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Capetti AF, Cossu MV, Orofino G, Sterrantino G, Cenderello G, De Socio GV, Cattelan AM, Soria A, Rusconi S, Riccardi N, Baldin GM, Niero FP, Barbarini G, Rizzardini G. A dual regimen of ritonavir/darunavir plus dolutegravir for rescue or simplification of rescue therapy: 48 weeks' observational data. BMC Infect Dis 2017; 17:658. [PMID: 28964268 PMCID: PMC5622573 DOI: 10.1186/s12879-017-2755-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 09/21/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dolutegravir (DTG) plus darunavir/ritonavir (DRV/r) is a simple combination of drugs that has the best genetic barrier to HIV-1 resistance and may be fit for salvage therapy. METHODS All HIV-1-infected subjects treated with DTG plus DRV/r between March 2014 and September 2015 in eight Italian centres were included in the analysis. The main metabolic data, efficacy parameters and safety data routinely collected were provided. This observational study is aimed to assess the efficacy of such approach. The primary end-point was the proportion of subjects achieving or maintaining virologic suppression <50 copies/mL at week 24. Secondary end points were maintaining virologic suppression in the follow-up (weeks 48 and 96) and safety. RESULTS One hundred and thirty subjects were followed for a median of 56 months. Reasons for switching were simplification (44.6%), viral failure (30%), toxicity (16.9%), non-adherence (4.6%), persistent low-level viremia (3.1%), and drug-drug interaction (0.8%). At baseline, 118 subjects had documented resistance to 1 to 5 antiretroviral classes while 12 had viral rebound at a time when genotypic tests were not yet available. Seventeen and 14 subjects took DRV/r and DTG twice daily, respectively. One subject was lost to follow-up, one discontinued for liver enzymes' elevation, one died of illicit drug abuse and one of cancer-related complications. The proportion of subjects with ongoing HIV replication dropped from 40% to 6.1%. Those with undetectable viral load increased from 38.5% to 76.2%. At week 48, 17.7% had HIV RNA between 1 and 49 copies/mL. The number of subjects with altered serum glucose, creatinine, ALT, AST, total-, HDL- and LDL-cholesterol, triglycerides and MDRD <90 mL/min decreased by week 48, while those having MDRD <60 mL/min remained 4.6%. Overall 90/283 baseline laboratory alterations returned to normality. CONCLUSIONS Switching to DTG plus DRV/r proved to be safe, suppressing viral replication without metabolic impact.
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Affiliation(s)
- Amedeo F Capetti
- 1st Division of Infectious Diseases, ASST Fatebenefratelli-Sacco, Via Giovanni Battista Grassi, 74, pavillion 56, Malattie Infettive, 2nd floor, 20157, Milan, Italy.
| | - Maria Vittoria Cossu
- 1st Division of Infectious Diseases, ASST Fatebenefratelli-Sacco, Via Giovanni Battista Grassi, 74, pavillion 56, Malattie Infettive, 2nd floor, 20157, Milan, Italy
| | - Giancarlo Orofino
- 1st Division of Infectious Diseases Amedeo di Savoia Hospital, Torino, Italy
| | | | | | - Giuseppe V De Socio
- Infectious Diseases Clinic, Azienda Ospedaliero-Universitaria di Perugia, Perugia, Italy
| | - Anna Maria Cattelan
- Infectious and Tropical Diseases, Azienda Ospedaliera-Universitaria di Padova, Padova, Italy
| | - Alessandro Soria
- Clinic of Infectious Diseases, San Gerardo Hospital, ASST Monza, University of Milano-Bicocca, Monza, Italy
| | - Stefano Rusconi
- Infectious Diseases Clinic, DIBIC Luigi Sacco, University of Milano, Milano, Italy
| | - Niccolò Riccardi
- Infectious Diseases Clinic, "San Martino" Hospital, Genova, Italy
| | - Gian Maria Baldin
- 2nd Division of Infectious Diseases, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Fosca P Niero
- 1st Division of Infectious Diseases, ASST Fatebenefratelli-Sacco, Via Giovanni Battista Grassi, 74, pavillion 56, Malattie Infettive, 2nd floor, 20157, Milan, Italy
| | - Giorgio Barbarini
- 2nd Division of Infectious Diseases, "Policlinico San Matteo" Hospital, Pavia, Italy
| | - Giuliano Rizzardini
- 1st Division of Infectious Diseases, ASST Fatebenefratelli-Sacco, Via Giovanni Battista Grassi, 74, pavillion 56, Malattie Infettive, 2nd floor, 20157, Milan, Italy.,Whitwaterstrand University, Johannesburg, South Africa
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Tashima KT, Smeaton LM, Fichtenbaum CJ, Andrade A, Eron JJ, Gandhi RT, Johnson VA, Klingman KL, Ritz J, Hodder S, Santana JL, Wilkin T, Haubrich RH. HIV Salvage Therapy Does Not Require Nucleoside Reverse Transcriptase Inhibitors: A Randomized, Controlled Trial. Ann Intern Med 2015; 163:908-17. [PMID: 26595748 PMCID: PMC4681296 DOI: 10.7326/m15-0949] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Nucleoside reverse transcriptase inhibitors (NRTIs) are often included in antiretroviral regimens in treatment-experienced patients in the absence of data from randomized trials. OBJECTIVE To compare treatment success between participants who omit versus those who add NRTIs to an optimized antiretroviral regimen of 3 or more agents. DESIGN Multicenter, randomized, controlled trial. (ClinicalTrials.gov: NCT00537394). SETTING Outpatient HIV clinics. PARTICIPANTS Treatment-experienced patients with HIV infection and viral resistance. INTERVENTION Open-label optimized regimens (not including NRTIs) were selected on the basis of treatment history and susceptibility testing. Participants were randomly assigned to omit or add NRTIs. MEASUREMENTS The primary efficacy outcome was regimen failure through 48 weeks using a noninferiority margin of 15%. The primary safety outcome was time to initial episode of a severe sign, symptom, or laboratory abnormality before discontinuation of NRTI assignment. RESULTS 360 participants were randomly assigned, and 93% completed a 48-week visit. The cumulative probability of regimen failure was 29.8% in the omit-NRTIs group versus 25.9% in the add-NRTIs group (difference, 3.2 percentage points [95% CI, -6.1 to 12.5 percentage points]). No significant between-group differences were found in the primary safety end points or the proportion of participants with HIV RNA level less than 50 copies/mL. No deaths occurred in the omit-NRTIs group compared with 7 deaths in the add-NRTIs group. LIMITATION Unblinded study design, and the study may not be applicable to resource-poor settings. CONCLUSION Treatment-experienced patients with HIV infection starting a new optimized regimen can safely omit NRTIs without compromising virologic efficacy. Omitting NRTIs will reduce pill burden, cost, and toxicity in this patient population. PRIMARY FUNDING SOURCES National Institute of Allergy and Infectious Diseases, Boehringer Ingelheim, Janssen, Merck, ViiV Healthcare, Roche, and Monogram Biosciences (LabCorp).
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Affiliation(s)
- Karen T. Tashima
- From The Miriam Hospital, Alpert Medical School of Brown University, Providence, Rhode Island; Harvard T.H. Chan School of Public Health and Massachusetts General Hospital, Boston, Massachusetts; University of Cincinnati College of Medicine, Cincinnati, Ohio; Johns Hopkins Hospital, Baltimore, Maryland; University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Birmingham Veterans Affairs Medical Center, Birmingham, Alabama
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland; West Virginia University School of Medicine, Morgantown, West Virginia; University of Puerto Rico, San Juan, Puerto Rico; Weill Cornell Medical College, New York, New York; and Gilead Sciences, Foster City, California
| | - Laura M. Smeaton
- From The Miriam Hospital, Alpert Medical School of Brown University, Providence, Rhode Island; Harvard T.H. Chan School of Public Health and Massachusetts General Hospital, Boston, Massachusetts; University of Cincinnati College of Medicine, Cincinnati, Ohio; Johns Hopkins Hospital, Baltimore, Maryland; University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Birmingham Veterans Affairs Medical Center, Birmingham, Alabama
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland; West Virginia University School of Medicine, Morgantown, West Virginia; University of Puerto Rico, San Juan, Puerto Rico; Weill Cornell Medical College, New York, New York; and Gilead Sciences, Foster City, California
| | - Carl J. Fichtenbaum
- From The Miriam Hospital, Alpert Medical School of Brown University, Providence, Rhode Island; Harvard T.H. Chan School of Public Health and Massachusetts General Hospital, Boston, Massachusetts; University of Cincinnati College of Medicine, Cincinnati, Ohio; Johns Hopkins Hospital, Baltimore, Maryland; University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Birmingham Veterans Affairs Medical Center, Birmingham, Alabama
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland; West Virginia University School of Medicine, Morgantown, West Virginia; University of Puerto Rico, San Juan, Puerto Rico; Weill Cornell Medical College, New York, New York; and Gilead Sciences, Foster City, California
| | - Adriana Andrade
- From The Miriam Hospital, Alpert Medical School of Brown University, Providence, Rhode Island; Harvard T.H. Chan School of Public Health and Massachusetts General Hospital, Boston, Massachusetts; University of Cincinnati College of Medicine, Cincinnati, Ohio; Johns Hopkins Hospital, Baltimore, Maryland; University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Birmingham Veterans Affairs Medical Center, Birmingham, Alabama
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland; West Virginia University School of Medicine, Morgantown, West Virginia; University of Puerto Rico, San Juan, Puerto Rico; Weill Cornell Medical College, New York, New York; and Gilead Sciences, Foster City, California
| | - Joseph J. Eron
- From The Miriam Hospital, Alpert Medical School of Brown University, Providence, Rhode Island; Harvard T.H. Chan School of Public Health and Massachusetts General Hospital, Boston, Massachusetts; University of Cincinnati College of Medicine, Cincinnati, Ohio; Johns Hopkins Hospital, Baltimore, Maryland; University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Birmingham Veterans Affairs Medical Center, Birmingham, Alabama
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland; West Virginia University School of Medicine, Morgantown, West Virginia; University of Puerto Rico, San Juan, Puerto Rico; Weill Cornell Medical College, New York, New York; and Gilead Sciences, Foster City, California
| | - Rajesh T. Gandhi
- From The Miriam Hospital, Alpert Medical School of Brown University, Providence, Rhode Island; Harvard T.H. Chan School of Public Health and Massachusetts General Hospital, Boston, Massachusetts; University of Cincinnati College of Medicine, Cincinnati, Ohio; Johns Hopkins Hospital, Baltimore, Maryland; University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Birmingham Veterans Affairs Medical Center, Birmingham, Alabama
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland; West Virginia University School of Medicine, Morgantown, West Virginia; University of Puerto Rico, San Juan, Puerto Rico; Weill Cornell Medical College, New York, New York; and Gilead Sciences, Foster City, California
| | - Victoria A. Johnson
- From The Miriam Hospital, Alpert Medical School of Brown University, Providence, Rhode Island; Harvard T.H. Chan School of Public Health and Massachusetts General Hospital, Boston, Massachusetts; University of Cincinnati College of Medicine, Cincinnati, Ohio; Johns Hopkins Hospital, Baltimore, Maryland; University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Birmingham Veterans Affairs Medical Center, Birmingham, Alabama
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland; West Virginia University School of Medicine, Morgantown, West Virginia; University of Puerto Rico, San Juan, Puerto Rico; Weill Cornell Medical College, New York, New York; and Gilead Sciences, Foster City, California
| | - Karin L. Klingman
- From The Miriam Hospital, Alpert Medical School of Brown University, Providence, Rhode Island; Harvard T.H. Chan School of Public Health and Massachusetts General Hospital, Boston, Massachusetts; University of Cincinnati College of Medicine, Cincinnati, Ohio; Johns Hopkins Hospital, Baltimore, Maryland; University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Birmingham Veterans Affairs Medical Center, Birmingham, Alabama
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland; West Virginia University School of Medicine, Morgantown, West Virginia; University of Puerto Rico, San Juan, Puerto Rico; Weill Cornell Medical College, New York, New York; and Gilead Sciences, Foster City, California
| | - Justin Ritz
- From The Miriam Hospital, Alpert Medical School of Brown University, Providence, Rhode Island; Harvard T.H. Chan School of Public Health and Massachusetts General Hospital, Boston, Massachusetts; University of Cincinnati College of Medicine, Cincinnati, Ohio; Johns Hopkins Hospital, Baltimore, Maryland; University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Birmingham Veterans Affairs Medical Center, Birmingham, Alabama
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland; West Virginia University School of Medicine, Morgantown, West Virginia; University of Puerto Rico, San Juan, Puerto Rico; Weill Cornell Medical College, New York, New York; and Gilead Sciences, Foster City, California
| | - Sally Hodder
- From The Miriam Hospital, Alpert Medical School of Brown University, Providence, Rhode Island; Harvard T.H. Chan School of Public Health and Massachusetts General Hospital, Boston, Massachusetts; University of Cincinnati College of Medicine, Cincinnati, Ohio; Johns Hopkins Hospital, Baltimore, Maryland; University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Birmingham Veterans Affairs Medical Center, Birmingham, Alabama
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland; West Virginia University School of Medicine, Morgantown, West Virginia; University of Puerto Rico, San Juan, Puerto Rico; Weill Cornell Medical College, New York, New York; and Gilead Sciences, Foster City, California
| | - Jorge L. Santana
- From The Miriam Hospital, Alpert Medical School of Brown University, Providence, Rhode Island; Harvard T.H. Chan School of Public Health and Massachusetts General Hospital, Boston, Massachusetts; University of Cincinnati College of Medicine, Cincinnati, Ohio; Johns Hopkins Hospital, Baltimore, Maryland; University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Birmingham Veterans Affairs Medical Center, Birmingham, Alabama
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland; West Virginia University School of Medicine, Morgantown, West Virginia; University of Puerto Rico, San Juan, Puerto Rico; Weill Cornell Medical College, New York, New York; and Gilead Sciences, Foster City, California
| | - Timothy Wilkin
- From The Miriam Hospital, Alpert Medical School of Brown University, Providence, Rhode Island; Harvard T.H. Chan School of Public Health and Massachusetts General Hospital, Boston, Massachusetts; University of Cincinnati College of Medicine, Cincinnati, Ohio; Johns Hopkins Hospital, Baltimore, Maryland; University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Birmingham Veterans Affairs Medical Center, Birmingham, Alabama
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland; West Virginia University School of Medicine, Morgantown, West Virginia; University of Puerto Rico, San Juan, Puerto Rico; Weill Cornell Medical College, New York, New York; and Gilead Sciences, Foster City, California
| | - Richard H. Haubrich
- From The Miriam Hospital, Alpert Medical School of Brown University, Providence, Rhode Island; Harvard T.H. Chan School of Public Health and Massachusetts General Hospital, Boston, Massachusetts; University of Cincinnati College of Medicine, Cincinnati, Ohio; Johns Hopkins Hospital, Baltimore, Maryland; University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Birmingham Veterans Affairs Medical Center, Birmingham, Alabama
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland; West Virginia University School of Medicine, Morgantown, West Virginia; University of Puerto Rico, San Juan, Puerto Rico; Weill Cornell Medical College, New York, New York; and Gilead Sciences, Foster City, California
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