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Lanzafame M, Lattuada E, Luise D, Delama A, Fait D, Vento S. Short Cycle, Intermittent Therapy: A Valuable Option in Selected, Virologically Suppressed People Living with HIV. AIDS Res Hum Retroviruses 2024; 40:69-72. [PMID: 37551977 DOI: 10.1089/aid.2022.0168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023] Open
Abstract
The use of long-acting antiretroviral regimens will not be suitable for all people living with HIV for various reasons (previous virological failure with drugs of the same class, side effects, logistic difficulties, and costs). We think that short-cycle therapies could represent a feasible and valuable option for antiretroviral treatment optimization in selected individuals. So here we review clinical evidence about efficacy of short-cycle therapy in suppressed HIV-infected patients.
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Affiliation(s)
- Massimiliano Lanzafame
- Unit of Infectious Diseases, Department of Medical Area, "Santa Chiara" Hospital, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Emanuela Lattuada
- Unit of Infectious Diseases, Specialist Department, "Santa Maria della Misericordia" Hospital, Rovigo, Italy
| | - Dora Luise
- Unit of Infectious Diseases, Department of medical Area, "San Bortolo" Hospital, Vicenza, Italy
| | - Andrea Delama
- Unit of Infectious Diseases, Department of Medical Area, "Santa Chiara" Hospital, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Daniela Fait
- Unit of Infectious Diseases, Department of Medical Area, "Santa Chiara" Hospital, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Sandro Vento
- Faculty of Medicine, University of Puthisastra, Phnom Penh, Cambodia
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Lambert-Niclot S, Abdi B, Bellet J, Fofana D, De Truchis P, Amat K, Alvarez JC, Surgers L, Allavena C, Zaegell-Faucher O, Morlat P, Palich R, Gibowski S, Costagliola D, Girard PM, Landman R, Assoumou L, Morand-Joubert L. Four days/week antiretroviral maintenance strategy (ANRS 170 QUATUOR): substudies of reservoirs and ultrasensitive drug resistance. J Antimicrob Chemother 2023:7146011. [PMID: 37104815 DOI: 10.1093/jac/dkad119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 04/04/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND In a 4 days/week (4/7 days) maintenance strategy (ANRS-170 QUATUOR trial), the virological impact of an intermittent strategy was assessed by ultrasensitive virological analyses of reservoirs and resistance. METHODS HIV-1 total DNA, ultra-sensitive plasma viral load (USpVL) and semen VL were measured in the first 121 participants. Sanger and ultra-deep sequencing (UDS) were performed on the HIV-1 genome (Illumina technology) according to the ANRS consensus. A generalized estimation equation with a Poisson distribution was used to compare changes in the proportion of residual viraemia, detectable semen HIV RNA and HIV DNA within and between the two groups over time. RESULTS The proportion of participants with residual viraemia at Day 0 (D0) and Week 48 (W48) was 16.7% and 25.0% in the 4/7 days group and 22.4% and 29.7% in the 7/7 days group, respectively (+8.3% versus +7.3%, P = 0.971). The proportion of detectable DNA (>40 copies/106 cells) at D0 and W48 was 53.7% and 57.4% in the 4/7 days group and 56.1% and 51.8% in the 7/7 days group, respectively (+3.7% versus -4.3%, P = 0.358). Semen HIV RNA was detectable (≥100 copies/mL) in 2.2% of participants at D0 and 4.5% at W48 in the 4/7 days group versus 6.1% and 9.1% in the 7/7 days group, respectively (+2.3% versus +3.0%, P = 0.743). Emerging resistance at failure was more frequent in the 4/7 days group detected by Sanger sequencing: 3/6 participants versus 1/4 in the 7/7 days group, and similar with the UDS assay: 5/6 versus 4/4, respectively. CONCLUSIONS These findings support the potency of a 4/7 days maintenance strategy on virological suppression at the reservoirs and emergent resistance level, including minority variants.
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Affiliation(s)
- Sidonie Lambert-Niclot
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), 184 rue du Faubourg Saint-Antoine, 75571 Cedex 12, Paris, France
- AP-HP Hôpital Saint-Antoine, Laboratoire de Virologie, Paris, France
| | - Basma Abdi
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), 184 rue du Faubourg Saint-Antoine, 75571 Cedex 12, Paris, France
- AP-HP Hôpital Pitié-Salpêtrière, Virology Department, Paris, France
| | - Jonathan Bellet
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), 184 rue du Faubourg Saint-Antoine, 75571 Cedex 12, Paris, France
| | - Djeneba Fofana
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), 184 rue du Faubourg Saint-Antoine, 75571 Cedex 12, Paris, France
- AP-HP Hôpital Saint-Antoine, Laboratoire de Virologie, Paris, France
| | - Pierre De Truchis
- Hôpitaux Universitaires Paris-Ile de France-Ouest, Hôpital Raymond Poincaré APHP, Université Versailles-Saint-Quentin, France, Infectious Diseases Department, Garches, France
| | - Karine Amat
- Institut de Médecine et Epidémiologie Appliquée, Hôpital Bichat, Université Paris 7, Paris, France
| | - Jean-Claude Alvarez
- Département de Pharmacologie-Toxicologie, Hôpital R Poincaré APHP, Inserm U-1173, Université Versailles-Saint-Quentin, Garches, France
| | - Laure Surgers
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), 184 rue du Faubourg Saint-Antoine, 75571 Cedex 12, Paris, France
- GHU APHP. Sorbonne Université, Service des Maladies Infectieuses et Tropicales, Hôpital Saint-Antoine, F75012, Paris, France
| | | | - Olivia Zaegell-Faucher
- CHU Sainte-Marguerite, Assistance Publique Hôpitaux de Marseille, Infectious Diseases Department, Marseille, France
| | - Philippe Morlat
- Hôpital Saint André, Internal Medicine and Infectious Diseases Department, CHU, Université de Bordeaux, Bordeaux, France
| | - Romain Palich
- AP-HP Hôpital Pitié-Salpêtrière, Infectious Diseases Department, Paris, France
| | | | - Dominique Costagliola
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), 184 rue du Faubourg Saint-Antoine, 75571 Cedex 12, Paris, France
| | - Pierre-Marie Girard
- GHU APHP. Sorbonne Université, Service des Maladies Infectieuses et Tropicales, Hôpital Saint-Antoine, F75012, Paris, France
| | - Roland Landman
- Infectious and Tropical Diseases Department, IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, AP-HP, Hôpital Bichat, AP-HP, Infectious and Tropical Diseases, Paris, France
| | - Lambert Assoumou
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), 184 rue du Faubourg Saint-Antoine, 75571 Cedex 12, Paris, France
| | - Laurence Morand-Joubert
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), 184 rue du Faubourg Saint-Antoine, 75571 Cedex 12, Paris, France
- AP-HP Hôpital Saint-Antoine, Laboratoire de Virologie, Paris, France
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Petit C. D’un protocole de soin au succès d’un essai clinique. Med Sci (Paris) 2022; 38:707-713. [DOI: 10.1051/medsci/2022109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Les innovations pour traiter l’infection par le virus de l’immunodéficience humaine (VIH) n’ont pas cessé depuis les premières monothérapies et, en 1996, les premières trithérapies. L’une d’elles vient d’être validée par l’essai ANRS QUATUOR. Elle consiste à prendre deux fois moins de médicaments, en rendant le traitement intermittent. À la demande des patients non adhérents à sa prescription standard, Jacques Leibowitch a encadré cette pratique dès 2002, en s’appuyant sur une étude transgressant le dogme de l’adhésion stricte au traitement quotidien. Ce concept de traitement à temps partiel provenait des travaux du groupe d’Anthony Fauci, mais il le revisitera pour le pousser à son apogée avec la cohorte Iccarre. Son intention strictement thérapeutique s’inscrivit initialement dans le cadre du protocole de soin Iccarre qui, en 2020, comptait 96 patients, majoritairement en réduction médicamenteuse de 70 % grâce à l’ultra-intermittence thérapeutique. Il a posé les bases de l’essai contrôlé QUATUOR dont le résultat, récemment publié, montre la non infériorité des traitements intermittents à 4 jours/7 de médicaments par rapport au traitement standard.
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Forgiveness of an intermittent HIV treatment strategy. THE LANCET HIV 2022; 9:e68-e69. [DOI: 10.1016/s2352-3018(21)00322-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 12/02/2021] [Indexed: 11/20/2022]
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Landman R, de Truchis P, Assoumou L, Lambert S, Bellet J, Amat K, Lefebvre B, Allavena C, Katlama C, Yazdanpanah Y, Molina JM, Petrov-Sanchez V, Gibowski S, Alvarez JC, Leibowitch J, Capeau J, Fellahi S, Duracinsky M, Morand-Joubert L, Costagliola D, Alvarez JC, Girard PM, LAMAURY I, BANI-SADR F, FORCE G, CHABROL A, CABY F, PATEY O, FRESARD A, GAGNEUX-BRUNON A, CHIROUZE C, DUVIVIER C, LOURENCO J, TOLSMA V, JANSSEN C, LEROLLE N, CATALAN P, RAMI A, DE PONTHAUD L, PICHANCOURT G, NASRI S, LANDOWSKI S, BOTTERO J, MFUTILA KAYKAY F, PIALOUX G, BOUCHAUD O, ABGRALL S, GATEY C, WEISS L, PAVIE J, SALMON-CERON D, ZUCMAN D, LELIEVRE JD, PALICH R, SIMON A, MEYOHAS MC, GRAS J, CABIE A, PIRCHER M, MORLAT P, HESSAMFAR M, NEAU D, CAZENAVE C, GENET C, FAUCHER JF, MAKHLOUFI D, BOIBIEUX A, BREGIGEON-RONOT S, LAROCHE H, SAUTEREAU A, REYNES J, MAKINSON A, RAFFI F, BOLLENGIER-STRAGIER O, NAQVI A, CUA E, ROSENTHAL E, ARVIEUX C, BUZELE R, REY D, BATARD ML, BERNARD L, DELOBEL P, PIFFAUT M, VERDON R, PIROTH L, BLOT M, LECLERCQ P, SIGNORI-SCHMUCK A, HULEUX T, MEYBECK A, MAY T, MIAILHES P, PERPOINT T, GREDER-BELAN A, ELHARRAR B, KHUONG MA, POUPARD M, BLUM L, MICHAU C, PRAZUCK T, PHILIBERT P, SLAMA L, HIKOMBO H, DARASTEANU I, GIRARD PM, ALVAREZ JC, MATHEZ D, DE TRUCHIS P, LANDMAN R, MEYNARD JL, MORAND-JOUBERT L, LAMBERT S, LE DU D, PERRONNE C, ASSOUMOU L, COSTAGLIOLA D, MELCHIOR JC, DURACINSKI M, PETROV-SANCHEZ V, AMAT K, BENALYCHERIF A, SYLLA B, GELLEY A, GIBOWSKI S, LE MEUT G, THIEBAUT R, CLUMECK N, LECLERCQ V, CECCHERINI-SILBERSTEIN F, DECOSTER L, LAMAURY I, BANI-SADR F, FORCE G, CHABROL A, CABY F, PATEY O, FRESARD A, GAGNEUX-BRUNON A, CHIROUZE C, DUVIVIER C, LOURENCO J, TOLSMA V, JANSSEN C, LEROLLE N, CATALAN P, RAMI A, DE PONTHAUD L, PICHANCOURT G, NASRI S, LANDOWSKI S, BOTTERO J, MFUTILA KAYKAY F, PIALOUX G, BOUCHAUD O, ABGRALL S, GATEY C, WEISS L, PAVIE J, SALMON-CERON D, ZUCMAN D, LELIEVRE JD, PALICH R, SIMON A, MEYOHAS MC, GRAS J, CABIE A, PIRCHER M, MORLAT P, HESSAMFAR M, NEAU D, CAZENAVE C, GENET C, FAUCHER JF, MAKHLOUFI D, BOIBIEUX A, BREGIGEON-RONOT S, LAROCHE H, SAUTEREAU A, REYNES J, MAKINSON A, RAFFI F, BOLLENGIER-STRAGIER O, NAQVI A, CUA E, ROSENTHAL E, ARVIEUX C, BUZELE R, REY D, BATARD ML, BERNARD L, DELOBEL P, PIFFAUT M, VERDON R, PIROTH L, BLOT M, LECLERCQ P, SIGNORI-SCHMUCK A, HULEUX T, MEYBECK A, MAY T, MIAILHES P, PERPOINT T, GREDER-BELAN A, ELHARRAR B, KHUONG MA, POUPARD M, BLUM L, MICHAU C, PRAZUCK T, PHILIBERT P, SLAMA L, HIKOMBO H, DARASTEANU I, GIRARD PM, ALVAREZ JC, MATHEZ D, DE TRUCHIS P, LANDMAN R, MEYNARD JL, MORAND-JOUBERT L, LAMBERT S, LE DU D, PERRONNE C, ASSOUMOU L, COSTAGLIOLA D, MELCHIOR JC, DURACINSKI M, PETROV-SANCHEZ V, AMAT K, BENALYCHERIF A, SYLLA B, GELLEY A, GIBOWSKI S, LE MEUT G, THIEBAUT R, CLUMECK N, LECLERCQ V, CECCHERINI-SILBERSTEIN F, DECOSTER L. A 4-days-on and 3-days-off maintenance treatment strategy for adults with HIV-1 (ANRS 170 QUATUOR): a randomised, open-label, multicentre, parallel, non-inferiority trial. THE LANCET HIV 2022; 9:e79-e90. [DOI: 10.1016/s2352-3018(21)00300-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 10/22/2021] [Accepted: 11/11/2021] [Indexed: 12/31/2022]
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Luise D, Lattuada E, Rizzardo S, Nicolè S, Lambertenghi L, Coledan I, Gambino S, Gottardo R, Lanzafame M, Vento S. Short-cycle therapy in HIV-infected adults: rilpivirine combination 4 days on/3 days off therapy. J Antimicrob Chemother 2021; 77:747-752. [PMID: 34849955 DOI: 10.1093/jac/dkab442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 10/29/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Short-cycle therapy (SCT) is the administration of ART for 4 or 5 consecutive days a week, followed by 3 or 2 days off therapy. Its benefits include improving patient satisfaction and reducing ART toxicity and costs. METHODS In this observational study we included HIV-infected adults with a three-drug ART containing rilpivirine, a history of long-term virological suppression and no evidence of resistance to previous drug regimens. Patients switched to a SCT of 4 days on/3 days off and were followed for 48 weeks with regular check-ups. The primary outcome was virological suppression; secondary outcomes were changes in CD4+ cells and rilpivirine plasma concentration, the occurrence of adverse events and resistance in the case of failure, and patient satisfaction. RESULTS At week 48 no virological failure was observed, with a virological suppression rate of 30/30 (100%). Three patients switched back to continuous therapy for other reasons, with an overall success rate of SCT of 30/33 (90.9%, 95% CI = 81.24% to 100%). The CD4+ mean value increased by +64 cells/mm3 (95% CI = -59 to +187 cells/mm3; P = 0.052). No adverse events were observed and the mean total score in the satisfaction questionnaire was 57.7/60 (96.22%). Rilpivirine plasma concentration was below the efficacy threshold in 71.3% of the samples, suggesting that the patients' characteristics, more than the drug's pharmacokinetics, played a role in maintaining virological suppression. CONCLUSIONS SCT with rilpivirine-containing regimens could be an effective alternative to continuous therapy in selected HIV-infected patients with previous long-term virological suppression.
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Affiliation(s)
- Dora Luise
- Infectious Diseases Unit, Vicenza Hospital, Vicenza, Italy
| | - Emanuela Lattuada
- Division of Infectious Diseases, Department of Diagnostic and Public Health, Integrated University Hospital of Verona, Verona, Italy
| | - Sebastiano Rizzardo
- Infectious Diseases Section, Internal Medicine Unit, Rovereto Hospital, Rovereto, Italy
| | - Stefano Nicolè
- Infectious Diseases Unit, Vicenza Hospital, Vicenza, Italy
| | - Lorenza Lambertenghi
- Division of Infectious Diseases, Department of Diagnostic and Public Health, Integrated University Hospital of Verona, Verona, Italy
| | - Ilaria Coledan
- Infectious Diseases Unit, Rovigo Hospital, Rovigo, Italy
| | - Silvia Gambino
- Infectious Diseases Unit, Bolzano Hospital, Bolzano, Italy
| | - Rossella Gottardo
- Division of Legal Medicine, Department of Diagnostic and Public Health, Integrated University Hospital of Verona, Verona, Italy
| | | | - Sandro Vento
- Faculty of Medicine, University of Puthisastra, Phnom Penh, Cambodia
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Mulato A, Acosta R, Chang S, Martin R, Yant SR, Cihlar T, White K. Simulating HIV Breakthrough and Resistance Development During Variable Adherence to Antiretroviral Treatment. J Acquir Immune Defic Syndr 2021; 86:369-377. [PMID: 33196554 DOI: 10.1097/qai.0000000000002562] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 10/26/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Barriers to lifelong HIV-1 suppression by antiretrovirals include poor adherence and drug resistance; regimens with higher tolerance to missed doses (forgiveness) would be beneficial to patients. To model short-term nonadherence, in vitro experiments monitoring viral breakthrough (VB) and resistance development were conducted. METHODS HIV breakthrough experiments simulated drug exposures at full adherence or suboptimal adherence to bictegravir+emtricitabine+tenofovir alafenamide (BIC+FTC+TAF) or dolutegravir + lamivudine (DTG+3TC). MT-2 cells were infected with wild-type or low frequency M184V HIV-1, exposed to drug combinations, monitored for VB, and rebound virus was deep sequenced. Drug concentrations were determined using human plasma-free adjusted clinical trough concentrations (Cmin), at simulated Cmin after missing 1 to 3 consecutive doses (Cmin - 1 or Cmin - 2, and Cmin - 3) based on drug or active metabolite half-lives. RESULTS Cultures infected with wild-type or low frequency M184V HIV-1 showed no VB with BIC+FTC+TAF at drug concentrations corresponding to Cmin, Cmin - 1, or Cmin - 2 but breakthrough did occur in 26 of 36 cultures at Cmin - 3, where the M184V variant emerged in one culture. Experiments using DTG + 3TC prevented most breakthrough at Cmin concentrations (9/60 had breakthrough) but showed more breakthroughs as drug concentrations decreased (up to 36/36) and variants associated with resistance to both drugs emerged in some cases. CONCLUSIONS These in vitro VB results suggest that the high potency, long half-lives, and antiviral synergy provided by the BIC/FTC/TAF triple therapy regimen may protect from viral rebound and resistance development after short-term lapses in drug adherence.
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Abe E, Assoumou L, de Truchis P, Amat K, Gibowski S, Gras G, Bellet J, Saillard J, Katlama C, Costagliola D, Girard PM, Landman R, Alvarez JC. Pharmacological data of a successful 4-days-a-week regimen in HIV antiretroviral therapy (ANRS 162-4D trial). Br J Clin Pharmacol 2020; 87:1930-1939. [PMID: 33010058 DOI: 10.1111/bcp.14586] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/16/2020] [Accepted: 09/21/2020] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Few data are available on plasma concentrations of antiretroviral therapy (ARV) during intermittent treatment. OBJECTIVE To compare plasma concentrations in OFF vs ON treatment periods at several time points during treatment. METHODS During a successful 48-week multicenter study (ANRS 162-4D trial) of 4 days with treatment (ON) followed by 3 days without treatment (OFF) in adults treated by two nucleoside analogues and a third agent belonging to a boosted protease-inhibitor (PI, darunavir [DRV], atazanavir [ATV], lopinavir [LPV]) or a non-nucleoside-reverse-transcriptase inhibitor (NNRTI, efavirenz [EFV], etravirine [ETR], rilpivirine [RPV]) conducted in 100 patients (96% success), we determined the plasma concentrations of ARV. Blood samples were collected for analysis at inclusion (W0, 7/7 strategy for all patients), W16 and W40 (ON) and at W4, W8, W12, W24, W32 and W48 (OFF). RESULTS A total of 866 samples was analysed. Plasma concentrations were not statistically lower after 4 days (ON) vs 7/7 days of treatment except for RPV (-30 ng/mL at 4/7, P = 0.003). Significant lower plasma concentrations were observed for OFF vs ON except for ETR (n = 5, P = 0.062). Overall, 87.1% of ON concentrations (ATV 92.1%, DRV 51.1%, LPV 62.5%, EFV 94.4%, ETR 100% and RPV 94.9%) and 21.8% of OFF concentrations (ATV 1.4%, DRV 0.0%, LPV 0.0%, EFV 16.0%, ETR 92.6% and RPV 39.0%) were above the theoretical limit of efficacy of the molecule. In the OFF period, 85.8% of PI concentrations were under the limit of quantification, while 98.0% of NNRTI concentrations were quantifiable. CONCLUSION Despite low/undetectable PI/NNRTI plasma concentrations in the OFF period, patients maintained an undetectable viral load. The mechanistic explanation should be investigated.
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Affiliation(s)
- Emuri Abe
- Département de Pharmacologie-Toxicologie, Hôpitaux Universitaires Paris-Ile de France-Ouest, APHP, Hôpital Raymond Poincaré, MasSpecLab, Plateforme de spectrométrie de masse, Inserm U-1173, Université Versailles Saint Quentin-en-Yvelines, Garches, France
| | - Lambert Assoumou
- Institut Pierre Louis d'Épidémiologie et de Santé Publique, Sorbonne Université, INSERM, Paris, France
| | - Pierre de Truchis
- Département d'Infectiologie, Hôpitaux Universitaires Paris-Ile de France-Ouest, APHP, Hôpital Raymond Poincaré Garches, Garches, France
| | - Karine Amat
- Institut de Médecine et Epidémiologie Appliquée, Hôpital Bichat-Claude Bernard, Université Paris 7, Paris, France
| | | | - Guillaume Gras
- Centre Hospitalier Universitaire Bretonneau, Tours, France
| | - Jonathan Bellet
- Institut Pierre Louis d'Épidémiologie et de Santé Publique, Sorbonne Université, INSERM, Paris, France
| | | | - Christine Katlama
- Institut Pierre Louis d'Épidémiologie et de Santé Publique, Sorbonne Université, INSERM, Paris, France.,Service Maladies Infectieuses et Tropicales, Hôpital Pitié-Salpétrière, APHP, Paris, France
| | - Dominique Costagliola
- Institut Pierre Louis d'Épidémiologie et de Santé Publique, Sorbonne Université, INSERM, Paris, France
| | - Pierre-Marie Girard
- Institut Pierre Louis d'Épidémiologie et de Santé Publique, Sorbonne Université, INSERM, Paris, France.,ANRS, France Recherche Nord & Sud SIDA-HIV hépatites, Paris, France.,Service Maladies Infectieuses, Hôpital Saint Antoine, APHP, Paris, France
| | - Roland Landman
- Institut de Médecine et Epidémiologie Appliquée, Hôpital Bichat-Claude Bernard, Université Paris 7, Paris, France.,Service de Maladies Infectieuses et Tropicales, IAME, UMR 1137, Université Paris Diderot, Sorbonne Paris Cité, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France
| | - Jean-Claude Alvarez
- Département de Pharmacologie-Toxicologie, Hôpitaux Universitaires Paris-Ile de France-Ouest, APHP, Hôpital Raymond Poincaré, MasSpecLab, Plateforme de spectrométrie de masse, Inserm U-1173, Université Versailles Saint Quentin-en-Yvelines, Garches, France
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Effects on immune system and viral reservoir of a short-cycle antiretroviral therapy in virologically suppressed HIV-positive patients. AIDS 2019; 33:965-972. [PMID: 30946150 DOI: 10.1097/qad.0000000000002169] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Atripla dose reduction decreases subclinical toxicity and maintains viral suppression in HIV+ individuals but the virological efficacy and immunological safety of this strategy needs to be further confirmed. METHODS Virologically suppressed HIV-infected adults on Atripla once-daily were randomized 1 : 1 to reduce therapy to 3 days a week (3W, n = 30) or to maintain it unchanged (once-daily, n = 31). HIV-1 reservoir (total and integrated HIV-1 DNA in CD4 cells) and immunological cell activation (CD38 and HLA-DR), senescence (CD57 and CD28), apoptosis (annexinV) as well as T-naive, effector memory (TEM) (CCR7, CD45RA) and stem cell memory (TSCM) (CD954 and CD27) populations were measured at baseline, 24 and 48 weeks. RESULTS No differences on activation, senescence or apoptosis of both CD4 and CD8 T cells were observed on follow-up. Nave CD4 T-cell proportion showed a significant decrease in the 3W group (mean ± SD): 24.6 ± 13.7 vs. 20.5 ± 12.9 (P = 0.002). No differences in both plasma viral load and HIV reservoir were detected on follow-up. CD4 TSCM levels at 48 weeks correlated with basal integrated HIV-1 DNA in the 3W group but not in the once-daily group. A post hoc analysis of data prior to the study entry revealed a higher viral load zenith and a trend to lower CD4 nadir in 3W vs. once-daily group. CONCLUSION No significant immunological or viral changes were induced in the 3W group confirming the virological efficacy and immunogical safety of this strategy. In-depth virological and immunological analyses are useful in providing additional information in antiretroviral switching studies (Clinical Trials.gov: NCT01778413).
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de Truchis P, Assoumou L, Landman R, Mathez D, Le Dû D, Bellet J, Amat K, Katlama C, Gras G, Bouchaud O, Duracinsky M, Abe E, Alvarez JC, Izopet J, Saillard J, Melchior JC, Leibowitch J, Costagliola D, Girard PM, Perronne C. Four-days-a-week antiretroviral maintenance therapy in virologically controlled HIV-1-infected adults: the ANRS 162-4D trial. J Antimicrob Chemother 2019; 73:738-747. [PMID: 29186458 DOI: 10.1093/jac/dkx434] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 10/25/2017] [Indexed: 11/12/2022] Open
Abstract
Background Intermittent treatment could improve the convenience, tolerability and cost of ART, as well as patients' quality of life. We conducted a 48 week multicentre study of a 4-days-a-week antiretroviral regimen in adults with controlled HIV-1-RNA plasma viral load (VL). Methods Eligible patients were adults with VL < 50 copies/mL for at least 1 year on triple therapy with a ritonavir-boosted PI (PI/r) or an NNRTI. The study protocol consisted of the same regimen taken on four consecutive days per week followed by a 3 day drug interruption. The primary outcome was the proportion of participants remaining in the strategy with VL < 50 copies/mL up to week 48. The study was designed to show an observed success rate of > 90%, with a power of 87% and a 5% type 1 error. The study was registered with ClinicalTrials.gov (NCT02157311) and EudraCT (2014-000146-29). Results One hundred patients (82 men), median age 47 years (IQR 40-53), were included. They had been receiving ART for a median of 5.1 (IQR 2.9-9.3) years and had a median CD4 cell count of 665 (IQR 543-829) cells/mm3. The ongoing regimen included PI/r in 29 cases and NNRTI in 71 cases. At 48 weeks, 96% of participants (95% CI 90%-98%) had no failure while remaining on the 4-days-a-week regimen. Virological failure occurred in three participants, who all resumed daily treatment and became resuppressed. One participant stopped the strategy. No severe treatment-related events occurred. Conclusions Antiretroviral maintenance therapy 4 days a week was effective for 48 weeks in 96% of patients, leading to potential reduction of long-term toxicities, high adherence to the antiretroviral regimen and drug cost saving.
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Affiliation(s)
- Pierre de Truchis
- Hôpitaux Universitaires Paris-Ile de France-Ouest, Hôpital Raymond Poincaré APHP, Garches, Université Versailles-Saint-Quentin, France
| | - Lambert Assoumou
- Sorbonne Universités, INSERM, UPMC Université Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
| | - Roland Landman
- Institut de Médecine et Epidémiologie Appliquée, Hôpital Bichat, Université Paris 7, Paris, France.,IAME, UMR 1137, Université Paris Diderot, Sorbonne Paris Cité, AP-HP, Hôpital Bichat-Claude Bernard, Service de Maladies Infectieuses et Tropicales, Paris, France
| | - Dominique Mathez
- Hôpitaux Universitaires Paris-Ile de France-Ouest, Hôpital Raymond Poincaré APHP, Garches, Université Versailles-Saint-Quentin, France
| | - Damien Le Dû
- Hôpitaux Universitaires Paris-Ile de France-Ouest, Hôpital Raymond Poincaré APHP, Garches, Université Versailles-Saint-Quentin, France
| | - Jonathan Bellet
- Sorbonne Universités, INSERM, UPMC Université Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
| | - Karine Amat
- Institut de Médecine et Epidémiologie Appliquée, Hôpital Bichat, Université Paris 7, Paris, France
| | - Christine Katlama
- Sorbonne Universités, INSERM, UPMC Université Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France.,APHP, Hôpital Pitié-Salpétrière, Service Maladies Infectieuses et Tropicales, Paris, France
| | - Guillaume Gras
- Centre Hospitalier Universitaire Bretonneau, Tours, France
| | - Olivier Bouchaud
- APHP, Centre Hospitalier Universitaire Avicenne, APHP, Bobigny 93, France
| | - Martin Duracinsky
- Université Paris Sorbonne-Diderot, EA 7334, APHP Hotel-Dieu, URC-ECO, Paris, France
| | - Emuri Abe
- APHP Hôpital R Poincaré, Département de Pharmacologie, Inserm U-1173, Université Paris-Ile de France Ouest, Garches 92, France
| | - Jean-Claude Alvarez
- APHP Hôpital R Poincaré, Département de Pharmacologie, Inserm U-1173, Université Paris-Ile de France Ouest, Garches 92, France
| | - Jacques Izopet
- INSERM U1043/CNRS5282, Université de Toulouse, CHU Purpan, Toulouse, France
| | - Juliette Saillard
- INSERM-ANRS, Agence Nationale pour la Recherche sur le Sida et les Hépatites, Paris, France
| | - Jean-Claude Melchior
- Hôpitaux Universitaires Paris-Ile de France-Ouest, Hôpital Raymond Poincaré APHP, Garches, Université Versailles-Saint-Quentin, France
| | - Jacques Leibowitch
- Hôpitaux Universitaires Paris-Ile de France-Ouest, Hôpital Raymond Poincaré APHP, Garches, Université Versailles-Saint-Quentin, France
| | - Dominique Costagliola
- Sorbonne Universités, INSERM, UPMC Université Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
| | - Pierre-Marie Girard
- Sorbonne Universités, INSERM, UPMC Université Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France.,Institut de Médecine et Epidémiologie Appliquée, Hôpital Bichat, Université Paris 7, Paris, France.,APHP, Hôpital Saint Antoine, Service Maladies Infectieuses, Paris, France
| | - Christian Perronne
- Hôpitaux Universitaires Paris-Ile de France-Ouest, Hôpital Raymond Poincaré APHP, Garches, Université Versailles-Saint-Quentin, France
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Boyer V, Vilotitch A, Marcellin F, Demoulin B, Dray-Spira R, Spire B. Self-Reported Bothersome Symptoms Across Different Socioepidemiological Groups of People Living With HIV Attending French Hospitals: Results From the ANRS-VESPA2 Survey. J Pain Symptom Manage 2017; 54:110-119. [PMID: 28479413 DOI: 10.1016/j.jpainsymman.2017.03.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 03/02/2017] [Accepted: 03/17/2017] [Indexed: 01/08/2023]
Abstract
CONTEXT Twenty years after the advent of combined antiretroviral therapies (ARTs), there is a growing need for up-to-date information about the daily experience of people living with HIV (PLWH). OBJECTIVES This study aimed to investigate the relationship between socioepidemiological groups and the types of bothersome symptoms reported by PLWH participating in a national survey in France. METHODS We analyzed self-reported bothersome symptoms in a representative sample of PLWH (ANRS-VESPA2 survey), most of whom were receiving ART treatment. PLWH (N = 2505) were grouped into three clusters according to the number of bothersome symptoms reported: Cluster A (low number, n = 1848), Cluster B (moderate number, n = 271), and Cluster C (high number, n = 386). RESULTS Individuals in Cluster A (low number of bothersome symptoms) were less likely to report all the symptom types investigated. Psychological, sexual, and general symptoms were more likely to be reported in Cluster B (moderate number), whereas gastric-, pain-, and appearance-related symptoms were more likely in Cluster C (high number). In multivariate analyses, women not natives of Sub-Saharan Africa and former/active female injecting drug users were more likely to report a medium or high number of symptoms, and lower adherence to ART. CONCLUSION Combining new biomedical strategies with coping mechanisms and providing better support to socially vulnerable PLWH may improve this population's quality of health and daily life.
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Affiliation(s)
- Véronique Boyer
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France; ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France; IRD UMI233, INSERM U1175 and Université de Montpellier, "Recherches Translationnelles sur le VIH et les Maladies Infectieuses" (TransVIHMI), Montpellier, France.
| | - Antoine Vilotitch
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France; ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Fabienne Marcellin
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France; ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Baptiste Demoulin
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France; ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Rosemary Dray-Spira
- Inserm U1018, Centre de recherche en épidémiologie et santé des populations, Hôpital Paul Brousse, Villejuif, France; Université de Versailles Saint-Quentin-en-Yvelines, UMRS, Villejuif, France
| | - Bruno Spire
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France; ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
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Weekends-off efavirenz-based antiretroviral therapy in HIV-infected children, adolescents, and young adults (BREATHER): a randomised, open-label, non-inferiority, phase 2/3 trial. Lancet HIV 2016; 3:e421-e430. [PMID: 27562743 PMCID: PMC4995440 DOI: 10.1016/s2352-3018(16)30054-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 05/24/2016] [Accepted: 05/26/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND For HIV-1-infected young people facing lifelong antiretroviral therapy (ART), short cycle therapy with long-acting drugs offers potential for drug-free weekends, less toxicity, and better quality-of-life. We aimed to compare short cycle therapy (5 days on, 2 days off ART) versus continuous therapy (continuous ART). METHODS In this open-label, non-inferiority trial (BREATHER), eligible participants were aged 8-24 years, were stable on first-line efavirenz with two nucleoside reverse transcriptase inhibitors, and had HIV-1 RNA viral load less than 50 copies per mL for 12 months or longer. Patients were randomly assigned (1:1) to remain on continuous therapy or change to short cycle therapy according to a computer-generated randomisation list, with permuted blocks of varying size, stratified by age and African versus non-African sites; the list was prepared by the trial statistician and randomisation was done via a web service accessed by site clinician or one of the three coordinating trials units. The primary outcome was the proportion of participants with confirmed viral load 50 copies per mL or higher at any time up to the 48 week assessment, estimated with the Kaplan-Meier method. The trial was powered to exclude a non-inferiority margin of 12%. Analyses were intention to treat. The trial was registered with EudraCT, number 2009-012947-40, ISRCTN, number 97755073, and CTA, number 27505/0005/001-0001. FINDINGS Between April 1, 2011, and June 28, 2013, 199 participants from 11 countries worldwide were randomly assigned, 99 to the short cycle therapy and 100 to continuous therapy, and were followed up until the last patient reached 48 weeks. 105 (53%) were men, median age was 14 years (IQR 12-18), and median CD4 cell count was 735 cells per μL (IQR 576-968). Six (6%) patients assigned to the short cycle therapy versus seven (7%) assigned to continuous therapy had confirmed viral load 50 copies per mL or higher (difference -1·2%, 90% CI -7·3 to 4·9, non-inferiority shown). 13 grade 3 or 4 events occurred in the short cycle therapy group and 14 in the continuous therapy group (p=0·89). Two ART-related adverse events (one gynaecomastia and one spontaneous abortion) occurred in the short cycle therapy group compared with 14 (p=0·02) in the continuous therapy group (five lipodystrophy, two gynaecomastia, one suicidal ideation, one dizziness, one headache and syncope, one spontaneous abortion, one neutropenia, and two raised transaminases). INTERPRETATION Non-inferiority of maintaining virological suppression in children, adolescents, and young adults was shown for short cycle therapy versus continous therapy at 48 weeks, with similar resistance and a better safety profile. This short cycle therapy strategy is a viable option for adherent HIV-infected young people who are stable on efavirenz-based ART. FUNDING UK National Institute for Health Research Health Technology Assessment; UK Medical Research Council; European Commission; PENTA Foundation; INSERM SC10-US19, France.
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Raltegravir/nevirapine dual therapy at reduced doses as 'maintenance' treatment in virally suppressed HIV-infected patients. AIDS 2015; 29:1722-3. [PMID: 26372286 DOI: 10.1097/qad.0000000000000775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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