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Marin RC, Bungau SG, Tit DM, Negru PA, Radu AF, Moleriu RD. Immune recovery among Romanian HIV/AIDS patients receiving darunavir/ritonavir or darunavir/cobicistat regimens in cART management: A three-year study. Biomed Pharmacother 2023; 161:114427. [PMID: 36822019 DOI: 10.1016/j.biopha.2023.114427] [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] [Received: 01/17/2023] [Revised: 02/16/2023] [Accepted: 02/17/2023] [Indexed: 02/23/2023] Open
Abstract
Approximately two-thirds of Romanian HIV patients were parenterally infected with the F subtype of HIV in early childhood. They are now in the context of immunological aging, with immunosuppression posing an additional challenge in developing the most effective and well-tolerated regimens. The risk of an improper immune recovery is higher in these patients than in newly diagnosed patients. The primary goal of this retrospective study was to conduct a comparative analysis of the immune recovery, measured at three time points, on 462 HIV-infected patients who were registered at the "Matei Balş National Institute of Infectious Diseases", Bucharest, Romania, between 2018 and 2021, as follows: darunavir (DRV) 600 mg plus ritonavir (RTV) 100 mg (twice daily) was given to 384 patients, while DRV 800 mg plus cobicistat (COBI) 150 mg was given to 78 patients (once daily). The immune response was assessed by counting T lymphocytes, CD4 count cells/mm3, and the CD4/CD8 lymphocyte count ratio. Additionally, the study assessed the relationship between the immune and virological responses to therapy. Using various statistical tests, the results revealed that the immune response is normal in both groups, but with a statistically significant difference (p < 0.05) for the DRV/c group. Statistical associations between RNA viral plasma load and immune response (CD4 count and CD4/CD8 ratio) were assessed at all three visits and showed an insignificant association for the first two time points; however, at the final visit, the outcomes changed and reached statistical significance for both groups.
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Affiliation(s)
- Ruxandra-Cristina Marin
- Doctoral School of Biological and Biomedical Sciences, University of Oradea, 410087 Oradea, Romania.
| | - Simona Gabriela Bungau
- Doctoral School of Biological and Biomedical Sciences, University of Oradea, 410087 Oradea, Romania; Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania.
| | - Delia Mirela Tit
- Doctoral School of Biological and Biomedical Sciences, University of Oradea, 410087 Oradea, Romania; Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania.
| | - Paul Andrei Negru
- Doctoral School of Biological and Biomedical Sciences, University of Oradea, 410087 Oradea, Romania.
| | - Andrei-Flavius Radu
- Doctoral School of Biological and Biomedical Sciences, University of Oradea, 410087 Oradea, Romania.
| | - Radu Dumitru Moleriu
- Department of Mathematics, Faculty of Mathematics and Computer Science, West University of Timisoara, 300223 Timisoara, Romania.
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Santos JR, Curran A, Navarro-Mercade J, Ampuero MF, Pelaez P, Pérez-Alvarez N, Clotet B, Paredes R, Moltó J. Simplification of Antiretroviral Treatment from Darunavir/Ritonavir Monotherapy to Darunavir/Cobicistat Monotherapy: Effectiveness and Safety in Routine Clinical Practice. AIDS Res Hum Retroviruses 2019; 35:513-518. [PMID: 30909716 DOI: 10.1089/aid.2018.0178] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Our aim was to evaluate the effectiveness and safety of darunavir/cobicistat (DRV/c) monotherapy as an antiretroviral treatment simplification strategy in HIV-infected patients already on suppressive darunavir/ritonavir (DRV/r) monotherapy in routine clinical practice. We conducted a retrospective multicenter study including all adult patients switched from DRV/r monotherapy to DRV/c monotherapy while HIV-1 RNA was <50 copies/mL and who had at least one follow-up visit. The primary endpoint was the percentage of patients remaining free of treatment failure (TF), defined as discontinuation of monotherapy for any reason, including loss of follow-up. Virological failure (VF) was defined as a confirmed HIV-1 RNA ≥50 copies/mL or any change in the regimen after a single determination with HIV-1 RNA ≥50 copies/mL. Changes in renal function parameters and lipid profile were also evaluated. Factors associated with VF were analyzed using Cox regression. In this study, 173 subjects were included. The median (interquartile range) time of follow-up was 58 (50-67) weeks. Overall, 90% of patients remained free of TF during follow-up. Ten (6%) patients discontinued DRV/c monotherapy for nonvirological reasons and eight (5%) developed VF. No DRV-related mutations were identified in patients with VF. A decrease in triglyceride levels (p = .006) and estimated glomerular filtration rate (p = .005) were observed during follow-up. The presence of blips and CD4+ nadir <100 cells/mm3 were predictors of VF. In conclusion, switching to DRV/c monotherapy seems to be safe and effective in routine clinical practice in HIV-infected patients undergoing suppressive DRV/r monotherapy.
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Affiliation(s)
- José R. Santos
- Lluita contra la SIDA Foundation, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
- Infectious Diseases Department, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Adrian Curran
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jordi Navarro-Mercade
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mario F. Ampuero
- Internal Medicine Service, Hospital Universitario de La Princesa, Madrid, Spain
| | - Pablo Pelaez
- School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Nuria Pérez-Alvarez
- Department of Econometrics, Statistics and Applied Economics, University of Barcelona, Barcelona, Spain
| | - Bonaventura Clotet
- Lluita contra la SIDA Foundation, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
- Infectious Diseases Department, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
- IrsiCaixa AIDS Research Institute, Barcelona, Spain
- Chair on AIDS and Related Diseases, Universitat de Vic-Universitat Central de Catalunya, Barcelona, Spain
| | - Roger Paredes
- Lluita contra la SIDA Foundation, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
- Infectious Diseases Department, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
- IrsiCaixa AIDS Research Institute, Barcelona, Spain
- Chair on AIDS and Related Diseases, Universitat de Vic-Universitat Central de Catalunya, Barcelona, Spain
| | - José Moltó
- Lluita contra la SIDA Foundation, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
- Infectious Diseases Department, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
- Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
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3
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De Wit S, Florence E, Vandekerckhove L, Vandercam B, Goffard JC, Van Wijngaerden E, Moutschen M, Demeester R, Thilakarathne P, Piryns H. Long-term use of darunavir/ritonavir-containing regimens in daily practice in Belgium: retrospective observational cohort data of 1701 HIV-patients. Acta Clin Belg 2018; 73:341-347. [PMID: 29623779 DOI: 10.1080/17843286.2018.1458428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Background Once daily (QD) ritonavir or cobicistat-boosted darunavir (DRV/b), in combination with other antiretrovirals (ARVs), is recommended as a first-line option for human immunodeficiency virus-infected patients in European and USA guidelines. The objective of this study was to analyse the outcomes of DRV/r QD-based antiretroviral therapy (ART) regimens in real-life settings. Methods This is an observational, non-interventional, non-comparative, retrospective, multicentre cohort study. Data were collected from the databases of eight Belgian AIDS Reference Centres. All patients who received at least one dose of DRV/r QD, regardless of background ARV regimen, with a minimum follow-up of 6 months were included. Results Data from 1701 subjects were collected. Most were male (66.5%) with a mean age of 42.9 years, 33.1% were treatment-naïve and 66.9% were ART experienced. During a median follow-up of 2.45 years (95% CI: 1.50-3.34), the probability to remain on treatment was 87% for the first year, 79% for the second year. DRV/r was well tolerated with few discontinuations due to adverse events (6.9%) or virological failure (0.8%). Among the 1138 treatment-experienced patients, 111 (9.8%) patients received DRV/r QD monotherapy. Conclusions This retrospective cohort analysis confirms the long-term effectiveness and good tolerability of DRV/r QD in a real-life setting. No unexpected adverse events were reported.
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Affiliation(s)
- Stéphane De Wit
- Saint-Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | | | | | | | | | | | | | | | | | - Hilde Piryns
- Medical Department, Janssen-Cilag NV, Beerse, Belgium
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Paton NI, Stöhr W, Oddershede L, Arenas-Pinto A, Walker S, Sculpher M, Dunn DT. The Protease Inhibitor Monotherapy Versus Ongoing Triple Therapy (PIVOT) trial: a randomised controlled trial of a protease inhibitor monotherapy strategy for long-term management of human immunodeficiency virus infection. Health Technol Assess 2016; 20:1-158. [PMID: 26986803 DOI: 10.3310/hta20210] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Standard-of-care antiretroviral therapy (ART) for human immunodeficiency virus (HIV) infection uses a combination of drugs, until now considered essential to minimise treatment failure and development of drug resistance. Protease inhibitors (PIs) are potent with a high genetic barrier to resistance and have the potential for use as monotherapy after viral load (VL) suppression achieved on combination therapy. However, longer-term resistance and toxicity risks are uncertain. OBJECTIVE To compare the effectiveness, toxicity profile and cost-effectiveness of PI monotherapy with those of standard-of-care triple therapy in a pragmatic long-term clinical trial. DESIGN Open-label, parallel-group, randomised controlled trial. SETTING Forty-three HIV clinical centres in the UK NHS. PARTICIPANTS HIV-positive adults taking standard combination ART with a suppressed VL for ≥ 6 months. INTERVENTIONS Patients were randomised to maintain ongoing triple therapy (OT) or switch to a strategy of physician-selected ritonavir-boosted PI monotherapy (PI-mono), with prompt return to combination therapy in the event of VL rebound. MAIN OUTCOME MEASURES The primary outcome was reduction of future drug options, defined as new intermediate-/high-level resistance to one or more drugs to which the patient's virus was considered to be sensitive at trial entry (non-inferiority comparison, 10% margin). Secondary outcomes included confirmed virological rebound, serious drug- or disease-related complications, total grade 3 or 4 adverse events (AEs), neurocognitive function change, cluster of differentiation 4 (CD4) cell count change, change in health-related quality of life, cardiovascular risk change, health-care costs and health economic analysis. RESULTS In total, 587 participants were randomised (77% male, 68% white) to OT (n = 291) or PI-mono (n = 296) and followed for a median of 44 months, of whom 2.7% withdrew/were lost to follow-up. One or more episodes of confirmed VL rebound were observed in eight patients (Kaplan-Meier estimate 3.2%) in the OT group and 95 patients (35.0%) in the PI-mono group [absolute risk difference 31.8%, 95% confidence interval (CI) 24.6% to 39.0%; p < 0.001]. PI-mono patients who changed to ART after VL rebound all resuppressed (median 3.5 weeks). The proportions with loss of a future drug option at 3 years were 0.7% in the OT group and 2.1% in the PI-mono group (difference 1.4%, (95% CI -0.4% to 3.4%); non-inferiority demonstrated). There were no significant differences in serious disease complications between groups or in the frequency of grade 3 or 4 clinical AEs (16.8% OT group vs. 22% PI-mono group; absolute risk difference 5.1%, 95% CI -1.3% to 11.5%; p = 0.12). Overall, the PI-mono strategy was shown to be cost-effective compared with OT under most scenarios explored. PI-mono was cost saving because of the large savings in ART drug costs while being no less effective in terms of quality-adjusted life-years in the within-trial analysis and only marginally less effective when extrapolated to lifetime outcomes. CONCLUSIONS PI monotherapy, with prompt reintroduction of combination therapy for VL rebound, was non-inferior to combination therapy in preserving future treatment options and is an acceptable and cost-effective alternative for long-term management of HIV infection. TRIAL REGISTRATION Current Controlled Trials ISRCTN04857074. FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 21. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Nicholas I Paton
- Medical Research Council Clinical Trials Unit at University College London, Institute of Clinical Trials and Methodology, University College London, London, UK.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wolfgang Stöhr
- Medical Research Council Clinical Trials Unit at University College London, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Lars Oddershede
- Danish Centre for Healthcare Improvements, Faculty of Social Sciences and Faculty of Health Sciences, Aalborg University, Aalborg, Denmark
| | - Alejandro Arenas-Pinto
- Medical Research Council Clinical Trials Unit at University College London, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Simon Walker
- Centre for Health Economics, University of York, York, UK
| | - Mark Sculpher
- Centre for Health Economics, University of York, York, UK
| | - David T Dunn
- Medical Research Council Clinical Trials Unit at University College London, Institute of Clinical Trials and Methodology, University College London, London, UK
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5
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El Bouzidi K, Collier D, Nastouli E, Copas AJ, Miller RF, Gupta RK. Virological efficacy of PI monotherapy for HIV-1 in clinical practice. J Antimicrob Chemother 2016; 71:3228-3234. [PMID: 27402006 PMCID: PMC5079296 DOI: 10.1093/jac/dkw265] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 05/16/2016] [Accepted: 06/01/2016] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Clinical trials of PI monotherapy indicate that most participants maintain viral suppression and emergent protease resistance is rare. However, outcomes among patients receiving PI monotherapy for clinical reasons, such as toxicity or adherence issues, are less well studied. METHODS An observational study of patients attending an HIV treatment centre in London, UK, who had received PI monotherapy between 2004 and 2013, was conducted using prospectively collected clinical data and genotypic resistance reports. Survival analysis techniques were used to examine the times to virological failure and treatment discontinuation. RESULTS Ninety-five patients had PI monotherapy treatment for a median duration of 126 weeks. Virological failure occurred during 64% of episodes and 8% of patients developed emergent protease mutations. We estimate failure occurs in half of episodes within 2 years following initiation. Where PI monotherapy was continued following virological failure, 68% of patients achieved viral re-suppression. Despite a high incidence of virological failure, many patients continued PI monotherapy and 79% of episodes were ongoing at the end of the study. The type of PI used, the presence of baseline protease mutations and the plasma HIV RNA at initiation did not have a significant impact on treatment outcomes. CONCLUSIONS There was a higher incidence of virological failure and emerging resistance in our UK clinical setting than described in PI monotherapy clinical trials and other European observational studies. Despite this, many patients continued PI monotherapy and regained viral suppression, indicating this strategy remains a viable option in certain individuals following careful clinical evaluation.
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Affiliation(s)
- Kate El Bouzidi
- Research Department of Infection, Division of Infection and Immunity, University College London, London, UK
- Research Department of Infection and Population Health, University College London, London, UK
| | - Dami Collier
- Research Department of Infection, Division of Infection and Immunity, University College London, London, UK
| | - Eleni Nastouli
- Research Department of Infection, Division of Infection and Immunity, University College London, London, UK
- Department of Clinical Virology, University College London Hospitals NHS Trust, London, UK
- NIHR University College London Hospitals Biomedical Research Centre, London, UK
| | - Andrew J Copas
- Research Department of Infection and Population Health, University College London, London, UK
| | - Robert F Miller
- Research Department of Infection and Population Health, University College London, London, UK
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Ravindra K Gupta
- Research Department of Infection, Division of Infection and Immunity, University College London, London, UK
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Pernas B, Grandal M, Tabernilla A, Cid P, Pértega S, Castro-Iglesias Á, Mena Á, Margusino L, Pedreira JD, Poveda E. Long-term clinical experience with darunavir (2007-2015) in a large cohort of HIV-infected patients in Spain. J Med Virol 2016; 88:2125-2131. [PMID: 27218208 DOI: 10.1002/jmv.24585] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2016] [Indexed: 01/23/2023]
Abstract
The clinical experience with the protease inhibitor darunavir/ritonavir (DRV/r) was retrospectively evaluated in a cohort of 173 HIV+ patients who initiated antiretroviral treatment including DRV/r (period 2007-2015). The 43.2% had a CD4 nadir ≤100 cells/mm3 , 64.1% were treatment-experienced, and 36.5% had failed to >3 lines of antiretroviral therapy. Nonetheless, the rate of virological suppression (HIV-RNA <50 copies/ml) in naïve patients was 63%, 66.7%, and 63.6% at 48, 96, and 144 weeks, respectively. The rate of virological suppression in treatment-experienced patients was 62.7%, 78.7%, and 79.1% at 48, 96, and 144 weeks, respectively. No differences were observed according to the immunovirological status neither dosage of DRV/r. Most of them (82.6%) maintained DRV/r treatment. Causes for DRV/r discontinuation were mainly gastrointestinal and cutaneous adverse events (10.5%), switch to simplification treatment strategies (3.5%) and virological failure (1.7%). These findings demonstrate the prolonged efficacy and tolerability of DRV/r even in multi-treated HIV+ patients with an unfavorable immunovirological status. J. Med. Virol. 88:2125-2131, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Berta Pernas
- Division of Clinical Virology, Instituto de Investigación Biomédica de A Coruña (INIBIC)-Complejo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidad de A Coruña, A Coruña, Spain
| | - Marta Grandal
- Division of Clinical Virology, Instituto de Investigación Biomédica de A Coruña (INIBIC)-Complejo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidad de A Coruña, A Coruña, Spain
| | - Andrés Tabernilla
- Division of Clinical Virology, Instituto de Investigación Biomédica de A Coruña (INIBIC)-Complejo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidad de A Coruña, A Coruña, Spain
| | - Purificación Cid
- Service of Pharmacy, Complejo Hospitalario Universitario de A Coruña, SERGAS, A Coruña, Spain
| | - Sonia Pértega
- Clinical Epidemiology and Biostatistics Unit, Instituto de Investigación Biomédica de A Coruña (INIBIC)-Complejo Hospitalario Universitario de A Coruña, SERGAS, A Coruña, Spain
| | - Ángeles Castro-Iglesias
- Division of Clinical Virology, Instituto de Investigación Biomédica de A Coruña (INIBIC)-Complejo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidad de A Coruña, A Coruña, Spain
| | - Álvaro Mena
- Division of Clinical Virology, Instituto de Investigación Biomédica de A Coruña (INIBIC)-Complejo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidad de A Coruña, A Coruña, Spain
| | - Luis Margusino
- Service of Pharmacy, Complejo Hospitalario Universitario de A Coruña, SERGAS, A Coruña, Spain
| | - José D Pedreira
- Division of Clinical Virology, Instituto de Investigación Biomédica de A Coruña (INIBIC)-Complejo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidad de A Coruña, A Coruña, Spain
| | - Eva Poveda
- Division of Clinical Virology, Instituto de Investigación Biomédica de A Coruña (INIBIC)-Complejo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidad de A Coruña, A Coruña, Spain.
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Santos JR, Llibre JM, Bravo I, García-Rosado D, Cañadas MP, Pérez-Álvarez N, Paredes R, Clotet B, Moltó J. Short Communication: Efficacy and Safety of Treatment Simplification to Lopinavir/Ritonavir or Darunavir/Ritonavir Monotherapy: A Randomized Clinical Trial. AIDS Res Hum Retroviruses 2016; 32:452-5. [PMID: 26781004 DOI: 10.1089/aid.2015.0248] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Antiretroviral treatment simplification strategies based on monotherapy with darunavir/ritonavir (DRV/r) or lopinavir/ritonavir (LPV/r) have not been directly compared in clinical trials. We evaluated the 48-week efficacy and safety of DRV/r versus LPV/r monotherapy as a treatment simplification strategy in a multicenter, randomized open-label study. Maintenance of viral suppression in cerebrospinal fluid (CSF) and semen was also explored. An intention to treat efficacy analysis was performed considering missing equals to failure (ITT:M = F). Virological failure (VF) was defined as a confirmed increase in plasma HIV-1 RNA >50 copies/mL. A total of 75 patients were enrolled: 40 were allocated to DRVr and 33 to LPVr. In the ITT: M = F analysis, 77.5% of patients on DRV/r and 66.6% of patients on LPV/r maintained HIV-1 RNA <50 copies/mL at week 48 (p = .302, treatment difference 10.8% [95% CI,-12.6 to 34.2]). In the DRV/r arm, no patients developed VF and 15.0% discontinued treatment due to adverse events. In the LPV/r arm, 2 (6.1%) patients developed VF and 18.2% discontinued monotherapy due to adverse events. Gastrointestinal disturbances were experienced by 18.2% and 2.5% of patients in the LPV/r and DRV/r arms, respectively (p = .019). Two patients had detectable HIV-1 RNA ≥50 copies/mL in CSF or semen. Monotherapy with LPV/r or DRV/r seems to be virologically effective in selected HIV-1-infected patients with sustained viral suppression. Differences between both regimens seem driven mainly by the better tolerability profile of DRV/r.
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Affiliation(s)
- José R Santos
- 1 Lluita contra la SIDA Foundation, Hospital Universitari Germans Trias i Pujol , Badalona, Spain
- 2 Universitat Autònoma de Barcelona , Barcelona, Spain
| | - Josep M Llibre
- 1 Lluita contra la SIDA Foundation, Hospital Universitari Germans Trias i Pujol , Badalona, Spain
- 2 Universitat Autònoma de Barcelona , Barcelona, Spain
| | - Isabel Bravo
- 1 Lluita contra la SIDA Foundation, Hospital Universitari Germans Trias i Pujol , Badalona, Spain
| | - Dácil García-Rosado
- 3 Hospital Universitario de Canarias , San Cristóbal de la Laguna, Tenerife, Spain
| | | | - Nuria Pérez-Álvarez
- 1 Lluita contra la SIDA Foundation, Hospital Universitari Germans Trias i Pujol , Badalona, Spain
- 5 Universitat Politécnica de Catalunya , Barcelona, Spain
| | - Roger Paredes
- 1 Lluita contra la SIDA Foundation, Hospital Universitari Germans Trias i Pujol , Badalona, Spain
- 6 IrsiCaixa Foundation , Barcelona, Spain
- 7 Universitat de Vic-Universitat Central de Catalunya , Vic, Spain
| | - Bonaventura Clotet
- 1 Lluita contra la SIDA Foundation, Hospital Universitari Germans Trias i Pujol , Badalona, Spain
- 2 Universitat Autònoma de Barcelona , Barcelona, Spain
- 6 IrsiCaixa Foundation , Barcelona, Spain
- 7 Universitat de Vic-Universitat Central de Catalunya , Vic, Spain
| | - José Moltó
- 1 Lluita contra la SIDA Foundation, Hospital Universitari Germans Trias i Pujol , Badalona, Spain
- 2 Universitat Autònoma de Barcelona , Barcelona, Spain
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8
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Guardiola M, Echeverria P, González M, Vallvé JC, Puig J, Clotet B, Ribalta J, Negredo E. Polymorphisms in LPL, CETP, and HL protect HIV-infected patients from atherogenic dyslipidemia in an allele-dose-dependent manner. AIDS Res Hum Retroviruses 2015; 31:882-8. [PMID: 26101956 DOI: 10.1089/aid.2015.0061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
HIV-infected patients treated with highly active antiretroviral therapy (HAART) may be predisposed to a lipid profile, associated with increased cardiovascular risk, derived from having high triglycerides (TG) and low high-density lipoprotein cholesterol (HDLc) levels. We propose that genetic variability leaves some HIV-infected patients more predisposed to this lipid profile than others. We performed a cross-sectional, observational study including 321 antiretroviral-treated HIV-infected patients classified as normolipidemic (n=173) or presenting with high TG (≥1.7 mmol/liter) and low HDLc [<1.02 (men) or 1.28 mmol/liter (women)] (n=148) to investigate the impact of 13 polymorphisms of 9 genes affecting lipid metabolism (APOA5, APOC3, LPL, CETP, HL, MTP, APOE, LRP5, and VLDLR genes). The polymorphism rs328 in LPL was 40% significantly more frequent in normolipidemics (p=0.018), and in the same group, polymorphisms rs708272 in CETP and rs1800588 in HL were 10% significantly more frequent (p=0.037 for both polymorphisms). Patients who presented a combination of one to six alleles from these polymorphisms had 10% increased HDLc levels [1.13 (0.40) vs. 1.24 (0.23) mmol/liter, p=0.002] and a trend toward lower triglycerides [2.23 (2.34) vs. 1.89 (1.24) mmol/liter] and lower remnant-like particle cholesterol (RLPc) [16.41 (11.42) vs. 12.99 (11.69) mmol/liter]. This effect was dependent on the number of protective alleles and independent of the regimen administered. Polymorphisms in LPL, CETP, and HL protect HIV-infected patients from developing the dyslipidemia derived from high TG and low HDLc levels in a dose-dependent manner.
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Affiliation(s)
- Montse Guardiola
- Unitat de Recerca en Lípids i Arteriosclerosi, CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Reus, Spain
| | - Patricia Echeverria
- Fundació Lluita contra la Sida, Hospital Universitari Germans Trias i Pujol, Badalona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta González
- Unitat de Recerca en Lípids i Arteriosclerosi, CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Reus, Spain
| | - Joan C. Vallvé
- Unitat de Recerca en Lípids i Arteriosclerosi, CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Reus, Spain
| | - Jordi Puig
- Fundació Lluita contra la Sida, Hospital Universitari Germans Trias i Pujol, Badalona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Bonaventura Clotet
- Fundació Lluita contra la Sida, Hospital Universitari Germans Trias i Pujol, Badalona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Josep Ribalta
- Unitat de Recerca en Lípids i Arteriosclerosi, CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Reus, Spain
| | - Eugènia Negredo
- Fundació Lluita contra la Sida, Hospital Universitari Germans Trias i Pujol, Badalona, Universitat Autònoma de Barcelona, Barcelona, Spain
- Universitat de Vic-Universitat Central de Barcelona, Barcelona, Spain
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9
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Santos JR, Saumoy M, Curran A, Bravo I, Llibre JM, Navarro J, Estany C, Podzamczer D, Ribera E, Negredo E, Clotet B, Paredes R. The Lipid-Lowering Effect of Tenofovir/Emtricitabine: A Randomized, Crossover, Double-Blind, Placebo-Controlled Trial. Clin Infect Dis 2015; 61:403-8. [DOI: 10.1093/cid/civ296] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 04/04/2015] [Indexed: 11/13/2022] Open
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10
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Casado JL, Moreno S. [Potential role of rilpivirine in simplification regimens]. Enferm Infecc Microbiol Clin 2015; 31 Suppl 2:30-5. [PMID: 24252531 DOI: 10.1016/s0213-005x(13)70140-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Antiretroviral simplification is a useful strategy to improve adherence and quality of life and prevent or reverse adverse effects in patients with HIV infection. The availability of new drugs with high efficacy and better tolerability in once-daily formulations or in fixed-dose combinations may be a better option for prolonged treatment. Rilpivirine, a new nonnucleoside reverse transcriptase inhibitor (NNRTI), has shown high antiviral efficacy in clinical trials with treatment-naïve patients, with a lower incidence of adverse effects and good tolerability. Its use in simplification regimens has been evaluated after the switch from efavirenz, demonstrating that dose adjustment is not required. In a large randomized study in patients who were receiving protease inhibitors, virological efficacy was maintained, with a lower incidence of adverse effects and improved lipid parameters and cardiovascular risk score. Given the ease of administration and good tolerability of this drug, recent communications at congresses have shown the rapid applicability of the results of studies in daily clinical practice in this scenario.
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Affiliation(s)
- José L Casado
- Departamento de Enfermedades Infecciosas, Hospital Ramón y Cajal, Madrid, España.
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11
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Santos JR, Llibre JM, Berrio-Galan D, Bravo I, Miranda C, Pérez-Alvarez S, Pérez-Alvarez N, Paredes R, Clotet B, Moltó J. Monotherapy with boosted PIs as an ART simplification strategy in clinical practice. J Antimicrob Chemother 2014; 70:1124-9. [PMID: 25525196 DOI: 10.1093/jac/dku509] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Data on the efficacy of simplifying therapy using darunavir/ritonavir and lopinavir/ritonavir monotherapy in clinical practice remain limited. METHODS A retrospective single-centre study including patients initiating darunavir/ritonavir or lopinavir/ritonavir monotherapy with a plasma HIV-1 viral load (pVL) <50 copies/mL and at least one subsequent follow-up visit. The primary endpoint was the percentage of patients remaining free of virological failure (VF; defined as a confirmed pVL >50 copies/mL or as any change in the regimen after a single determination with a pVL >50 copies/mL) during the follow-up. We also evaluated the percentage of patients remaining free of treatment failure (TF; defined as VF or the early discontinuation of monotherapy for any reason) and compared the effectiveness of the two regimens. Effectiveness was evaluated using cumulative survival analysis (at Weeks 48 and 96). Factors associated with VF and TF were analysed using Cox regression. RESULTS A total of 522 patients were included (309 receiving lopinavir/ritonavir and 213 receiving darunavir/ritonavir). The median follow-up was 64.3 (30.5-143.0) weeks. The percentage of patients free of VF and TF was 94% (95% CI 91%-96%) and 79% (95% CI 75%-82%) at 48 weeks, respectively, and 86% (95% CI 81%-89%) and 62% (95% CI 57%-67%) at 96 weeks, respectively. The risk of VF was similar for the two regimens (HR=1.0, 95% CI 0.6-1.8; P=0.962). Lopinavir/ritonavir monotherapy was associated with a 1.5-fold greater risk of TF (95% CI 1.1-2.1; P=0.012) and a 2.3-fold greater risk of discontinuation of therapy due to adverse events (95% CI 1.3-3.9; P=0.003). CONCLUSIONS The virological efficacy of darunavir/ritonavir and lopinavir/ritonavir monotherapy is high in clinical practice. Treatment discontinuation due to safety issues is more frequent with lopinavir/ritonavir.
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Affiliation(s)
- José R Santos
- Lluita contra la SIDA Foundation, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Josep M Llibre
- Lluita contra la SIDA Foundation, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Isabel Bravo
- Lluita contra la SIDA Foundation, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Cristina Miranda
- Lluita contra la SIDA Foundation, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | | | - Nuria Pérez-Alvarez
- Lluita contra la SIDA Foundation, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain Universitat Politécnica de Catalunya, Barcelona, Spain
| | - Roger Paredes
- Lluita contra la SIDA Foundation, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain IrsiCaixa Foundation, Barcelona, Spain Universitat de Vic - Universitat Central de Catalunya, Vic, Spain
| | - Bonaventura Clotet
- Lluita contra la SIDA Foundation, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain Universitat Autònoma de Barcelona, Barcelona, Spain IrsiCaixa Foundation, Barcelona, Spain Universitat de Vic - Universitat Central de Catalunya, Vic, Spain
| | - José Moltó
- Lluita contra la SIDA Foundation, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain Universitat Autònoma de Barcelona, Barcelona, Spain
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12
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Echeverria P, Guardiola M, González M, Vallvé JC, Bonjoch A, Puig J, Clotet B, Ribalta J, Negredo E. Association between polymorphisms in genes involved in lipid metabolism and immunological status in chronically HIV-infected patients. Antiviral Res 2014; 114:48-52. [PMID: 25500319 DOI: 10.1016/j.antiviral.2014.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 11/24/2014] [Accepted: 12/01/2014] [Indexed: 12/15/2022]
Abstract
Several studies have reported associations between lipid parameters and clinical progression of HIV infection. We performed a cross-sectional study including 468 antiretroviral-treated HIV-infected patients to investigate the impact of 13 polymorphisms of 9 genes affecting lipid metabolism and CD4 and CD8-T cell levels. Polymorphisms were identified in genes selected for their role in the development of atherogenic dyslipidemia, defined as triglycerides ⩾1.7mmol/L and high-density lipoprotein cholesterol (HDLc) <1.02 in women or 1.28mmol/L in men. Lipid and lipoprotein parameters were determined in all participants, as well as CD4 and CD8 T-cell counts. ANOVA was performed to compare the mean values of lipid and CD4 and CD8 T-cell count data. A Bonferroni correction for multiple comparisons was applied. 468 patients were included, 148 of them had a diagnosis of atherogenic dyslipidemia. The polymorphism rs3135506 in APOA5 was associated with a 9% increase in triglycerides (p=0.002), 10% and 21% decrease in HDLc (p=0.005), and CD4 T-cell count (p=0.024), respectively. APOA5 rs662799, was associated with a 19% increase in CD8 T-cell count (p=0.002). Carriers of LPL rs328 in the dyslipidemic group presented 11% higher levels of HDLc (p=0.015) and 14% higher levels of CD4 cells (p=0.038). In conclusion, polymorphisms in genes associated to the development of atherogenic dyslipidemia, especially variants in APOA5 gene (rs3135506 and rs662799), can influence the circulating CD4 T-cell levels in chronically HIV-infected patients. These data support previous reports on the effect of lipid metabolism on immunologic parameters in HIV+ individuals on antiretroviral therapy.
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Affiliation(s)
- Patricia Echeverria
- Lluita contra la SIDA Foundation, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Catalonia, Spain.
| | - Montse Guardiola
- Unitat de Recerca en Lípids i Arteriosclerosi, CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Institut d' Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Reus, Spain
| | - Marta González
- Unitat de Recerca en Lípids i Arteriosclerosi, CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Institut d' Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Reus, Spain
| | - Joan Carles Vallvé
- Unitat de Recerca en Lípids i Arteriosclerosi, CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Institut d' Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Reus, Spain
| | - Anna Bonjoch
- Lluita contra la SIDA Foundation, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Catalonia, Spain
| | - Jordi Puig
- Lluita contra la SIDA Foundation, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Catalonia, Spain
| | - Bonaventura Clotet
- Lluita contra la SIDA Foundation, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Catalonia, Spain; AIDS Research Institute - IrsiCaixa, Hospital Universitari Germans Trias i Pujol, Catalonia, Spain; Universitat de VIC - Universitat Central de Catalunya, Catalonia, Spain
| | - Josep Ribalta
- Unitat de Recerca en Lípids i Arteriosclerosi, CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Institut d' Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Reus, Spain
| | - Eugènia Negredo
- Lluita contra la SIDA Foundation, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Catalonia, Spain; Universitat de VIC - Universitat Central de Catalunya, Catalonia, Spain
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13
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Ragland DA, Nalivaika EA, Nalam MNL, Prachanronarong KL, Cao H, Bandaranayake RM, Cai Y, Kurt-Yilmaz N, Schiffer CA. Drug resistance conferred by mutations outside the active site through alterations in the dynamic and structural ensemble of HIV-1 protease. J Am Chem Soc 2014; 136:11956-63. [PMID: 25091085 PMCID: PMC4151706 DOI: 10.1021/ja504096m] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
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HIV-1 protease inhibitors are part
of the highly active antiretroviral
therapy effectively used in the treatment of HIV infection and AIDS.
Darunavir (DRV) is the most potent of these inhibitors, soliciting
drug resistance only when a complex combination of mutations occur
both inside and outside the protease active site. With few exceptions,
the role of mutations outside the active site in conferring resistance
remains largely elusive. Through a series of DRV–protease complex
crystal structures, inhibition assays, and molecular dynamics simulations,
we find that single and double site mutations outside the active site
often associated with DRV resistance alter the structure and dynamic
ensemble of HIV-1 protease active site. These alterations correlate
with the observed inhibitor binding affinities for the mutants, and
suggest a network hypothesis on how the effect of
distal mutations are propagated to pivotal residues at the active
site and may contribute to conferring drug resistance.
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Affiliation(s)
- Debra A Ragland
- Department of Biochemistry and Molecular Pharmacology, University of Massachusetts Medical School , Worcester, Massachusetts 01605, United States
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15
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Yunihastuti E, Widhani A, Karjadi TH. Drug hypersensitivity in human immunodeficiency virus-infected patient: challenging diagnosis and management. Asia Pac Allergy 2014; 4:54-67. [PMID: 24527412 PMCID: PMC3921866 DOI: 10.5415/apallergy.2014.4.1.54] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 01/16/2013] [Indexed: 01/11/2023] Open
Abstract
Human immunodeficiency virus (HIV)-infected patients present complex immunological alterations. Multiple drugs that usually prescribed for prevention or treatment of opportunistic infections and antiretroviral pose these patients a higher risk of developing drug hypersensitivity. All antiretroviral agents and drugs to treat opportunistic infections have been reported to cause drug hypersensitivity reactions. Allergic reactions with antiretroviral are not restricted to older agents, although newer drugs usually more tolerated. Cutaneous adverse drug reactions are the most common manifestation of drug hypersensitivity in HIV, typically manifesting as maculopapular rash with or without systemic symptoms in the presence or absence of internal organ involvement. The onset of an allergic reaction is usually delayed. Severe drug hypersensitity reactions as erythema multiforme, Stevens Johnson syndrome and toxic epidermal necrolysis develop more often in HIV-infected patients compared to other populations. Mild to moderate rash without systemic symptom or organ involvement usually do not need drug discontinuation. Appropriate diagnosis and management of drug hypersensitivity reactions are essential, especially in patients with very low CD4+ T-cell count and multiple opportunistic infections. Clinicians should aware of different half-life of each drug when decided to stop the drug. Knowledge of the metabolism, recognition of the risk factors, and the ability to suggest the probability of particular drug as causative are also important points. A step wise rechallenge test or desensitization with the offending drug might be a preferable action and more commonly used in managing drug hypersensitivity in HIV-infected patients. Desensitization protocols have been successfully done for several antiretroviral and opportunistic infection drugs.
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Affiliation(s)
- Evy Yunihastuti
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Jakarta 10430, Indonesia. ; HIV Integrated Clinic Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia
| | - Alvina Widhani
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Jakarta 10430, Indonesia
| | - Teguh Harjono Karjadi
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Jakarta 10430, Indonesia. ; HIV Integrated Clinic Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia
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Curran A, Monteiro P, Domingo P, Villar J, Imaz A, Martinez E, Fernandez I, Knobel H, Podzamczer D, Iribarren JA, Penaranda M, Crespo M, Curran A, Ribera E, Navarro J, Crespo M, Monteiro P, Martinez E, Fernandez I, Domingo P, Villar J, Knobel H, Imaz A, Podzamczer D, Ibarguren M, Iribarren JA, Penaranda M, Riera M. Effectiveness of ritonavir-boosted protease inhibitor monotherapy in the clinical setting: same results as in clinical trials? The PIMOCS Study Group. J Antimicrob Chemother 2014; 69:1390-6. [DOI: 10.1093/jac/dkt517] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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17
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Stuurman FE, Nuijen B, Beijnen JH, Schellens JHM. Oral anticancer drugs: mechanisms of low bioavailability and strategies for improvement. Clin Pharmacokinet 2013; 52:399-414. [PMID: 23420518 DOI: 10.1007/s40262-013-0040-2] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The use of oral anticancer drugs has increased during the last decade, because of patient preference, lower costs, proven efficacy, lack of infusion-related inconveniences, and the opportunity to develop chronic treatment regimens. Oral administration of anticancer drugs is, however, often hampered by limited bioavailability of the drug, which is associated with a wide variability. Since most anticancer drugs have a narrow therapeutic window and are dosed at or close to the maximum tolerated dose, a wide variability in the bioavailability can have a negative impact on treatment outcome. This review discusses mechanisms of low bioavailability of oral anticancer drugs and strategies for improvement. The extent of oral bioavailability depends on many factors, including release of the drug from the pharmaceutical dosage form, a drug's stability in the gastrointestinal tract, factors affecting dissolution, the rate of passage through the gut wall, and the pre-systemic metabolism in the gut wall and liver. These factors are divided into pharmaceutical limitations, physiological endogenous limitations, and patient-specific limitations. There are several strategies to reduce or overcome these limitations. First, pharmaceutical adjustment of the formulation or the physicochemical characteristics of the drug can improve the dissolution rate and absorption. Second, pharmacological interventions by combining the drug with inhibitors of transporter proteins and/or pre-systemic metabolizing enzymes can overcome the physiological endogenous limitations. Third, chemical modification of a drug by synthesis of a derivative, salt form, or prodrug could enhance the bioavailability by improving the absorption and bypassing physiological endogenous limitations. Although the bioavailability can be enhanced by various strategies, the development of novel oral products with low solubility or cell membrane permeability remains cumbersome and is often unsuccessful. The main reasons are unacceptable variation in the bioavailability and high investment costs. Furthermore, novel oral anticancer drugs are frequently associated with toxic effects including unacceptable gastrointestinal adverse effects. Therefore, compliance is often suboptimal, which may negatively influence treatment outcome.
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Affiliation(s)
- Frederik E Stuurman
- Division of Clinical Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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18
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Pérez-Valero I, González-Baeza A, Estébanez M, Montes-Ramírez ML, Bayón C, Pulido F, Bernardino JI, Zamora FX, Monge S, Gaya F, Lagarde M, Rubio R, Hernando A, Arnalich F, Arribas JR. Neurocognitive impairment in patients treated with protease inhibitor monotherapy or triple drug antiretroviral therapy. PLoS One 2013; 8:e69493. [PMID: 23936029 PMCID: PMC3723908 DOI: 10.1371/journal.pone.0069493] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 06/10/2013] [Indexed: 01/23/2023] Open
Abstract
Background In patients who remain virologically suppressed in plasma with triple-drug ART a switch to protease inhibitor monotherapy maintains high rates of suppression; however it is unknown if protease inhibitor monotherapy is associated to a higher rate of neurocognitive impairment. Methods In this observational, cross-sectional study we included patients with plasma virological suppression (≥1 year) without concomitant major neurocognitive confounders, currently receiving for ≥1 year boosted lopinavir or darunavir as monotherapy or as triple ART. Neurocognitive impairment was defined as per the 2007 consensus of the American Association of Neurology. The association between neurocognitive impairment and protease inhibitor monotherapy, adjusted by significant confounders, was analysed. Results Of the 191 included patients - triple therapy: 96, 1–2 years of monotherapy: 40 and >2 years of monotherapy: 55 - proportions (95% CI) with neurocognitive impairment were: overall, 27.2% (20.9–33.6); triple therapy, 31.6% (22.1–41.0); short-term monotherapy, 25.0% (11.3–38.7); long-term monotherapy: 21.4% (10.5–32.3); p = 0.38. In all groups, neurocognitive impairment was mildly symptomatic or asymptomatic by self-report. There were not significant differences in Global Deficit Score by group. In the regression model confounding variables for neurocognitive impairment were years on ART, ethnicity, years of education, transmission category and the HOMA index. Adjusted by these variables the Odds Ratio (95% CI) for neurocognitive impairment of patients receiving short-term monotherapy was 0.85 (0.29–2.50) and for long-term monotherapy 0.40 (0.14–1.15). Conclusions Compared to triple drug antiretroviral therapy, monotherapy with lopinavir/ritonavir or darunavir/ritonavir in patients with adequate plasma suppression was not associated with a higher rate of asymptomatic neurocognitive impairment than triple drug ART.
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Affiliation(s)
- Ignacio Pérez-Valero
- HIV Unit-Internal Medicine Service, Hospital Universitario La Paz-IdiPAZ, Madrid, Madrid, Spain
- * E-mail:
| | - Alicia González-Baeza
- HIV Unit-Internal Medicine Service, Hospital Universitario La Paz-IdiPAZ, Madrid, Madrid, Spain
| | - Miriam Estébanez
- HIV Unit-Internal Medicine Service, Hospital Universitario La Paz-IdiPAZ, Madrid, Madrid, Spain
| | - María L. Montes-Ramírez
- HIV Unit-Internal Medicine Service, Hospital Universitario La Paz-IdiPAZ, Madrid, Madrid, Spain
| | - Carmen Bayón
- Psychiatry Service, Hospital Universitario La Paz-IdiPAZ, Madrid, Madrid, Spain
| | - Federico Pulido
- HIV Unit-Internal Medicine Service, Hospital Universitario 12 de Octubre-i+12, Madrid, Madrid, Spain
| | - José I. Bernardino
- HIV Unit-Internal Medicine Service, Hospital Universitario La Paz-IdiPAZ, Madrid, Madrid, Spain
| | - Francisco X. Zamora
- HIV Unit-Internal Medicine Service, Hospital Universitario La Paz-IdiPAZ, Madrid, Madrid, Spain
| | - Susana Monge
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Madrid, Spain
| | - Francisco Gaya
- HIV Unit-Internal Medicine Service, Hospital Universitario La Paz-IdiPAZ, Madrid, Madrid, Spain
| | - María Lagarde
- HIV Unit-Internal Medicine Service, Hospital Universitario 12 de Octubre-i+12, Madrid, Madrid, Spain
| | - Rafael Rubio
- HIV Unit-Internal Medicine Service, Hospital Universitario 12 de Octubre-i+12, Madrid, Madrid, Spain
| | - Asunción Hernando
- Departamento de Especialidades Médicas, Universidad Europea de Madrid, Madrid, Madrid, Spain
| | - Francisco Arnalich
- HIV Unit-Internal Medicine Service, Hospital Universitario La Paz-IdiPAZ, Madrid, Madrid, Spain
| | - José R. Arribas
- HIV Unit-Internal Medicine Service, Hospital Universitario La Paz-IdiPAZ, Madrid, Madrid, Spain
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Sarmati L, Parisi SG, Montano M, Andreis S, Scaggiante R, Galgani A, Viscione M, Maffongelli G, Ricciardi A, Andreoni C, Boros S, Palu G, Andreoni M. Nevirapine use, prolonged antiretroviral therapy and high CD4 nadir values are strongly correlated with undetectable HIV-DNA and -RNA levels and CD4 cell gain. J Antimicrob Chemother 2012; 67:2932-8. [DOI: 10.1093/jac/dks331] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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