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Gibas KM, Kelly SG, Arribas JR, Cahn P, Orkin C, Daar ES, Sax PE, Taiwo BO. Two-drug regimens for HIV treatment. Lancet HIV 2022; 9:e868-e883. [PMID: 36309038 PMCID: PMC10015554 DOI: 10.1016/s2352-3018(22)00249-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 08/16/2022] [Accepted: 08/22/2022] [Indexed: 12/05/2022]
Abstract
Combination therapy with three antiretroviral agents has been integral to successful HIV-1 treatment since 1996. Although the efficacy, adverse effects, and toxicities of contemporary three-drug regimens have improved, even the newest therapies have potential adverse effects. The use of two-drug regimens is one way to reduce lifetime exposure to antiretroviral drugs while maintaining the benefits of viral suppression. Multiple large, randomised trials have shown the virological non-inferiority of certain two-drug regimens versus three-drug comparators, including adverse effect differences that reflect known profiles of the antiretroviral drugs in the respective regimens. Two-drug combinations are now recommended in treatment guidelines and include the first long-acting antiretroviral regimen for the treatment of HIV-1. Recommended two-drug regimens differ in their risks for, and factors associated with, virological failure and emergent resistance. The tolerability, safety, metabolic profiles, and drug interactions of two-drug regimens also vary by the constituent drugs. No current two-drug regimen is recommended for people with chronic hepatitis B virus as none include tenofovir. Two-drug regimens have increased options for individualised care.
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Affiliation(s)
- Kevin M Gibas
- Division of Infectious Diseases, Vanderbilt University Medical Center, Vanderbilt University, Nashville, TN, USA
| | - Sean G Kelly
- Division of Infectious Diseases, Vanderbilt University Medical Center, Vanderbilt University, Nashville, TN, USA
| | - Jose R Arribas
- Infectious Diseases Unit, La Paz University Hospital, Hospital La Paz Institute for Health Research, Madrid, Spain; School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
| | - Pedro Cahn
- Fundación Huésped, Buenos Aires, Argentina
| | - Chloe Orkin
- Department of Immunobiology, Queen Mary University of London, London, UK
| | - Eric S Daar
- The Lundquist Institute, Harbor University of California, Los Angeles, Torrence, CA, USA
| | - Paul E Sax
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA
| | - Babafemi O Taiwo
- Division of Infectious Diseases, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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2
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Bastard JP, Pelloux V, Alili R, Fellahi S, Aron-Wisnewsky J, Capel E, Fève B, Assoumou L, Prifti E, Katlama C, Clément K, Capeau J. Altered subcutaneous adipose tissue parameters after switching ART-controlled HIV+ patients to raltegravir/maraviroc. AIDS 2021; 35:1625-1630. [PMID: 33831906 DOI: 10.1097/qad.0000000000002900] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the effect on anthropometric, metabolic and adipose tissue parameters of switching ART-controlled persons living with HIV (PLWH) from a protease inhibitor regimen to raltegravir/maraviroc. DESIGN Sub-study of the ANRS157 ROCnRAL study with the investigation of subcutaneous abdominal adipose tissue (SCAT) biopsy at inclusion and study end. METHODS We performed lipoaspiration of paired SCAT samples, histology on fresh/fixed samples and examined the transcriptomic profile analyzed using Illumina microarrays after RNA extraction. Statistical analyses used the Wilcoxon-paired test. RESULTS The patients (n = 8) were mainly male (7/8), aged (mean ± standard error of the mean) 54.9 ± 1.2 years, BMI 26.1 ± 1.2 kg/m2, CD4+ 699 ± 56 cells/mm3, all viral load (VL) <50 copies/ml. After a follow-up of 6 ± 0.5 months, all PLWH remained with VL <50 copies/ml. BMI, trunk and limb fat amounts were unchanged yet systemic insulin resistance increased. Adipose tissue histology was unchanged except for borderline increased adipocyte diameter (P = 0.1). Among the 16 094 RNA transcripts, 458 genes were up-regulated and 244 were down-regulated. Analyses of the Kyoto Encyclopedia of Genes and Genomes and Gene Ontology databases, evaluating modifications in the main functional pathways, revealed that genes related to immune recognition/function were less expressed as were genes encoding T-cell receptor and receptor signaling pathways. The gene expression profiles indicated decreased inflammation but genes involved in adipogenesis and insulin resistance were overexpressed. CONCLUSION After 6 months of raltegravir/maraviroc, adipogenesis-related gene profile was enhanced in SCAT, in agreement with a tendency for increased adipocyte size. Enhanced SCAT insulin resistance-related profile was concordant with higher systemic insulin resistance. However, the immune activation/inflammation profile was globally lowered. We propose that raltegravir/maraviroc might favor SCAT gain but reduce inflammation/immune activation.
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Affiliation(s)
- Jean-Philippe Bastard
- Sorbonne Université, Inserm, Faculty of Medicine, Centre de Recherche Saint-Antoine (CRSA), ICAN, Paris
- Department of Biochemistry-Pharmacology-Molecular Biology, APHP, Henri-Mondor Hospital, Université Paris Est Créteil
| | - Véronique Pelloux
- Sorbonne Université, Inserm, Faculty of Medicine, Nutrition and Obesities: Systemic Approaches (NutriOmics)
- Assistance Publique Hôpitaux de Paris, Sorbonne Université, Nutrition Department, Pitié-Salpétrière hospital, CRNH Ile-de-France, GH APHP-Sorbonne Université
| | - Rohia Alili
- Sorbonne Université, Inserm, Faculty of Medicine, Nutrition and Obesities: Systemic Approaches (NutriOmics)
- Assistance Publique Hôpitaux de Paris, Sorbonne Université, Nutrition Department, Pitié-Salpétrière hospital, CRNH Ile-de-France, GH APHP-Sorbonne Université
| | - Soraya Fellahi
- Sorbonne Université, Inserm, Faculty of Medicine, Centre de Recherche Saint-Antoine (CRSA), ICAN, Paris
| | - Judith Aron-Wisnewsky
- Sorbonne Université, Inserm, Faculty of Medicine, Nutrition and Obesities: Systemic Approaches (NutriOmics)
- Assistance Publique Hôpitaux de Paris, Sorbonne Université, Nutrition Department, Pitié-Salpétrière hospital, CRNH Ile-de-France, GH APHP-Sorbonne Université
| | - Emilie Capel
- Sorbonne Université, Inserm, Faculty of Medicine, Centre de Recherche Saint-Antoine (CRSA), ICAN, Paris
| | - Bruno Fève
- Sorbonne Université, Inserm, Faculty of Medicine, Centre de Recherche Saint-Antoine (CRSA), ICAN, Paris
- Department of Endocrinology, CRMR Prisis, Saint-Antoine Hospital, GH APHP-Sorbonne Université
| | - Lambert Assoumou
- Sorbonne Université, Inserm, Faculty of Medicine, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Paris
| | - Edi Prifti
- IRD, Sorbonne University, UMMISCO, Bondy
| | - Christine Katlama
- Sorbonne Université, Inserm, Faculty of Medicine, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Paris
- Department of Infectious Diseases, Pitié-Salpétrière Hospital, GH APHP-Sorbonne Université, Paris, France
| | - Karine Clément
- Sorbonne Université, Inserm, Faculty of Medicine, Nutrition and Obesities: Systemic Approaches (NutriOmics)
- Assistance Publique Hôpitaux de Paris, Sorbonne Université, Nutrition Department, Pitié-Salpétrière hospital, CRNH Ile-de-France, GH APHP-Sorbonne Université
| | - Jacqueline Capeau
- Sorbonne Université, Inserm, Faculty of Medicine, Centre de Recherche Saint-Antoine (CRSA), ICAN, Paris
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Lagathu C, Béréziat V, Gorwood J, Fellahi S, Bastard JP, Vigouroux C, Boccara F, Capeau J. Metabolic complications affecting adipose tissue, lipid and glucose metabolism associated with HIV antiretroviral treatment. Expert Opin Drug Saf 2019; 18:829-840. [PMID: 31304808 DOI: 10.1080/14740338.2019.1644317] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Introduction: Efficient antiretroviral-treatment (ART) generally allows control of HIV infection. However, persons-living-with-HIV (PLWH), when aging, present a high prevalence of metabolic diseases. Area covered: Altered adiposity, dyslipidemias, insulin resistance, diabetes, and their consequences are prevalent in PLWH and could be partly related to ART. Expert opinion: At first, personal and lifestyle factors are involved in the onset of these complications. The persistence of HIV in tissue reservoirs could synergize with some ART and enhance metabolic disorders. Altered fat repartition, diagnosed as lipodystrophy, has been related to first-generation nucleoside-reverse-transcriptase-inhibitors (NRTIs) (stavudine zidovudine) and some protease inhibitors (PIs). Recently, use of some integrase-inhibitors (INSTI) resulted in weight/fat gain, which represents a worrisome unresolved situation. Lipid parameters were affected by some first-generation NRTIs, non-NRTIs (efavirenz) but also PIs boosted by ritonavir, with increased total and LDL-cholesterol and triglycerides. Insulin resistance is common associated with abdominal obesity. Diabetes incidence, high with first-generation-ART (zidovudine, stavudine, didanosine, indinavir) has declined with contemporary ART close to that of the general population. Metabolic syndrome, a dysmetabolic situation with central obesity and insulin resistance, and liver steatosis are common in PLWH and could indirectly result from ART-associated fat gain and insulin resistance. All these dysmetabolic situations increase the atherogenic cardiovascular risk.
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Affiliation(s)
- Claire Lagathu
- a Faculty of Medicine, Sorbonne Université, Inserm UMR_S938, ICAN , Paris , France
| | - Véronique Béréziat
- a Faculty of Medicine, Sorbonne Université, Inserm UMR_S938, ICAN , Paris , France
| | - Jennifer Gorwood
- a Faculty of Medicine, Sorbonne Université, Inserm UMR_S938, ICAN , Paris , France
| | - Soraya Fellahi
- a Faculty of Medicine, Sorbonne Université, Inserm UMR_S938, ICAN , Paris , France.,b Department of Biochemistry, APHP, Hôpital Tenon , Paris , France
| | - Jean-Philippe Bastard
- a Faculty of Medicine, Sorbonne Université, Inserm UMR_S938, ICAN , Paris , France.,b Department of Biochemistry, APHP, Hôpital Tenon , Paris , France
| | - Corinne Vigouroux
- a Faculty of Medicine, Sorbonne Université, Inserm UMR_S938, ICAN , Paris , France.,c Centre de Référence des Pathologies Rares de l'Insulino-Sécrétion et de l'Insulino-Sensibilité (PRISIS), Laboratoire Commun de Biologie et Génétique Moléculaires, APHP, Hôpital Saint-Antoine , Paris , France
| | - Franck Boccara
- a Faculty of Medicine, Sorbonne Université, Inserm UMR_S938, ICAN , Paris , France.,d Department of Cardiology, APHP Hôpital Saint-Antoine , Paris , France
| | - Jacqueline Capeau
- a Faculty of Medicine, Sorbonne Université, Inserm UMR_S938, ICAN , Paris , France
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Chastain D, Badowski M, Huesgen E, Pandit NS, Pallotta A, Michienzi S. Optimizing Antiretroviral Therapy in Treatment-Experienced Patients Living with HIV: A Critical Review of Switch and Simplification Strategies. An Opinion of the HIV Practice and Research Network of the American College of Clinical Pharmacy. J Int Assoc Provid AIDS Care 2019; 18:2325958219867325. [PMID: 31516088 PMCID: PMC6900586 DOI: 10.1177/2325958219867325] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 06/11/2019] [Accepted: 07/02/2019] [Indexed: 12/28/2022] Open
Abstract
Simplifying or switching antiretroviral therapy (ART) in treatment-experienced people living with HIV (PLWH) may improve adherence, tolerability, toxicities, and/or drug-drug interactions. The purpose of this review is to critically evaluate the literature for efficacy and safety associated with switching or simplifying ART in treatment-experienced PLWH. A systematic literature search using MEDLINE was performed from January 1, 2010 to April 30, 2018. References within articles of interest, the Department of Health and Human Services guidelines, and conference abstracts were also reviewed. Switch/simplification strategies were categorized as those supported by high-level clinical evidence and those with emerging data. Rates of virologic suppression were noninferior for several switch/simplification strategies when compared to baseline ART. Potential for reducing adverse events was also seen. Additional evidence for some strategies, including most 2-drug regimens, is needed before they can be recommended.
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Affiliation(s)
| | - Melissa Badowski
- Department of Pharmacy Practice, University of Illinois at Chicago, College
of Pharmacy, Chicago, IL, USA
| | | | - Neha Sheth Pandit
- Department of Pharmacy Practice and Science, University of Maryland School
of Pharmacy, Baltimore, MD, USA
| | - Andrea Pallotta
- Department of Pharmacy, Cleveland Clinic, Cleveland, OH, USA
| | - Sarah Michienzi
- Department of Pharmacy Practice, University of Illinois at Chicago, College
of Pharmacy, Chicago, IL, USA
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5
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Allavena C, Hanf M, Rey D, Duvivier C, BaniSadr F, Poizot-Martin I, Jacomet C, Pugliese P, Delobel P, Katlama C, Joly V, Chidiac C, Dournon N, Merrien D, May T, Reynes J, Gagneux-Brunon A, Chirouze C, Huleux T, Cabié A, Raffi F. Antiretroviral exposure and comorbidities in an aging HIV-infected population: The challenge of geriatric patients. PLoS One 2018; 13:e0203895. [PMID: 30240419 PMCID: PMC6150468 DOI: 10.1371/journal.pone.0203895] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 08/29/2018] [Indexed: 11/25/2022] Open
Abstract
As HIV-infected adults on successful antiretroviral therapy (ART) are expected to have close to normal lifespans, they will increasingly develop age-related comorbidities. The objective of this cross-sectional study was to compare in the French Dat’AIDS cohort, the HIV geriatric population, aged 75 years and over, to the elderly one, aged from 50 to 74 years. As of Dec 2015, 16,436 subjects (43.8% of the French Dat’AIDS cohort) were aged from 50 to 74 (elderly group) and 572 subjects (1.5%) were aged 75 and over (geriatric group). Durations of HIV infection and of ART were slightly but significantly different, median at 19 and 18 years, and 15 and 16 years in the elderly and geriatric group, respectively. The geriatric group was more frequently at CDC stage C and had a lower nadir CD4. This group had been more exposed to first generation protease inhibitors and thymidine analogues. Despite similar virologic suppression, type of ART at the last visit significantly differed between the 2 groups: triple ART in 74% versus 68.2%, ART ≥ 4 drugs in 4.7% versus 2.7%; dual therapy in 11.6% versus 16.4% in the elderly group and the geriatric group, respectively. In the geriatric group all co-morbidities were significantly more frequent, except dyslipidemia, 4.3% of the elderly group had ≥4 co-morbidities versus18.4% in the geriatric group. Despite more co-morbidities and more advanced HIV infection the geriatric population achieve similar high rate of virologic suppression than the elderly population. A multidisciplinary approach should be developed to face the incoming challenge of aging HIV population.
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Affiliation(s)
- Clotilde Allavena
- Infectious Diseases Department, University Hospital of Nantes, Nantes, France
- INSERM CIC1413, University Hospital of Nantes, Nantes, France
- * E-mail:
| | - Matthieu Hanf
- INSERM CIC1413, University Hospital of Nantes, Nantes, France
- INSERM UMR 1181 B2PHI, Versailles Saint Quentin University, institut Pasteur, Villejuif, France
| | - David Rey
- Centre for HIV Infection Care, Strasbourg, France
| | - Claudine Duvivier
- AP-HP-Necker Hospital, Infectious Diseases Department, Necker-Pasteur Infectiology Centre, Paris, France
- Medical Centre of Pasteur Institut, Necker-Pasteur Infectiology Centre, Paris, France
- EA7327, Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - Firouze BaniSadr
- Department of Internal Medicine, Infectious Diseases, and Clinical Immunology, Reims Teaching Hospitals, University of Reims, Reims, France
- Université de Reims Champagne-Ardenne, Faculté de médecine, EA-4684 / SFR CAP-SANTE, Reims, France
| | - Isabelle Poizot-Martin
- Immuno-Hematology Clinic, Aix-Marseille University, APHM Hôpital Sainte-Marguerite, Marseille, France
- Inserm U912 (SESSTIM), Marseille, France
| | - Christine Jacomet
- Infectious Diseases Department, University of Clermont-Ferrand, Clermont-Ferrand, France
| | - Pascal Pugliese
- Department of Infectious Diseases, Centre Hospitalier Universitaire de l'Archet, Nice, France
| | - Pierre Delobel
- INSERM, UMR1043, Toulouse and Université Toulouse III Paul Sabatier, Toulouse, France
- Department of Infectious Diseases, Toulouse University Hospital, Toulouse, France
| | - Christine Katlama
- Department of Infectious Diseases, Assistance publique-Hôpitaux de Paris, Pitié-Salpêtrière University Hospital, Paris, France
- Inserm Unité Mixte de Recherche en Santé 1136, Université Pierre et Marie Curie Paris 06, Sorbonne Universités, Paris, France
| | - Véronique Joly
- Infectious Diseases Department, Hôpital Bichat, AP-HP, Paris, France
- National Institute of Health and Medical Research (INSERM) IAME, UMR 1137, Paris Diderot University, Sorbonne Paris Cité, Paris, France
| | - Christian Chidiac
- Infectious and Tropical Diseases Department, Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Lyon, France
| | - Nathalie Dournon
- Service de Maladies Infectieuses et Tropicales, Dermatologie, Médecine Interne, Faculté de Médecine Hyacinthe Bastaraud, Université des Antilles, Pointe à Pitre, France
- Inserm CIC 1424, Centre Hospitalier Universitaire de Pointe-à-Pitre, Pointe-à-Pitre, France
| | - Dominique Merrien
- Departement of infectious diseases, CHD Vendee, La Roche sur yon, France
| | - Thierry May
- Department of infectious diseases, University Hospital Centre, Nancy, France
| | - Jacques Reynes
- Infectious Diseases Department, Montpellier University Hospital, Montpellier, France
- UMI233 INSERM U1175, Montpellier University Hospital, Montpellier, France
| | | | - Catherine Chirouze
- Infectious Diseases Department, University hospital of Besançon, Besançon, France
- UMR CNRS 6249, University of Bourgogne-Franche Comté, Besançon, France
| | - Thomas Huleux
- Infectious Diseases Department, University hospital of Tourcoing, Tourcoing, France
| | - André Cabié
- Inserm CIC 1424, Centre Hospitalier Universitaire de Pointe-à-Pitre, Pointe-à-Pitre, France
- Infectious Diseases Department, University Hospital of Martinique, Fort-de-France, France
- EA4537, Université des Antilles, Fort-de-France, France
| | - François Raffi
- Infectious Diseases Department, University Hospital of Nantes, Nantes, France
- INSERM CIC1413, University Hospital of Nantes, Nantes, France
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CCR5 Revisited: How Mechanisms of HIV Entry Govern AIDS Pathogenesis. J Mol Biol 2018; 430:2557-2589. [PMID: 29932942 DOI: 10.1016/j.jmb.2018.06.027] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 06/10/2018] [Accepted: 06/13/2018] [Indexed: 01/01/2023]
Abstract
The chemokine receptor CCR5 has been the focus of intensive studies since its role as a coreceptor for HIV entry was discovered in 1996. These studies lead to the development of small molecular drugs targeting CCR5, with maraviroc becoming in 2007 the first clinically approved chemokine receptor inhibitor. More recently, the apparent HIV cure in a patient transplanted with hematopoietic stem cells devoid of functional CCR5 rekindled the interest for inactivating CCR5 through gene therapy and pharmacological approaches. Fundamental research on CCR5 has also been boosted by key advances in the field of G-protein coupled receptor research, with the realization that CCR5 adopts a variety of conformations, and that only a subset of these conformations may be targeted by chemokine ligands. In addition, recent genetic and pathogenesis studies have emphasized the central role of CCR5 expression levels in determining the risk of HIV and SIV acquisition and disease progression. In this article, we propose to review the key properties of CCR5 that account for its central role in HIV pathogenesis, with a focus on mechanisms that regulate CCR5 expression, conformation, and interaction with HIV envelope glycoproteins.
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Casado JL, Monsalvo M, Rojo AM, Fontecha M, Rodriguez-Sagrado MA. Dolutegravir and rilpivirine for the maintenance treatment of virologically suppressed HIV-1 infection. Expert Rev Clin Pharmacol 2018; 11:561-570. [PMID: 29775399 DOI: 10.1080/17512433.2018.1478726] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
INTRODUCTION Triple combinations of antiretroviral therapy (ART) drugs are the standard treatment for human immunodeficiency virus (HIV) infection, but the challenges include long-term side effects, high costs, and adherence. The recent advent of potent and well-tolerated ART has renewed the interest for newer ART strategies. A dual regimen with the combination of dolutegravir (DTG) and rilpivirine (RPV), two well-tolerated, metabolic-friendly, and potent drugs could offer additional benefits. Areas covered: A review of recent randomized trials and observational cohorts concerning the use of a dual therapy with DTG plus RPV as a switching strategy in patients with viral suppression. Expert commentary: Currently, data of more of 900 patients switched to this dual regimen are available. This combination shows a high rate of virological suppression, above 90% at 48 weeks, few discontinuations due to adverse events, improvement in bone and kidney parameters for patients discontinuing tenofovir disoproxil fumarate, lack of loss of the inflammatory control achieved with triple therapy, and a neutral effect on lipid parameters. Thus, for the first time, a dual regimen without protease inhibitors is effective, avoiding metabolic side effects and drug interactions. Longer follow-up is needed, but this dual regimen appears as a promising strategy for aging HIV-infected patients.
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Affiliation(s)
- Jose L Casado
- a Department of Infectious Diseases, HIV Unit, and Pharmacy , Ramón y Cajal Hospital , Madrid , Spain
| | - Marta Monsalvo
- a Department of Infectious Diseases, HIV Unit, and Pharmacy , Ramón y Cajal Hospital , Madrid , Spain
| | - Aurora M Rojo
- a Department of Infectious Diseases, HIV Unit, and Pharmacy , Ramón y Cajal Hospital , Madrid , Spain
| | - María Fontecha
- a Department of Infectious Diseases, HIV Unit, and Pharmacy , Ramón y Cajal Hospital , Madrid , Spain
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8
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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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10
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Abstract
The advent of combination antiretroviral therapy (ART) has significantly decreased AIDS-related morbidity and mortality. Nevertheless, the benefits of ART are only realized through adherence to lifelong treatment. Though contemporary antiretroviral (ARV) drugs have fewer adverse effects in comparison to older ARV drugs, many agents are associated with negative or unknown long-term effects. There is increasing evidence that two-drug (dual-therapy) regimens may be an effective alternative to the currently recommended three-drug (triple-therapy) regimens. In this review, we provide a comprehensive and critical review of recently completed and ongoing trials of dual-therapy regimens in treatment-naïve and treatment-experienced HIV-1-infected patients. We also review current HIV/AIDS society recommendations regarding dual therapy as well as future therapeutic possibilities.
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Affiliation(s)
- Sean G Kelly
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, 645 N Michigan Ave, Suite 900, Chicago, IL, 60611, USA
| | - Amesika N Nyaku
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, 645 N Michigan Ave, Suite 900, Chicago, IL, 60611, USA
| | - Babafemi O Taiwo
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, 645 N Michigan Ave, Suite 900, Chicago, IL, 60611, USA. .,Center for Global Health, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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11
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Switch to Ritonavir-Boosted versus Unboosted Atazanavir plus Raltegravir Dual-Drug Therapy Leads to Similar Efficacy and Safety Outcomes in Clinical Practice. PLoS One 2016; 11:e0164240. [PMID: 27798641 PMCID: PMC5087881 DOI: 10.1371/journal.pone.0164240] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 09/21/2016] [Indexed: 01/08/2023] Open
Abstract
Objectives To assess immunovirological response, safety and pharmacokinetic of NRTI-sparing regimen dual therapy of atazanavir (ATV) and raltegravir (RAL) in maintenance strategy. Methods A retrospective analysis was conducted on a cohort of HIV-infected adults followed in French centers (Dat’AIDS cohort), comparing the proportions of virological and therapeutic failures between ATV + RAL and ATV/ritonavir + RAL dual therapy regimens. Results 283 patients were assessed: 185 switched for ATV + RAL and 98 for ATV/ritonavir + RAL dual therapy. Virological failure rate at week 96 was 13.8% (95% CI, 9.8–17.8), without difference between the two groups (Log-rank Test, p = 0.87). The cumulative percentages of patients remaining free of therapeutic failure at week 24, 48 and 96 of dual therapy were 74.9% (95% CI, 69.9–80.0), 65.4% (95% CI, 59.8–70.9) and 53.4% (95% CI, 47.5–59.2), respectively. Four out of 39 confirmed virological failures developed RAL resistance. By multivariate analysis, virological failure was associated with high HIV-1 RNA zenith (p = 0.02), low CD4+ T-cell count at baseline (p<0.001) and short duration on antiretroviral therapy (p<0.001). Before week 96, dual therapy was discontinued in 44 patients (16%) because of various adverse events, with no difference between the two groups. Minimal plasma levels were targeted in 84% and 87% of patients for ATV and RAL, respectively, and both were significantly higher in ritonavir-boosted regimen. Conclusions Emerging RAL-resistance and discontinuations for adverse events resulted in moderate efficacy rates of ATV and RAL dual therapy in heavily pretreated patients.
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Abstract
HIV-1-infected patients with suppressed plasma viral loads often require changes to their antiretroviral (ARV) therapy to manage drug toxicity and intolerance, to improve adherence, and to avoid drug interactions. In patients who have never experienced virologic failure while receiving ARV therapy and who have no evidence of drug resistance, switching to any of the acceptable US Department of Health and Human Services first-line therapies is expected to maintain virologic suppression. However, in virologically suppressed patients with a history of virologic failure or drug resistance, it can be more challenging to change therapy while still maintaining virologic suppression. In these patients, it may be difficult to know whether the discontinuation of one of the ARVs in a suppressive regimen constitutes the removal of a key regimen component that will not be adequately supplanted by one or more substituted ARVs. In this article, we review many of the clinical scenarios requiring ARV therapy modification in patients with stable virologic suppression and outline the strategies for modifying therapy while maintaining long-term virologic suppression.
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Pradat P, Durant J, Brochier C, Trabaud MA, Cottalorda-Dufayard J, Izopet J, Raffi F, Lucht F, Gagnieu MC, Gatey C, Jacomet C, Vassallo M, Dellamonica P, Cotte L. Maraviroc/raltegravir simplification strategy following 6 months of quadruple therapy with tenofovir/emtricitabine/maraviroc/raltegravir in treatment-naive HIV patients. J Antimicrob Chemother 2016; 71:3235-3241. [PMID: 27432606 DOI: 10.1093/jac/dkw273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 05/23/2016] [Accepted: 06/01/2016] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE We assessed the virological efficacy of a 6 month maraviroc/raltegravir simplification strategy following 6 months of quadruple therapy combining tenofovir disoproxil fumarate/emtricitabine with maraviroc/raltegravir. METHODS HIV-1-infected naive patients were enrolled in an open label, single-arm, Phase 2 trial. All patients received maraviroc 300 mg twice daily, raltegravir 400 mg twice daily and tenofovir/emtricitabine for 24 weeks. Patients with stable HIV-RNA <50 copies/mL stopped tenofovir/emtricitabine at week (W) 24 and pursued maraviroc/raltegravir until W48. The primary endpoint was the virological response defined by HIV-RNA <50 copies/mL at W48. RESULTS Thirty-three patients were analysed. Patients were mostly male (94%), Caucasians (91%), MSM (82%); their median age was 42 years. At baseline, median CD4 cell count was 453 cells/mm3 and HIV-RNA was 4.3 log copies/mL. All patients had CCR5-tropic viruses by genotropism and phenotropism assays. All but one patient had an HIV-RNA < 50 copies/mL at W24 and entered the simplification phase. Virological success was maintained at W48 in 88% (90% CI 79%-97%) of patients. N155H mutation was detected at failure in one patient. No tropism switch was observed. Raltegravir and maraviroc plasma exposure were satisfactory in 92% and 79% of 41 samples from 21 patients. Five severe adverse events (SAEs) were observed up to W48; none was related to the study drugs. Four patients presented grade 3 AEs; none was related to the study. No grade 4 AE was observed. No patient died. CONCLUSIONS Maraviroc/raltegravir maintenance therapy following a 6 month induction phase with maraviroc/raltegravir/tenofovir/emtricitabine was well tolerated and maintained virological efficacy in these carefully selected patients.
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Affiliation(s)
- Pierre Pradat
- Centre for Clinical Research, Department of Hepatology, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Jacques Durant
- Department of Infectious Diseases, Hôpital de l'Archet, Nice, France
| | - Corinne Brochier
- Centre for Clinical Research, Department of Hepatology, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Mary-Anne Trabaud
- Department of Virology, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | | | | | - François Raffi
- Department of Infectious Diseases, Nantes University Hospital, Nantes, France
| | - Frédéric Lucht
- Department of Infectious Diseases, Hôpital Nord, Saint Etienne, France
| | - Marie-Claude Gagnieu
- Department of Pharmacology, Hôpital E. Herriot, Hospices Civils de Lyon, Lyon, France
| | - Caroline Gatey
- Department of Infectious Diseases, Saint-Louis Hospital, Paris, France
| | - Christine Jacomet
- Department of Infectious Diseases, CHU Gabriel Montpied, Clermont-Ferrand, France
| | - Matteo Vassallo
- Department of Internal Medicine, Centre Hospitalier de Cannes, Cannes, France
| | | | - Laurent Cotte
- Department of Infectious Diseases and Tropical Medicine, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
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Casado JL, Bañón S. Dutrebis (lamivudine and raltegravir) for use in combination with other antiretroviral products for the treatment of HIV-1 infection. Expert Rev Clin Pharmacol 2016; 8:709-18. [PMID: 26517111 DOI: 10.1586/17512433.2015.1090873] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Raltegravir and lamivudine have been part of highly active therapy regimens throughout the past years of antiretroviral therapy. A fixed-dose, single-tablet regimen comprising a non-poloxamer formulation of the integrase inhibitor raltegravir and the transcriptase inhibitor lamivudine (raltegravir/lamivudine; Dutrebis(®)) has been recently licensed for the treatment of HIV-1 infection. In several Phase I pharmacokinetic studies, one Dutrebis (150 mg lamivudine/300 mg raltegravir) fixed-dose combination tablet showed a higher bioavailability but comparable lamivudine and 400 mg raltegravir poloxamer exposures. Thus, the co-administration of raltegravir together with lamivudine created a potent, effective, well-tolerated antiretroviral combination, which could be more convenient for the patient. However, the disadvantage of twice a day administration, and the existence of other fixed-dose combinations limit its widespread clinical use. This article reviews pharmacokinetics data and appraises their potential use in current and future HIV therapy.
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Affiliation(s)
| | - Sara Bañón
- a Department of Infectious Diseases, HIV Unit, Ramón y Cajal Hospital , Madrid, Spain
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Pett SL, Amin J, Horban A, Andrade-Villanueva J, Losso M, Porteiro N, Sierra Madero J, Belloso W, Tu E, Silk D, Kelleher A, Harrigan R, Clark A, Sugiura W, Wolff M, Gill J, Gatell J, Fisher M, Clarke A, Ruxrungtham K, Prazuck T, Kaiser R, Woolley I, Arnaiz JA, Cooper D, Rockstroh JK, Mallon P, Emery S. Maraviroc, as a Switch Option, in HIV-1-infected Individuals With Stable, Well-controlled HIV Replication and R5-tropic Virus on Their First Nucleoside/Nucleotide Reverse Transcriptase Inhibitor Plus Ritonavir-boosted Protease Inhibitor Regimen: Week 48 Results of the Randomized, Multicenter MARCH Study. Clin Infect Dis 2016; 63:122-32. [PMID: 27048747 DOI: 10.1093/cid/ciw207] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Accepted: 03/23/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Alternative combination antiretroviral therapies in virologically suppressed human immunodeficiency virus (HIV)-infected patients experiencing side effects and/or at ongoing risk of important comorbidities from current therapy are needed. Maraviroc (MVC), a chemokine receptor 5 antagonist, is a potential alternative component of therapy in those with R5-tropic virus. METHODS The Maraviroc Switch Study is a randomized, multicenter, 96-week, open-label switch study in HIV type 1-infected adults with R5-tropic virus, virologically suppressed on a ritonavir-boosted protease inhibitor (PI/r) plus double nucleoside/nucleotide reverse transcriptase inhibitor (2 N(t)RTI) backbone. Participants were randomized 1:2:2 to current combination antiretroviral therapy (control), or replacing the protease inhibitor (MVC + 2 N(t)RTI arm) or the nucleoside reverse transcriptase inhibitor backbone (MVC + PI/r arm) with twice-daily MVC. The primary endpoint was the difference (switch minus control) in proportion with plasma viral load (VL) <200 copies/mL at 48 weeks. The switch arms were judged noninferior if the lower limit of the 95% confidence interval (CI) for the difference in the primary endpoint was < -12% in the intention-to-treat (ITT) population. RESULTS The ITT population comprised 395 participants (control, n = 82; MVC + 2 N(t)RTI, n = 156; MVC + PI/r, n = 157). Baseline characteristics were well matched. At week 48, noninferior rates of virological suppression were observed in those switching away from a PI/r (93.6% [95% CI, -9.0% to 2.2%] and 91.7% [95% CI, -9.6% to 3.8%] with VL <200 and <50 copies/mL, respectively) compared to the control arm (97.6% and 95.1% with VL <200 and <50 copies/mL, respectively). In contrast, MVC + PI/r did not meet noninferiority bounds and was significantly inferior (84.1% [95% CI, -19.8% to -5.8%] and 77.7% [95% CI, -24.9% to -8.4%] with VL <200 and <50 copies/mL, respectively) to the control arm in the ITT analysis. CONCLUSIONS These data support MVC as a switch option for ritonavir-boosted PIs when partnered with a 2-N(t)RTI backbone, but not as part of N(t)RTI-sparing regimens comprising MVC with PI/r. CLINICAL TRIALS REGISTRATION NCT01384682.
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Affiliation(s)
- Sarah Lilian Pett
- The Kirby Institute, University of New South Wales, Sydney, Australia Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology Clinical Research Group, Infection and Population Health, University College London, United Kingdom
| | - Janaki Amin
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Andrejz Horban
- Wojewodzki Szpital Zakazny Centrum Diagnostyki i Terapii AIDS, Warsaw, Poland
| | | | - Marcelo Losso
- Hospital General de Agudos J M Ramos Mejia Fundación IBIS Coordinacion de Investigacion Clinica Academica en Latinoamerica
| | - Norma Porteiro
- Fundación Infectologia de Atencion Ambulatoria, Buenos Aires, Argentina
| | - Juan Sierra Madero
- Instituto Nacional de Ciencias Medicas y Nutriciòn Salvador Zubiran, Tlalpan, Mexico
| | - Waldo Belloso
- Fundación IBIS Coordinacion de Investigacion Clinica Academica en Latinoamerica Hospital Italiano de Buenos Aires, Argentina
| | - Elise Tu
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - David Silk
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Anthony Kelleher
- The Kirby Institute, University of New South Wales, Sydney, Australia St Vincent's Hospital, Sydney, Australia
| | - Richard Harrigan
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | | | | | | | - John Gill
- Southern Alberta Clinic, Calgary, Canada
| | | | - Martin Fisher
- Brighton and Sussex University Hospitals National Health Service Trust, Brighton, United Kingdom
| | - Amanda Clarke
- Brighton and Sussex University Hospitals National Health Service Trust, Brighton, United Kingdom
| | - Kiat Ruxrungtham
- HIV Netherlands, Australia, Thailand Research Collaboration, Bangkok
| | - Thierry Prazuck
- Orleans Hospital (Centre Hospitalier Regional D'Orleans Orleans La Source), France
| | | | | | | | - David Cooper
- The Kirby Institute, University of New South Wales, Sydney, Australia St Vincent's Hospital, Sydney, Australia
| | | | - Patrick Mallon
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Sean Emery
- The Kirby Institute, University of New South Wales, Sydney, Australia
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Calcagno A, D'Avolio A, Bonora S. Pharmacokinetic and pharmacodynamic evaluation of raltegravir and experience from clinical trials in HIV-positive patients. Expert Opin Drug Metab Toxicol 2016; 11:1167-76. [PMID: 26073580 DOI: 10.1517/17425255.2015.1056732] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Raltegravir was the first available integrase inhibitor for treating HIV-positive patients. This review aims to provide an overview of its role in the management of HIV-1 infection, highlighting its key pharmacokinetic and pharmacodynamic properties. AREAS COVERED This review covers material searched and obtained through Medline and PubMed up to April 2015. EXPERT OPINION Raltegravir for its tolerability, efficacy, few drug-to-drug interactions and for the amount of available data in difficult subgroups of patients is a key drug in the antiretroviral armamentarium. For its weak genetic barrier to resistance and erratic pharmacokinetic profile, it should be administered twice daily and with fully active companion antiretrovirals.
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Affiliation(s)
- Andrea Calcagno
- University of Torino, Amedeo di Savoia Hospital, Unit of Infectious Diseases, Department of Medical Sciences , C.so Svizzera 164 - 10149, Torino , Italy + 39 011 439 3884 ; + 39 011 439 3942 ;
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Baril JG, Angel JB, Gill MJ, Gathe J, Cahn P, van Wyk J, Walmsley S. Dual Therapy Treatment Strategies for the Management of Patients Infected with HIV: A Systematic Review of Current Evidence in ARV-Naive or ARV-Experienced, Virologically Suppressed Patients. PLoS One 2016; 11:e0148231. [PMID: 26849060 PMCID: PMC4746196 DOI: 10.1371/journal.pone.0148231] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 01/14/2016] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE We reviewed the current literature regarding antiretroviral (ARV)-sparing therapy strategies to determine whether these novel regimens can be considered appropriate alternatives to standard regimens for the initial treatment of ARV-naive patients or as switch therapy for those patients with virologically suppressed HIV infection. METHODS A search for studies related to HIV dual therapy published from January 2000 through April 2014 was performed using Biosis, Derwent Drug File, Embase, International Pharmaceutical Abstracts, Medline, Pascal, SciSearch, and TOXNET databases; seven major trial registries, and the abstracts of major conferences. Using predetermined criteria for inclusion, an expert review committee critically reviewed and qualitatively evaluated all identified trials for efficacy and safety results and potential limitations. RESULTS Sixteen studies of dual therapy regimens were critiqued for the ARV-naive population. Studies of a protease inhibitor/ritonavir in combination with the integrase inhibitor raltegravir or the nucleoside reverse transcriptase inhibitor lamivudine provided the most definitive evidence supporting a role for dual therapy. In particular, lopinavir/ritonavir or darunavir/ritonavir combined with raltegravir and lopinavir/ritonavir combined with lamivudine demonstrated noninferiority to standard of care triple therapy after 48 weeks of treatment. Thirteen trials were critiqued in ARV-experienced, virologically suppressed patients. The virologic efficacy outcomes were mixed. Although overall data regarding toxicity are limited, when compared with standard triple therapy, certain dual therapy regimens may offer advantages in renal function, bone mineral density, and limb fat changes; however, some dual combinations may elevate lipid or bilirubin levels. CONCLUSIONS The potential benefits of dual therapy regimens include reduced toxicity, improved tolerability and adherence, and reduced cost. Although the data reviewed here provide valuable insights into the effectiveness and tolerability of dual therapy regimens, it remains unclear whether these potential benefits can be maintained long-term. Appropriately powered studies with longer follow-up periods are needed to more definitively assess potential toxicity reduction advantages with dual therapy.
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Affiliation(s)
- Jean-Guy Baril
- Clinique médicale du Quartier latin, Montreal, Quebec, Canada
| | - Jonathan B. Angel
- Division of Infectious Diseases, University of Ottawa and the Ottawa Hospital, Ottawa, Ontario, Canada
| | - M. John Gill
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Joseph Gathe
- Therapeutic Concepts, Houston, Texas, United States of America
| | - Pedro Cahn
- Fundación Huesped, Buenos Aires, Argentina
| | - Jean van Wyk
- AbbVie Inc., North Chicago, Illinois, United States of America
| | - Sharon Walmsley
- Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
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LMNA mutations resulting in lipodystrophy and HIV protease inhibitors trigger vascular smooth muscle cell senescence and calcification: Role of ZMPSTE24 downregulation. Atherosclerosis 2016; 245:200-11. [DOI: 10.1016/j.atherosclerosis.2015.12.012] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 11/21/2015] [Accepted: 12/07/2015] [Indexed: 11/23/2022]
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Woollard SM, Kanmogne GD. Maraviroc: a review of its use in HIV infection and beyond. DRUG DESIGN DEVELOPMENT AND THERAPY 2015; 9:5447-68. [PMID: 26491256 PMCID: PMC4598208 DOI: 10.2147/dddt.s90580] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The human immunodeficiency virus-1 (HIV-1) enters target cells by binding its envelope glycoprotein gp120 to the CD4 receptor and/or coreceptors such as C-C chemokine receptor type 5 (CCR5; R5) and C-X-C chemokine receptor type 4 (CXCR4; X4), and R5-tropic viruses predominate during the early stages of infection. CCR5 antagonists bind to CCR5 to prevent viral entry. Maraviroc (MVC) is the only CCR5 antagonist currently approved by the United States Food and Drug Administration, the European Commission, Health Canada, and several other countries for the treatment of patients infected with R5-tropic HIV-1. MVC has been shown to be effective at inhibiting HIV-1 entry into cells and is well tolerated. With expanding MVC use by HIV-1-infected humans, different clinical outcomes post-approval have been observed with MVC monotherapy or combination therapy with other antiretroviral drugs, with MVC use in humans infected with dual-R5- and X4-tropic HIV-1, infected with different HIV-1 genotype or infected with HIV-2. This review discuss the role of CCR5 in HIV-1 infection, the development of the CCR5 antagonist MVC, its pharmacokinetics, pharmacodynamics, drug–drug interactions, and the implications of these interactions on treatment outcomes, including viral mutations and drug resistance, and the mechanisms associated with the development of resistance to MVC. This review also discusses available studies investigating the use of MVC in the treatment of other diseases such as cancer, graft-versus-host disease, and inflammatory diseases.
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Affiliation(s)
- Shawna M Woollard
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, USA
| | - Georgette D Kanmogne
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, USA
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Soulié C, Assoumou L, Darty M, Rodriguez C, Donati F, Sayon S, Peytavin G, Valantin MA, Caby F, Schneider L, Canestri A, Costagliola D, Katlama C, Calvez V, Marcelin AG. Virological factors associated with outcome of dual maraviroc/raltegravir therapy (ANRS-157 trial). J Antimicrob Chemother 2015; 70:3339-44. [PMID: 26396157 DOI: 10.1093/jac/dkv280] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 08/10/2015] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES ROCnRAL ANRS-157 was a single-arm study designed to evaluate a switch to a maraviroc (300 mg twice a day) plus raltegravir (400 mg twice a day) regimen in virologically suppressed HIV-1-infected patients (ClinicalTrials.gov: NCT01420523). The aim of this work was to investigate the factors associated with virological failure (VF) (5/44 patients) or virological rebound defined as one viral load (VL) >50 copies/mL or VL >1 copy/mL. METHODS At baseline (BL), ultradeep sequencing (UDS) of DNA gp120 V3 and integrase regions and quantification of HIV DNA were performed in PBMCs. Tropism, VL, BL ultrasensitive HIV RNA VL, BL HIV DNA VL, subtype, age, ethnicity, transmission group, AIDS status, nadir CD4 and BL CD4 cell count, time since HIV diagnosis, duration of ART and suppressed viraemia, VL zenith, CD4/CD8 ratio and BL CD8 cell count were investigated as potential factors associated with virological rebound. RESULTS The proportion of patients with VL <1 copy/mL did not evolve over time. Among the 44 included patients, 3 had minority X4-tropic viruses determined by UDS at BL and one of them presented VF. Minority resistant variants in the integrase gene were detected at BL at two positions (E138 and G140) for three patients who did not have VF. Among all studied factors, none was associated with virological rebound. CONCLUSIONS Maraviroc plus raltegravir failed to maintain virological suppression in virologically suppressed HIV-1-infected patients. However, neither minority viral variants nor ultrasensitive viraemia was found to be a predictive factor of VF or virological rebound in this context.
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Affiliation(s)
- Cathia Soulié
- Sorbonne Universités, UPMC Université Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F-75013 Paris, France AP-HP, Groupe hospitalier Pitié Salpêtrière, Laboratoire de Virologie, Paris F-75013, France
| | - Lambert Assoumou
- Sorbonne Universités, UPMC Université Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F-75013 Paris, France
| | - Mélanie Darty
- National Reference Center for Viral Hepatitis B, C and Delta, Department of Virology, Hôpital Henri Mondor, Université Paris-Est, Créteil, France INSERM U955, Créteil, France
| | - Christophe Rodriguez
- National Reference Center for Viral Hepatitis B, C and Delta, Department of Virology, Hôpital Henri Mondor, Université Paris-Est, Créteil, France INSERM U955, Créteil, France
| | - Flora Donati
- National Reference Center for Viral Hepatitis B, C and Delta, Department of Virology, Hôpital Henri Mondor, Université Paris-Est, Créteil, France INSERM U955, Créteil, France
| | - Sophie Sayon
- Sorbonne Universités, UPMC Université Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F-75013 Paris, France AP-HP, Groupe hospitalier Pitié Salpêtrière, Laboratoire de Virologie, Paris F-75013, France
| | - Gilles Peytavin
- IAME, UMR 1137, Univ Paris Diderot, Sorbonne Paris Cité, INSERM, F-75018 Paris, France AP-HP, Hôpital Bichat, Laboratoire de Pharmacologie, F-75018 Paris, France
| | - Marc-Antoine Valantin
- Sorbonne Universités, UPMC Université Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F-75013 Paris, France AP-HP, Groupe hospitalier Pitié Salpêtrière, Service de maladies infectieuses, F-75013 Paris, France
| | - Fabienne Caby
- Sorbonne Universités, UPMC Université Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F-75013 Paris, France AP-HP, Groupe hospitalier Pitié Salpêtrière, Service de maladies infectieuses, F-75013 Paris, France
| | - Luminita Schneider
- Sorbonne Universités, UPMC Université Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F-75013 Paris, France AP-HP, Groupe hospitalier Pitié Salpêtrière, Service de maladies infectieuses, F-75013 Paris, France
| | - Ana Canestri
- AP-HP, Hôpital Kremlin-Bicêtre, Service de maladies infectieuses, F-94270 Kremlin-Bicêtre, France
| | - Dominique Costagliola
- Sorbonne Universités, UPMC Université Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F-75013 Paris, France
| | - Christine Katlama
- Sorbonne Universités, UPMC Université Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F-75013 Paris, France AP-HP, Groupe hospitalier Pitié Salpêtrière, Service de maladies infectieuses, F-75013 Paris, France
| | - Vincent Calvez
- Sorbonne Universités, UPMC Université Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F-75013 Paris, France AP-HP, Groupe hospitalier Pitié Salpêtrière, Laboratoire de Virologie, Paris F-75013, France
| | - Anne-Geneviève Marcelin
- Sorbonne Universités, UPMC Université Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F-75013 Paris, France AP-HP, Groupe hospitalier Pitié Salpêtrière, Laboratoire de Virologie, Paris F-75013, France
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Lê MP, Soulié C, Assoumou L, Valantin MA, Duvivier C, Chas J, Ponscarme D, Marcelin AG, Calvez V, Katlama C, Peytavin G. Plasma concentrations of maraviroc and raltegravir after dual therapy in patients with long-term suppressed viraemia: ROCnRAL ANRS 157 study: Figure 1. J Antimicrob Chemother 2015; 70:2418-20. [DOI: 10.1093/jac/dkv113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Switch to maraviroc/raltegravir dual therapy leads to an unfavorable immune profile with low-level HIV viremia. AIDS 2015; 29:853-6. [PMID: 25719828 DOI: 10.1097/qad.0000000000000626] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Immunovirological consequences of a switch to a maraviroc/raltegravir dual therapy were analyzed in 16 HIV-infected patients with persistent viral load below 50 copies/ml. At 26-week postswitch, the CD4/CD8 ratio decreased and the CD8 T-cell activation increased. A decrease in classical monocytes was associated with a shift toward a proinflammatory monocyte profile and negatively correlated with ultrasensitive viral load. Thus, this therapeutic switch induced a proinflammatory profile probably driven by a slight loss of virus control.
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Casado JL, Bañón S, Rodriguez MA, Moreno A, Moreno S. Efficacy and pharmacokinetics of the combination of etravirine plus raltegravir as novel dual antiretroviral maintenance regimen in HIV-infected patients. Antiviral Res 2014; 113:103-6. [PMID: 25460844 DOI: 10.1016/j.antiviral.2014.11.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 11/15/2014] [Accepted: 11/17/2014] [Indexed: 10/24/2022]
Abstract
Novel combination antiretroviral regimens may be needed for selected HIV-infected patients with toxicity or resistance. We evaluated prospectively 25 virologically suppressed patients, largely pretreated (15.6 years on therapy) with antiretroviral drug toxicity (n=19) or interactions (n=9, mainly with chemotherapy against non-Hodgkin lymphoma or anti-HCV therapy), who switched to a dual therapy with etravirine (ETR) plus raltegravir (RAL). Patients were required not to have prior virological failure or resistance to both drugs. After a median follow up of 722 days (473-1088: 53.3 patients-year), there were no cases of transient virological replication or failure. Only 1 patient left therapy at day 10 due to a grade 2 rash, and therefore efficacy by intent-to-treat analysis was 96% at 48 weeks. There were no cases of liver toxicity grade 3-4, and total cholesterol (TC) and triglycerides (TG) levels decrease significantly after initiation (TC, -17 mg/dl; p=0.01; TG, -42 mg/dl; p=0.01), as well as the TC/High density lipoprotein-cholesterol ratio (from 4.35 to 4.28). Geometric mean plasma trough level of RAL was 166 ng/ml (IQR, 40-249), well above the inhibitory concentration 90 (IC(90)). In conclusion, a novel dual therapy with ETR plus RAL is effective and well tolerated, and it could be an option to maintain durable viral suppression in hard-to-treat HIV-infected patients.
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Affiliation(s)
- José L Casado
- Department of Infectious Diseases, Ramón y Cajal Hospital, Madrid, Spain.
| | - Sara Bañón
- Department of Infectious Diseases, Ramón y Cajal Hospital, Madrid, Spain
| | | | - Ana Moreno
- Department of Infectious Diseases, Ramón y Cajal Hospital, Madrid, Spain
| | - Santiago Moreno
- Department of Infectious Diseases, Ramón y Cajal Hospital, Madrid, Spain
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Casado JL, Banon S, Rodriguez MA, Santiuste C, Perez-Elias MJ, Moreno A, Moreno S. Efficacy of dual therapy with lamivudine plus darunavir boosted with ritonavir once daily in HIV-infected patients with nucleoside analogue toxicity. J Antimicrob Chemother 2014; 70:630-2. [DOI: 10.1093/jac/dku402] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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Van den Eynde E, Podzamczer D. Switch strategies in antiretroviral therapy regimens. Expert Rev Anti Infect Ther 2014; 12:1055-74. [PMID: 25075752 DOI: 10.1586/14787210.2014.944506] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Despite great advances in antiretroviral therapy in the last decade, several limitations still remain such as adverse effects, lack of adherence and drug-drug interactions. Switching antiretroviral therapy in stable, virologically suppressed patients with the aim of improving tolerability and convenience is an expanding strategy in clinical practice. Several factors need to be taken into consideration when switching a suppressive regimen, such as previous virologic failure, genetic barrier of the new regimen, prior duration of virologic suppression and expected level of adherence. The most frequently used strategies include reductions in the number of pills, drugs or doses. Although switching strategies may be useful, not all the regimens used in clinical practice are based on data from randomized clinical trials and some may not be the best option for certain patients; therefore, therapy should be individualized taking into consideration available information as well as patient and drug characteristics.
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Affiliation(s)
- Eva Van den Eynde
- HIV Unit, Infectious Disease Service, Hospital Universitari de Bellvitge, c/Feixa Llarga s/n. L'Hospitalet de Llobregat, 08907 Barcelona, Spain
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Achhra AC, Boyd MA, Law MG, Matthews GV, Kelleher AD, Cooper DA. Moving away from Ritonavir, Abacavir, Tenofovir, and Efavirenz (RATE)--agents that concern prescribers and patients: a feasibility study and call for a trial. PLoS One 2014; 9:e99530. [PMID: 24968324 PMCID: PMC4072535 DOI: 10.1371/journal.pone.0099530] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 05/15/2014] [Indexed: 11/19/2022] Open
Abstract
Objectives Regimens sparing RATE (ritonavir, abacavir, tenofovir, efavirienz) agents might have better long-term safety. We conducted a feasibility exercise to assess the potential for a randomised trial evaluating RATE-sparing regimens. Design Observational. Methods We first calculated RATE-sparing options available to an average patient receiving RATE agents. We reviewed treatment history and all resistance assays from patients attending the St. Vincent’s Hospital (Sydney) clinic and receiving ≥2 RATE agents (n = 120). A viable RATE-sparing regimen with 2 or 3 fully-active agents was constructed from the following six ‘safer’ agents: rilpivirine or etravirine; atazanavir; raltegravir; maraviroc; and lamivudine. Activity for each drug was predicted as 1 (full-activity), 0.5 or 0 (no activity) using the Stanford mutation database. The utility of maraviroc was calculated assuming both maraviroc activity and inactivity where unknown. The analysis was restricted to regimens for which supporting evidence was identified in the literature or conference proceedings. Finally, we calculated the proportion of patients in the nationally representative Australian HIV Observational Database (AHOD) cohort receiving ≥2 RATE agents (n = 1473) to measure the potential population-level uptake of RATE-sparing agents. Results Assuming full maraviroc activity, 117(97.5%) and 107(89.2%) individuals had at least one option with 2 or 3 active RATE-sparing agents, respectively. Assuming no maraviroc activity this decreased to 113(94.2%) and 104(86.7%), respectively. In AHOD, 837(56.8%) patients were receiving ≥2 RATE agents. Conclusion Feasible treatment switch options sparing RATE agents exist for the majority of patients. Understanding the pros and cons of switching stable patients onto new RATE-sparing regimens requires evidence derived from randomised controlled trials.
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Affiliation(s)
- Amit C. Achhra
- The Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia
- * E-mail:
| | - Mark A. Boyd
- The Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia
| | - Matthew G. Law
- The Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia
| | - Gail V. Matthews
- The Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia
| | | | - David A. Cooper
- The Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia
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Achhra AC, Boyd MA. Antiretroviral regimens sparing agents from the nucleoside(tide) reverse transcriptase inhibitor class: a review of the recent literature. AIDS Res Ther 2013; 10:33. [PMID: 24330617 PMCID: PMC3874614 DOI: 10.1186/1742-6405-10-33] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 11/30/2013] [Indexed: 01/11/2023] Open
Abstract
The nucleoside(tide) reverse transcriptase inhibitors (NRTIs) have traditionally been an important 'back-bone' of an antiretroviral therapy (ART) regimen. However all agents have been associated with both short- and long-term toxicity. There have also been concerns regarding the efficacy and safety of a treatment sequencing strategy in which those with past exposure and/or resistance to one or more NRTIs are re-exposed to 'recycled' NRTIs in subsequent ART regimens. Newer, potent and possible safer, agents from various ART classes continue to become available. There has therefore been growing interest in evaluating NRTI-sparing regimens. In this review, we examined studies of NRTI-sparing regimens in adult HIV-positive patients with varying degrees of ART experience. We found that in treatment experienced patients currently on a failing regimen with detectable viral load, there now exists a robust evidence for the use of NRTI-sparing regimens including raltegravir with a boosted-protease inhibitor with or without a third agent. In those on a virologically suppressive regimen switching to a NRTI-sparing regimen or in those ART-naïve patients initiating an NRTI-sparing regimen, evidence is sparse and largely comes from small exploratory trials or observational studies. Overall, these studies suggest that caution needs to be exercised in carefully selecting the right candidate and agents, especially in the context of a dual-therapy regimen, to minimise the risks of virological failure. There is residual toxicity conferred by the ritonavir boost in protease-inhibitor containing NRTI-sparing regimens. Fully-powered studies are needed to explore the place of N (t)RTI-sparing regimens in the sequencing of ART. Additionally research is required to explore how to minimise the adverse effects associated with ritonavir-based pharmacoenhancement.
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Affiliation(s)
- Amit C Achhra
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Mark A Boyd
- The Kirby Institute, University of New South Wales, Sydney, Australia
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