabolic and body composition effects of newer antiretrovirals in HIV-infected patients. Eur J Endocrinol 2014; 170:R185-202. [PMID: 24523497 DOI: 10.1530/eje-13-0967] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
In the absence of a cure, HIV-infected patients are being successfully treated with antiretroviral therapies (ART) and living longer. Indeed, an increasing number of HIV-infected patients are living beyond the age of 50 years, and in that regard, the use of ART has transformed HIV into a chronic medical condition. As more HIV-infected patients are virologically controlled and living longer, the trajectory of disease morbidity has shifted, however, primarily from opportunistic infections and immune dysfunction to metabolic complications. Evidence suggests that HIV-infected patients acquire significant metabolic risks, including lipodystrophic changes, subclinical atherosclerosis, and insulin resistance. The etiology of these metabolic complications specifically in HIV-infected patients is not entirely clear but may be related to a complex interaction between long-term consequences of infection and HIV itself, chronic use of antiretrovirals, and underlying inflammatory processes. Previous classes of ART, such as protease inhibitors (PIs) and reverse transcriptase inhibitors, have been implicated in altering fat redistribution and lipid and glucose homeostasis. Advances in drug development have introduced newer ART with strategies to target novel mechanisms of action and improve patient adherence with multi-class drug combinations. In this review, we will focus on these newer classes of ART, including selected entry inhibitors, integrase inhibitors, and multi-class drug combinations, and two newer PIs, and the potential of these newer agents to cause metabolic complications in HIV-infected patients. Taken together, further reduction of morbidity in HIV-infected patients will require increasing awareness of the deleterious metabolic complications of ART with subsequent management to mitigate these risks.
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Affiliation(s)
- Suman Srinivasa
- Program in Nutritional Metabolism, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, LON207, Boston, Massachusetts 02114, USA
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Shiau S, Kuhn L, Strehlau R, Martens L, McIlleron H, Meredith S, Wiesner L, Coovadia A, Abrams EJ, Arpadi SM. Sex differences in responses to antiretroviral treatment in South African HIV-infected children on ritonavir-boosted lopinavir- and nevirapine-based treatment. BMC Pediatr 2014; 14:39. [PMID: 24521425 PMCID: PMC3927631 DOI: 10.1186/1471-2431-14-39] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 02/06/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While studies of HIV-infected adults on antiretroviral treatment (ART) report no sex differences in immune recovery and virologic response but more ART-associated complications in women, sex differences in disease progression and response to ART among children have not been well assessed. The objective of this study was to evaluate for sex differences in response to ART in South African HIV-infected children who were randomized to continue ritonavir-boosted lopinavir (LPV/r)-based ART or switch to nevirapine-based ART. METHODS ART outcomes in HIV-infected boys and girls in Johannesburg, South Africa from 2005-2010 were compared. Children initiated ritonavir-boosted lopinavir (LPV/r)-based ART before 24 months of age and were randomized to remain on LPV/r or switch to nevirapine-based ART after achieving viral suppression. Children were followed for 76 weeks post-randomization and then long-term follow up continued for a minimum of 99 weeks and maximum of 245 weeks after randomization. Viral load, CD4 count, lipids, anthropometrics, drug concentrations, and adherence were measured at regular intervals. Outcomes were compared between sexes within treatment strata. RESULTS A total of 323 children (median age 8.8 months, IQR 5.1-13.5), including 168 boys and 155 girls, initiated LPV/r-based ART and 195 children were randomized. No sex differences in risk of virological failure (confirmed viral load >1000 copies/mL) by 156 weeks post-randomization were observed within either treatment group. Girls switched to nevirapine had more robust CD4 count improvement relative to boys in this group through 112 weeks post-randomization. In addition, girls remaining on LPV/r had higher plasma concentrations of ritonavir than boys during post-randomization visits. After a mean of 3.4 years post-randomization, girls remaining on LPV/r also had a higher total cholesterol:HDL ratio and lower mean HDL than boys on LPV/r. CONCLUSIONS Sex differences are noted in treated HIV-infected children even at a young age, and appear to depend on treatment regimen. Future studies are warranted to determine biological mechanisms and clinical significance of these differences. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT00117728.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Stephen M Arpadi
- Gertrude H, Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY USA.
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Kariya R, Taura M, Suzu S, Kai H, Katano H, Okada S. HIV protease inhibitor Lopinavir induces apoptosis of primary effusion lymphoma cells via suppression of NF-κB pathway. Cancer Lett 2013; 342:52-9. [PMID: 24012878 DOI: 10.1016/j.canlet.2013.08.045] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 08/01/2013] [Accepted: 08/19/2013] [Indexed: 11/27/2022]
Abstract
Primary effusion lymphoma (PEL) is a non-Hodgkin lymphoma that occurs predominantly in patients with advanced AIDS. In this study, we examined the effect of HIV protease inhibitors, Lopinavir (LPV), Ritonavir (RTV) and Darunavir (DRV) on PEL cell lines in vitro and in vivo. LPV and RTV, but not DRV induced caspase-dependent apoptosis and suppressed NF-κB activity by inhibiting IKK phosphorylation in PEL cells. In a PEL xenograft mouse model, LPV significantly inhibited the growth and invasion of PEL cells. These results suggest that LPV may have promise for the treatment and prevention of PEL, which occurs in HIV/AIDS patients.
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Affiliation(s)
- Ryusho Kariya
- Division of Hematopoiesis, Center for AIDS Research, Kumamoto University, 2-2-1, Honjo, Kumamoto 860-0811, Japan
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[Consensus statement on assistance to women with human immunodeficiency virus infection in the health care sector. National AIDS Plan (PNS) and AIDS Study Group (GeSIDA)]. Enferm Infecc Microbiol Clin 2013; 32:99.e1-99.e14. [PMID: 23896395 DOI: 10.1016/j.eimc.2013.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Accepted: 04/12/2013] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To develop a consensus document on clinical recommendations for the health care of women with human immunodeficiency virus (HIV) infection. METHODS We assembled a panel of experts appointed by the Secretariat of the National AIDS Plan and GeSIDA that included internal medicine physicians with expertise in the field of HIV infection, gynecologists, pediatricians and psychologists, and two panel members acting as coordinators. Scientific information was reviewed in publications and conference reports up to October 2012. In keeping with the criteria of the Infectious Disease Society of America, two levels of evidence were applied to support the proposed recommendations: the strength of the recommendation according to expert opinion (A, B, C), and the level of empirical evidence (i, ii, iii), already used in previous documents from SPNS/GeSIDA. RESULTS We provide multiple recommendations for the clinical management of women with HIV infection, considering both the diagnostic and possible therapeutic strategies. The consensus recommends gender mainstreaming in health care, and promoting training for healthcare professionals in order to avoid gender bias. With currently available data it seems that the effectiveness of the treatment is the same in both men and women, there being no limitation as to the use of any antiretroviral for this reason. Women have more treatments suspended for reasons other than virological failure, thus they require better monitoring. CONCLUSIONS This document presents recommendations for addressing women with HIV infection. This must be multidisciplinary, taking into account the differences that can be found in the diagnosis, disease development, and treatment between men and women.
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Squires K, Feinberg J, Bridge DA, Currier J, Ryan R, Seyedkazemi S, Dayaram YK, Mrus J. Insights on GRACE (Gender, Race, And Clinical Experience) from the patient's perspective: GRACE participant survey. AIDS Patient Care STDS 2013; 27:352-62. [PMID: 23701200 DOI: 10.1089/apc.2013.0015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The Gender, Race And Clinical Experience (GRACE) study was conducted between October 2006 and December 2008 to evaluate sex- and race-based differences in outcomes after treatment with a darunavir/ritonavir-based antiretroviral regimen. Between June 2010 and June 2011, former participants of the GRACE trial at participating sites were asked to complete a 40-item questionnaire as part of the GRACE Participant Survey study, with a primary objective of assessing patients' characteristics, experiences, and opinions about participation in GRACE. Of 243 potential survey respondents, 151 (62%) completed the survey. Respondents were representative of the overall GRACE population and were predominantly female (64%); fewer were black, and more reported recreational drug use compared with nonrespondents (55% vs. 62% and 17% vs. 10%, respectively). Access to treatment (41%) and too many blood draws (26%) were reported as the best and worst part of GRACE, respectively. Support from study site staff was reported as the most important factor in completing the study (47%). Factors associated with nonadherence, study discontinuation, and poor virologic response in univariate analyses were being the primary caregiver for children, unemployment, and transportation difficulties, respectively. Patients with these characteristics may be at risk of poor study outcomes and may benefit from additional adherence and retention strategies in future studies and routine clinical care.
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Affiliation(s)
- Kathleen Squires
- Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Judith Feinberg
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | - Judith Currier
- University of California, Los Angeles, School of Medicine, Los Angeles, California
| | - Robert Ryan
- Janssen Research & Development, Titusville, New Jersey
| | | | | | - Joseph Mrus
- Janssen Services, LLC, Titusville, New Jersey
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Haberl A, Johnson M, Dominguez S, Miralles C, d’Arminio Monforte A, Anderson J. The need for data on women living with HIV in Europe. Antivir Ther 2013; 18 Suppl 2:1-10. [DOI: 10.3851/imp2640] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2013] [Indexed: 10/26/2022]
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Overton ET, Arathoon E, Baraldi E, Tomaka F. Effect of darunavir on lipid profile in HIV-infected patients. HIV CLINICAL TRIALS 2012; 13:256-70. [PMID: 23134626 DOI: 10.1310/hct1305-256] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Highly active antiretroviral therapy regimens, consisting of a ritonavir-boosted protease inhibitor (PI) and 2 nucleoside reverse transcriptase inhibitors, are established first-line regimens for HIV-infected patients. However, a common adverse effect in patients receiving PIs is dyslipidemia, characterized by increases in plasma levels of triglycerides, low-density lipoprotein cholesterol, and total cholesterol (TC). These lipid changes, as well as other well-described risk factors, may predispose patients to the development of cardiovascular disease, an important comorbidity, especially as the lifespan of HIV-infected patients has increased dramatically in recent years. Among PIs, ritonavir-boosted atazanavir (ATV/r) and, more recently, ritonavir-boosted darunavir (DRV/r) have demonstrated potent antiviral efficacy with more favorable lipid profiles than other PIs. This review provides an overview of the lipid effects of DRV/r. Studies with DRV/r in healthy volunteers and in both treatment-naïve and -experienced patients have demonstrated that changes in tri-glycerides and TC are comparable to those seen with ATV/r.
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Aberg JA, Tebas P, Overton ET, Gupta SK, Sax PE, Landay A, Falcon R, Ryan R, De La Rosa G. Metabolic effects of darunavir/ritonavir versus atazanavir/ritonavir in treatment-naive, HIV type 1-infected subjects over 48 weeks. AIDS Res Hum Retroviruses 2012; 28:1184-95. [PMID: 22352336 DOI: 10.1089/aid.2011.0327] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
We assessed metabolic changes for darunavir/ritonavir (DRV/r) once daily (qd) versus atazanavir/ritonavir (ATV/r) qd with fixed-dose tenofovir/emtricitabine. This was a phase 4, multicenter, open-label, randomized exploratory study. Treatment-naive, HIV-1-infected adults received DRV/r 800/100 mg qd or ATV/r 300/100 mg qd, both with emtricitabine/tenofovir 200/300 mg qd. Primary end point: change in triglyceride levels from baseline to week 12. Secondary end points: week 12 and week 48 changes in lipid parameters, insulin sensitivity, inflammatory/coagulation/bacterial translocation biomarkers, viral load, CD4(+) cell count, and week 48 changes in adipose tissue distribution and subjects' perceptions of body changes. In the DRV/r arm, 32/34 and 29/34 subjects completed weeks 12 and 48, respectively; in the ATV/r arm, 30/31 and 25/31 subjects completed weeks 12 and 48, respectively. Small changes in lipid parameters from baseline to weeks 12 and 48 were observed in both arms. Differences were noted between arms in mean changes in total cholesterol (DRV/r, 20.3 mg/dl; ATV/r, 4.6 mg/dl) and apolipoprotein A1 (DRV/r, 10.7 mg/dl; ATV/r, -0.7 mg/dl) at week 12. At week 48, no clinically relevant differences between arms were noted for changes in any lipid parameter, fasting glucose, or insulin sensitivity. Biomarkers generally decreased and efficacy parameters improved in both arms over 48 weeks. Changes in adipose tissue were small and comparable between arms. Subjects' perceptions of body changes generally improved in both study arms. This first pilot comparison in HIV-1-infected subjects suggests that DRV/r has a metabolic profile similar to ATV/r over 48 weeks of treatment. Further randomized studies are warranted.
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Affiliation(s)
- Judith A. Aberg
- Bellevue Hospital Center at New York University School of Medicine, New York, New York
| | - Pablo Tebas
- AIDS Clinical Trials Unit, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | | | - Samir K. Gupta
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Paul E. Sax
- Division of Infectious Diseases, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts
| | - Alan Landay
- Rush University Medical Center, Chicago, Illinois
| | - Ron Falcon
- Janssen Therapeutics, Titusville, New Jersey
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Robertson J, Feinberg J. Darunavir : a nonpeptidic protease inhibitor for antiretroviral-naive and treatment-experienced adults with HIV infection. Expert Opin Pharmacother 2012; 13:1363-75. [PMID: 22594781 DOI: 10.1517/14656566.2012.681776] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Darunavir , a nonpeptidic inhibitor of the HIV-1 protease with potent activity against resistant virus, was initially approved by the FDA (2006) and the EMA (2007) for the treatment of antiretroviral-experienced adults, and later for naive adults. Darunavir/ritonavir (600/100 mg twice daily, ideally given with two other active antiretrovirals) demonstrated superior efficacy compared to lopinavir/ritonavir and other protease inhibitors in highly experienced patients. Darunavir/ritonavir (800/100 mg once daily) was demonstrated to be safe and effective for the treatment of naive patients and those with limited darunavir resistance-associated mutations (RAMs). Because darunavir must be coadministered with ritonavir, cytochrome P450 drug-drug interactions can be problematic. AREAS COVERED The chemistry, pharmacokinetics, pharmacodynamics, efficacy and safety of darunavir are reviewed in this paper. A PubMed search was conducted using the search terms 'randomized', 'darunavir' and 'efficacy'. Review articles and studies that primarily focused on other drugs were excluded. EXPERT OPINION Because darunavir exhibits efficacy against virus with significant protease inhibitor resistance mutations, it is critically important in the treatment of experienced patients, although viral suppression rates may be lower in those with a high baseline viral load or a greater number of cumulative darunavir RAMs. Darunavir/ritonavir is efficacious and well tolerated as a once-daily regimen in naive patients.
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Affiliation(s)
- Jaime Robertson
- University of Cincinnati, Division of Infectious Diseases, 231 Albert Sabin Way, Cincinnati, OH 45267-0560, USA
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