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Raltegravir versus efavirenz in antiretroviral-naive pregnant women living with HIV (NICHD P1081): an open-label, randomised, controlled, phase 4 trial. Lancet HIV 2020; 7:e322-e331. [PMID: 32386720 DOI: 10.1016/s2352-3018(20)30038-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 01/26/2020] [Accepted: 01/31/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Although antiretroviral regimens containing integrase inhibitors rapidly suppress HIV viral load in non-pregnant adults, few published data from randomised controlled trials have compared the safety and efficacy of any integrase inhibitor to efavirenz when initiated during pregnancy. We compared safety and efficacy of antiretroviral therapy with either raltegravir or efavirenz in late pregnancy. METHODS An open-label, randomised controlled trial was done at 19 hospitals and clinics in Argentina, Brazil, South Africa, Tanzania, Thailand, and the USA. Antiretroviral-naive pregnant women (20-<37 weeks gestation) living with HIV were assigned to antiretroviral regimens containing either raltegravir (400 mg twice daily) or efavirenz (600 mg each night) plus lamivudine 150 mg and zidovudine 300 mg twice daily (or approved alternative backbone regimen), using a web-based, permuted-block randomisation stratified by gestational age and backbone regimen. The primary efficacy outcome was plasma HIV viral load below 200 copies per mL at (or near) delivery. The primary efficacy analysis included all women with a viral load measurement at (or near) delivery who had viral load of at least 200 copies per mL before treatment and no genotypic resistance to any study drugs; secondary analyses eliminated these exclusion criteria. The primary safety analyses included all women who received study drug, and their infants. This trial is registered with Clinicaltrials.gov, number NCT01618305. FINDINGS From Sep 5, 2013, to Dec 11, 2018, 408 women were enrolled (206 raltegravir, 202 efavirenz) and 394 delivered on-study (200 raltegravir, 194 efavirenz); 307 were included in the primary efficacy analysis (153 raltegravir, 154 efavirenz). 144 (94%) women in the raltegravir group and 129 (84%) in the efavirenz group met the primary efficacy outcome (absolute difference 10%, 95% CI 3-18; p=0·0015); the difference primarily occurred among women enrolling later in pregnancy (interaction p=0·040). Frequencies of severe or life-threatening adverse events were similar among mothers (30% in each group; 61 raltegravir, 59 efavirenz) and infants (25% in each group; 50 raltegravir, 48 efavirenz), with no treatment-related deaths. INTERPRETATION Our findings support major guidelines. The integrase inhibitor dolutegravir is currently a preferred regimen for the prevention of perinatal HIV transmission with raltegravir recommended as a preferred or alternative integrase inhibitor for pregnant women living with HIV. FUNDING Eunice Kennedy Shriver National Institute of Child Health and Human Development and National Institute of Allergy and Infectious Diseases.
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Is There a Safety Signal for Dolutegravir and Integrase Inhibitors During Pregnancy? J Acquir Immune Defic Syndr 2020; 81:481-486. [PMID: 31021990 DOI: 10.1097/qai.0000000000002065] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Dolutegravir, an integrase strand transfer inhibitor (InSTI), is a major antiretroviral agent for HIV infection. Its use is promising, especially in low- and middle-income countries, because of a high resistance barrier and a good safety profile. Very recently, a World Health Organization safety signal has been raised regarding neural tube defects after the first-trimester exposure. Furthermore, to date, the experience is limited regarding the use of the other InSTI drugs (raltegravir and elvitegravir) during pregnancy. Our objective is to analyze the safety of InSTI drugs in pregnant women. SETTING Nation-wide database cohort analysis. METHODS We evaluated the risk of major birth defects according to EUROCAT classification in pregnant women, which had had a first-trimester exposure to dolutegravir, raltegravir, or elvitegravir. RESULTS We found a major birth defect rate of 1.9% in the general population between 2012 and 2016. As InSTI drugs are not used as first-line therapy in pregnant women, we found a very low exposure in this population. Among 49, 240, and 70 pregnancy outcomes exposed to dolutegravir, raltegravir, and elvitegravir, respectively, during the first trimester, there were 2, 3, and 1 major birth defects, respectively. There was no case of neural tube defect. CONCLUSIONS Drug exposure to InSTI is limited in our nation-wide database. Nevertheless, our data do not support a pharmacovigilance signal on neural tube defects in women exposed to dolutegravir, raltegravir or elvitegravir during pregnancy. Owing to a small number of pregnancy outcomes, these results need to be confirmed with further studies.
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Raltegravir 1200 mg Once Daily vs 400 mg Twice Daily, With Emtricitabine and Tenofovir Disoproxil Fumarate, for Previously Untreated HIV-1 Infection: Week 96 Results From ONCEMRK, a Randomized, Double-Blind, Noninferiority Trial. J Acquir Immune Defic Syndr 2019; 78:589-598. [PMID: 29771789 PMCID: PMC6075877 DOI: 10.1097/qai.0000000000001723] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Supplemental Digital Content is Available in the Text. Background: Raltegravir 1200mg (2×600mg tablets) once daily (QD) demonstrated noninferior efficacy and similar safety to raltegravir 400mg twice daily (BID) at week 48 of the ONCEMRK trial. Here, we report the week 96 results from this study. Methods: ONCEMRK is a phase 3, multicenter, double-blind, noninferiority trial comparing raltegravir 1200mg QD with raltegravir 400mg BID in treatment-naive HIV-1–infected adults. Participants were assigned (2:1) to raltegravir 2×600mg QD or 400mg BID, both with emtricitabine and tenofovir disoproxil fumarate (FTC/TDF) for 96 weeks. Randomization was stratified by screening HIV-1 RNA and hepatitis B/C status. Efficacy was assessed as the proportion of participants with HIV-1 RNA <40 copies per milliliter (Food and Drug Administration Snapshot approach); the noninferiority margin was 10 percentage points. Results: Of the 797 participants who received study therapy (84.6% were men, 59.3% were white, and mean age was 35.9 years), 694 completed 96 weeks of treatment (87.6% QD; 84.4% BID), with few discontinuations because of lack of efficacy (1.1% for both groups) or adverse events (1.3% QD; 2.3% BID). At week 96, 81.5% (433/531) of QD recipients and 80.1% (213/266) of BID recipients achieved HIV-1 RNA <40 copies per milliliter (difference 1.4%, 95% confidence interval: −4.4 to 7.3). CD4+ T-cell counts increased >260 cells/mm3 from baseline in both groups. Resistance to raltegravir was infrequent, occurring in 0.8% of each treatment group through week 96. Adverse event rates were similar for the 2 regimens. Conclusions: In HIV-1–infected treatment-naive adults receiving FTC/TDF, raltegravir 1200mg QD demonstrated noninferior efficacy to raltegravir 400mg BID that was durable to week 96, with a safety profile similar to raltegravir 400mg BID.
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Moreira FDL, Marques MP, Duarte G, Lanchote VL. Determination of raltegravir and raltegravir glucuronide in human plasma and urine by LC-MS/MS with application in a maternal-fetal pharmacokinetic study. J Pharm Biomed Anal 2019; 177:112838. [PMID: 31525573 DOI: 10.1016/j.jpba.2019.112838] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 08/22/2019] [Accepted: 08/26/2019] [Indexed: 12/01/2022]
Abstract
Raltegravir (RAL) is a HIV-integrase inhibitor recommended for treatment of HIV type 1 infection during pregnancy. The elimination of RAL to RAL glucuronide (RAL GLU) is mediated primarily by UDP glucuronosyltransferase 1A1 (UGT1A1). The present study shows the development and validation of 4 different methods for the analysis of RAL and RAL GLU in plasma and in urine samples. The methods were applied to evaluate the maternal-fetal pharmacokinetics of RAL and RAL GLU in a HIV-infected pregnant woman receiving RAL 400 mg twice daily. The sample preparation for RAL and RAL GLU analysis in 25 μL plasma and 100 μL diluted urine (10-fold with water containing 0.1% formic acid) were carried out by protein precipitation procedure. RAL and RAL GLU generate similar product mass fragments and require separation in the chromatographic system, so a suitable resolution was achieved for unchanged RAL and RAL GLU employing Ascentis Express C18 (75 × 4.6 mm, 2.7 μm) for both plasma and urine samples. The methods showed linearities at the ranges of 0.1-13.5 μg/mL RAL and 0.15-19.5 μg/mL RAL GLU in urine and 10-2000 ng/mL RAL and 2.5-800 RAL GLU in plasma. Precise and accurate evaluation showed coefficients of variation and relative errors ≤ 15%. The methods have been successfully applied in a maternal-fetal pharmacokinetic study.
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Affiliation(s)
- Fernanda de Lima Moreira
- Departamento de Análises Clínicas, Toxicológicas e Bromatológicas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Maria Paula Marques
- Departamento de Análises Clínicas, Toxicológicas e Bromatológicas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Geraldo Duarte
- Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Vera Lucia Lanchote
- Departamento de Análises Clínicas, Toxicológicas e Bromatológicas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
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Gantner P, Sylla B, Morand-Joubert L, Frange P, Lacombe K, Khuong MA, Duvivier C, Launay O, Karmochkine M, Arvieux C, Ménard A, Piroth L, Canestri A, Trias D, Peytavin G, Landman R, Ghosn J. "Real life" use of raltegravir during pregnancy in France: The Coferal-IMEA048 cohort study. PLoS One 2019; 14:e0216010. [PMID: 31017957 PMCID: PMC6481866 DOI: 10.1371/journal.pone.0216010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 04/11/2019] [Indexed: 02/05/2023] Open
Abstract
Introduction Limited “real life” data on raltegravir (RAL) use during pregnancy are available. Thus, we aimed at describing effectiveness and safety of RAL-based combined antiretroviral therapy (cART) in this setting. Methods HIV-1-infected women receiving RAL during pregnancy between 2008 and 2014 in ten French centers were retrospectively analysed for: (1) proportion of women receiving RAL anytime during pregnancy who achieved a plasma HIV-RNA (pVL) < 50 copies/mL at delivery, and (2) description of demographics, immuno-virological parameters and safety in women and new-borns. Results We included 94 women (median age, 33 years) of which 85% originated from Sub-Saharan Africa and 16% did not have regular health insurance coverage. Sixteen women were cART-naïve (median HIV diagnosis at 30 weeks of gestation), whereas 78 were already on cART before pregnancy (40% with pVL < 50 copies/mL). RAL was initiated before pregnancy (n = 33), during the second trimester (n = 11) and the third trimester of pregnancy (n = 50). No RAL discontinuations due to adverse events were observed. Overall, at the time of delivery, pVL was < 50 copies/mL in 70% and < 400 copies/mL in 84% of women. Specifically, pVL at delivery was < 50 copies/mL in 82%, 55% and 56% of cases when RAL was started before pregnancy, during the second or third trimester of pregnancy, respectively. Median term was 38 weeks of gestation, no defect was reported and all new-borns were HIV non-infected at Month 6. Conclusions RAL appears safe and effective in this “real-life” study. No defect and no HIV transmission was reported in new-borns.
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Affiliation(s)
- Pierre Gantner
- Hôpitaux Universitaires de Strasbourg, Laboratoire de Virologie, Strasbourg, France
| | - Babacar Sylla
- IMEA, CHU Bichat Claude Bernard, Paris, France Paris, France
| | - Laurence Morand-Joubert
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), AP-HP, Laboratoire de Virologie, Hôpital Saint-Antoine, Paris, France
| | - Pierre Frange
- APHP, Hopital Necker Enfants malades, Laboratoire de Microbiologie clinique, Paris, France
- EHU 7328, Institut Imagine, Université Paris Descartes, Paris, France
| | - Karine Lacombe
- Inserm UMR-S1136, IPLESP, AP-HP, Hôpital Saint Antoine, Department of Infectious Diseases, Paris, France
| | - Marie-Aude Khuong
- Hôpital Delafontaine, Department of Infectious Diseases, Saint Denis, France
| | - Claudine Duvivier
- APHP, Hopital Necker Enfants Malades, Department of Infectious Diseases, Centre d’Infectiologie Necker – Pasteur, IHU Imagine, Paris, France
| | - Odile Launay
- Université Paris Descartes, APHP, CIC Cochin Pasteur, Paris, France
| | - Marina Karmochkine
- APHP, Hopital Européen Georges Pompidou, Department of Clinical Immunology, Paris, France
| | | | - Amélie Ménard
- Institut hospitalo-universitaire (IHU) Méditerranée infection, Marseille, France
| | - Lionel Piroth
- Département d’Infectiologie, CHU Dijon, Dijon, France
| | - Ana Canestri
- APHP, Hôpital Tenon, Maladies Infectieuses, Paris, France
| | | | - Gilles Peytavin
- APHP, Hopital Bichat Claude Bernard, Department of Pharmacology-Toxicology, Paris, France
- INSERM IAME UMR-S 1137, Université Paris Diderot, Paris, France
| | - Roland Landman
- IMEA, CHU Bichat Claude Bernard, Paris, France Paris, France
- INSERM IAME UMR-S 1137, Université Paris Diderot, Paris, France
- APHP, Hopital Bichat Claude Bernard, Department of Infectious Diseases, Paris, France
| | - Jade Ghosn
- INSERM IAME UMR-S 1137, Université Paris Diderot, Paris, France
- APHP, Hopital Bichat Claude Bernard, Department of Infectious Diseases, Paris, France
- * E-mail:
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Nguyen B, Foisy MM, Hughes CA. Pharmacokinetics and Safety of the Integrase Inhibitors Elvitegravir and Dolutegravir in Pregnant Women With HIV. Ann Pharmacother 2019; 53:833-844. [PMID: 30739498 DOI: 10.1177/1060028019830788] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To synthesize data on the pharmacokinetics and safety of dolutegravir and elvitegravir in pregnant women living with HIV. Data Sources: A PubMed, EMBASE, Web of Science, and Google Scholar literature search (January 2010 to December 2018) was performed using the search terms dolutegravir, elvitegravir, women, pregnant*, and HIV. Additional reports were identified from conference abstracts and review of reference lists. Study Selection and Data Extraction: English-language studies reporting pharmacokinetic and/or safety data in pregnant women receiving dolutegravir or elvitegravir/cobicistat were included. Data Synthesis: A total of 17 studies were selected. Studies demonstrated a modest decrease in dolutegravir concentrations in pregnancy. Preliminary data suggest an increased risk of neural tube defects when dolutegravir is used at the time of conception. Available pharmacokinetic data in pregnant women showed significantly reduced plasma concentrations of elvitegravir/cobicistat which may increase the risk of virological failure. Current guidelines recommend that dolutegravir should not be initiated in women who have the potential to become pregnant or women in their first trimester of pregnancy and elvitegravir/cobicistat should be avoided during pregnancy. Relevance to Patient Care and Clinical Practice: This review highlights pharmacokinetic and safety data for dolutegravir and elvitegravir/cobicistat in pregnant women. Clinicians need to be aware of these data to convey the risks and benefits of using these agents in women of child-bearing potential. Conclusions: Changes in guideline recommendations reflect emerging data regarding the use of dolutegravir and elvitegravir/cobicistat in pregnancy. Until further information is available, raltegravir or other first-line agents are recommended for women with HIV planning to become pregnant.
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Affiliation(s)
- Binh Nguyen
- 1 University of Alberta Hospital, Edmonton, AB, Canada
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Brites C, Nóbrega I, Luz E, Travassos AG, Lorenzo C, Netto EM. Raltegravir versus lopinavir/ritonavir for treatment of HIV-infected late-presenting pregnant women. HIV CLINICAL TRIALS 2018; 19:94-100. [PMID: 29629852 DOI: 10.1080/15284336.2018.1459343] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Background Late-presenting pregnant women pose a challenge in the prevention of HIV-1 mother-to-child-transmission. We compared the safety and efficacy of raltegravir and lopinavir/ritonavir for this population. Methods We did a single-center, pilot, open-label, randomized trial in Brazil (N = 44). We randomly allocated late-presenting HIV-infected pregnant women (older than 18 years with a plasma HIV-1 RNA >1000 copies/mL) to receive raltegravir 400 mg twice a day or lopinavir/ritonavir 400/100 mg twice a day plus zidovudine and lamivudine (1:1). The primary endpoint was virological suppression at delivery (HIV-1 RNA <50 copies per mL), in all patients who received at least one dose of study drugs (modified intention-to-treat analysis). Missing information was treated as failure. We assessed safety in all patients. Results We enrolled and randomly assigned treatment to 33 patients (17 in raltegravir group) between June 2015 and June 2017. The study was interrupted by the IRB because a significant difference between arms was detected in an interim analysis. All patients completed follow up at delivery. At delivery, virological suppression was achieved by 13/17 (76.5%) of patients in raltegravir group, versus 4/16 (25.0%) in lopinavir/ritonavir group (RR 3.1, 95% CI: 1.3-7.4). Patients in raltegravir group had significantly higher proportion of virological suppression at 2, 4, and 6 weeks than lopinavir/ritonavir group. Adverse events were most of mild intensity, but patients in lopinavir/ritonavir group had significantly more gastrointestinal adverse events. There was neither discontinuation nor deaths in this trial. Conclusion Raltegravir might be a first-line option for treatment of HIV-infected late-presenting pregnant women.
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Affiliation(s)
- Carlos Brites
- a LAPI - Laboratório de Pesquisa em Infectologia , Comlexo Hospitalar Prof. Edgard Santos, Universidade Federal da Bahia , Salvador , Brazil
| | - Isabella Nóbrega
- a LAPI - Laboratório de Pesquisa em Infectologia , Comlexo Hospitalar Prof. Edgard Santos, Universidade Federal da Bahia , Salvador , Brazil.,b Secretaria de Saúde do Estado da Bahia , CEDAP - Centro Estadual Especializado em Diagnóstico, Assistência e Pesquisa , Salvador , Brazil
| | - Estela Luz
- a LAPI - Laboratório de Pesquisa em Infectologia , Comlexo Hospitalar Prof. Edgard Santos, Universidade Federal da Bahia , Salvador , Brazil
| | - Ana Gabriela Travassos
- b Secretaria de Saúde do Estado da Bahia , CEDAP - Centro Estadual Especializado em Diagnóstico, Assistência e Pesquisa , Salvador , Brazil.,c School of Medicine , UNEB-Universidade do Estado da Bahia , Salvador , Brazil
| | - Cynthia Lorenzo
- a LAPI - Laboratório de Pesquisa em Infectologia , Comlexo Hospitalar Prof. Edgard Santos, Universidade Federal da Bahia , Salvador , Brazil.,b Secretaria de Saúde do Estado da Bahia , CEDAP - Centro Estadual Especializado em Diagnóstico, Assistência e Pesquisa , Salvador , Brazil
| | - Eduardo M Netto
- a LAPI - Laboratório de Pesquisa em Infectologia , Comlexo Hospitalar Prof. Edgard Santos, Universidade Federal da Bahia , Salvador , Brazil
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Puthanakit T, Thepnarong N, Chaithongwongwatthana S, Anugulruengkitt S, Anunsittichai O, Theerawit T, Ubolyam S, Pancharoen C, Phanuphak P. Intensification of antiretroviral treatment with raltegravir for pregnant women living with HIV at high risk of vertical transmission. J Virus Erad 2018. [DOI: 10.1016/s2055-6640(20)30246-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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de Miguel R, Montejano R, Stella-Ascariz N, Arribas JR. A safety evaluation of raltegravir for the treatment of HIV. Expert Opin Drug Saf 2017; 17:217-223. [PMID: 29199485 DOI: 10.1080/14740338.2018.1411903] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Raltegravir (RAL) was the first commercialized agent from a new drug class with an innovative target, the integrase. Since its introduction in clinical practice RAL has become widely used for the treatment of HIV-1 infected patients. A decade after its approval, this article reviews key evidence from RAL with a special interest on safety outcomes. Areas covered: Pharmacologic, safety and efficacy data of RAL from clinical trials and post-commercialization published reports are hereby summarized after a literature review including PubMed search, relating proceedings and abstracts from relevant international HIV conferences, assessment reports from European and United States regulatory agencies and treatment guidelines (World Health Organization, United States Department of Health and Human Services and European AIDS Clinical Society), up to October 2017. Most frequent search terms were 'raltegravir', 'safety', 'adverse events', 'efficacy' and 'integrase-inhibitors'. Expert opinion: Despite the arrival of new integrase strand transfer inhibitors (INSTIs) with advantages in terms of dosing convenience (elvitegravir, ELV) and higher genetic barrier (dolutegravir, DTG), RAL has stood the test of time and its overall favourable safety profile, without significant appearance of unexpected adverse events, vouch for its relevance in the antiretroviral armamentarium.
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Affiliation(s)
- Rosa de Miguel
- a HIV Unit, Internal Medicine Service , Hospital Universitario La Paz-IdiPAZ , Madrid , Spain
| | - Rocio Montejano
- a HIV Unit, Internal Medicine Service , Hospital Universitario La Paz-IdiPAZ , Madrid , Spain
| | - Natalia Stella-Ascariz
- a HIV Unit, Internal Medicine Service , Hospital Universitario La Paz-IdiPAZ , Madrid , Spain
| | - Jose R Arribas
- a HIV Unit, Internal Medicine Service , Hospital Universitario La Paz-IdiPAZ , Madrid , Spain
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Cahn P, Kaplan R, Sax PE, Squires K, Molina JM, Avihingsanon A, Ratanasuwan W, Rojas E, Rassool M, Bloch M, Vandekerckhove L, Ruane P, Yazdanpanah Y, Katlama C, Xu X, Rodgers A, East L, Wenning L, Rawlins S, Homony B, Sklar P, Nguyen BY, Leavitt R, Teppler H, Cahn PE, Cassetti I, Losso M, Bloch MT, Roth N, McMahon J, Moore RJ, Smith D, Clumeck N, Vanderkerckhove L, Vandercam B, Moutschen M, Baril J, Conway B, Smaill F, Smith GHR, Rachlis A, Walmsley SL, Perez C, Wolff M, Lasso MF, Chahin CE, Velez JD, Sussmann O, Reynes J, Katlama C, Yazdanpanah Y, Ferret S, Durant J, Duvivier C, Poizot-Martin I, Ajana F, Rockstroh JK, Faetkanheuer G, Esser S, Jaeger H, Degen O, Bickel M, Bogner J, Arasteh K, Hartl H, Stoehr A, Rojas EM, Arathoon E, Gonzalez LD, Mejia CR, Shahar E, Turner D, Levy I, Sthoeger Z, Elinav H, Gori A, Monforte AD, Di Perri G, Lazzarin A, Rizzardini G, Antinori A, Celesia BM, Maggiolo F, Chow TS, Lee CKC, Azwa RISR, Mustafa M, Oyanguren M, Castillo RA, Hercilla L, Echiverri C, Maltez F, da Cunha JGS, Neves I, Teofilo E, Serrao R, Nagimova F, Khaertynova I, Orlova-Morozova E, Voronin E, Sotnikov V, Yakovlev AA, Zakharova NG, Tsybakova OA, Botes ME, Mohapi L, Kaplan R, Rassool MS, Arribas JR, Gatell JM, Negredo E, Ortega E, Troya J, Berenguer J, Aguirrebengoa K, Antela A, Calmy A, Cavassini M, Rauch A, Stoeckle M, Sheng WH, Lin HH, Tsai HC, Changpradub D, Avihingsanon A, Kiertiburanakul S, Ratanasuwan W, Nelson MR, Clarke A, Ustianowski A, Winston A, Johnson MA, Asmuth DM, Cade J, Gallant JE, Ruane PJ, Kumar PN, Luque AE, Panther L, Tashima KT, Ward D, Berger DS, Dietz CA, Fichtenbaum C, Gupta S, Mullane KM, Novak RM, Sweet DE, Crofoot GE, Hagins DP, Lewis ST, McDonald CK, DeJesus E, Sloan L, Prelutsky DJ, Rondon JC, Henn S, Scarsella AJ, Morales JO, Ramirez, Santiago L, Zorrilla CD, Saag MS, Hsiao CB. Raltegravir 1200 mg once daily versus raltegravir 400 mg twice daily, with tenofovir disoproxil fumarate and emtricitabine, for previously untreated HIV-1 infection: a randomised, double-blind, parallel-group, phase 3, non-inferiority trial. LANCET HIV 2017; 4:e486-e494. [DOI: 10.1016/s2352-3018(17)30128-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 06/22/2017] [Accepted: 06/23/2017] [Indexed: 12/20/2022]
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Cecchini DM, Martinez MG, Morganti LM, Rodriguez CG. Antiretroviral Therapy Containing Raltegravir to Prevent Mother-to-Child Transmission of HIV in Infected Pregnant Women. Infect Dis Rep 2017; 9:7017. [PMID: 28663779 PMCID: PMC5477474 DOI: 10.4081/idr.2017.7017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 03/13/2017] [Accepted: 03/17/2017] [Indexed: 11/23/2022] Open
Abstract
We conducted a retrospective study in a general hospital in Buenos Aires, Argentina (2009-2015) aimed at evaluating outcomes in HIV-infected pregnant women (HIPW), who were prescribed raltegravir (RAL)-containing antiretroviral therapy (ART). A total of 239 HIPW were enrolled in our study; among them 31 received RAL (12.9%) at different clinical stages: i) intensification (INS): addition of RAL to current ART because of detectable antepartum viral load, 13 (41.9%); ii) late presenter (LP): standard ART + RAL as fourth drug, 15 (48.4%); iii) treatment of resistant-HIV: 3 (9.7%). Median gestational age at RAL initiation was 34 weeks and median exposure was 30 days. In INS-group, median viral load (VL) decrease was 1.48 log10. In LP-group, median VL decline was 2.15 log10. No clinical adverse events or maternal intolerance attributable to RAL were observed. Elective cesarean section was done in 51.7%; mild elevation of transaminases was observed in 35% of neonates. No vertical transmission was documented.
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Affiliation(s)
- Diego M. Cecchini
- Hospital General de Agudos “Cosme Argerich”, Buenos Aires, Argentina
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