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Lackey P, Mills A, Carpio F, Hsu R, DeJesus E, Pierone G, Henegar C, Fusco J, Fusco G, Wohlfeiler M. Virologic Effectiveness of Abacavir/Lamivudine with Darunavir/Ritonavir Versus Other Protease Inhibitors in Treatment-Experienced HIV-Infected Patients in Clinical Practice. Clin Drug Investig 2017; 37:51-60. [PMID: 27587070 PMCID: PMC5209413 DOI: 10.1007/s40261-016-0456-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background and Objectives The standard of care for HIV treatment is a three-drug regimen consisting of two nucleoside reverse transcriptase inhibitors (NRTIs) and either a non-nucleoside reverse transcriptase inhibitor, a protease inhibitor (PI) or an integrase strand transfer inhibitor. Darunavir boosted with ritonavir (DRV/r) is the only preferred PI in the US Department of Health and Human Services (DHHS) HIV treatment guidelines for antiretroviral-naïve patients, recommended in combination with tenofovir/emtricitabine for antiretroviral-naïve patients. For treatment-experienced and certain antiretroviral-naïve patients, abacavir and lamivudine (ABC/3TC) in combination with DRV/r is considered an effective and tolerable alternative, despite limited research on the effectiveness of this particular combination. This study evaluated virologic outcomes in treatment-experienced patients taking ABC/3TC + DRV/r compared to treatment-experienced patients taking ABC/3TC with any other PI. Methods Treatment-experienced HIV-infected patients initiating their first regimen containing ABC/3TC in combination with any PI in the year 2005 or later were selected from the Observational Pharmaco-Epidemiology Research and Analysis (OPERA®) cohort, a prospective observational cohort reflecting routine medical care. Viral load measurements taken during follow-up were compared between patients taking ABC/3TC + DRV/r and ABC/3TC with a PI other than DRV/r. Logistic regression models were fit to assess the association between regimen exposure and viral load suppression. Results A total of 151 patients initiating ABC/3TC + DRV/r and 525 patients initiating ABC/3TC + a non-darunavir PI were included. Patients in both treatment groups had comparable clinical indicators (viral load, CD4) at baseline. A regimen of ABC/3TC + DRV/r was more likely to be prescribed in the later years of the study period, leading to a shorter median follow-up in the DRV/r treatment group (as-treated analysis: 14 vs. 17 months, p = 0.04; intent-to-treat analysis: 33 vs. 68 months, p < 0.001). Multivariable logistic regression models accounting for year of regimen initiation, among other factors, indicated no statistically significant differences in achieving an undetectable viral load for patients taking DRV/r with ABC/3TC compared with other PIs, both in the as-treated (odds ratio [95 % confidence interval]: 0.84 [0.53–1.34]) and intent-to-treat analyses (0.82 [0.48–1.40]). Patients in both treatment groups also showed similar reductions in viral load (median darunavir vs. non-darunavir: −23.0 vs. −23.0 copies/mL; p = 0.72) and gains in CD4 T cell counts (median darunavir vs. non-darunavir: 106 vs. 108 cells/mm3; p = 0.59] while being treated with the regimen of interest. Conclusions Patients receiving ABC/3TC + DRV/r appear to experience similar treatment benefit to patients taking ABC/3TC with other PIs in terms of achieving suppression, as well as absolute reductions in viral load and CD4 lymphocyte gains.
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Affiliation(s)
- Philip Lackey
- Carolinas Healthcare System, Charlotte, NC, USA.,OPERA Clinical and Epidemiological Advisory Board, Epividian Inc., Durham, NC, USA
| | - Anthony Mills
- OPERA Clinical and Epidemiological Advisory Board, Epividian Inc., Durham, NC, USA.,Anthony Mills MD, Inc., Los Angeles, CA, USA
| | - Felix Carpio
- OPERA Clinical and Epidemiological Advisory Board, Epividian Inc., Durham, NC, USA.,Altamed Health Services, Los Angeles, CA, USA
| | | | - Edwin DeJesus
- OPERA Clinical and Epidemiological Advisory Board, Epividian Inc., Durham, NC, USA.,Orlando Immunology Center, Orlando, FL, USA
| | - Gerald Pierone
- OPERA Clinical and Epidemiological Advisory Board, Epividian Inc., Durham, NC, USA.,AIDS Research and Treatment Center of the Treasure Coast, Vero Beach, FL, USA
| | - Cassidy Henegar
- OPERA Database, Epividian, Inc., 4819 Emperor Blvd., Suite 400, Durham, NC, 27703, USA.
| | - Jennifer Fusco
- OPERA Clinical and Epidemiological Advisory Board, Epividian Inc., Durham, NC, USA.,OPERA Database, Epividian, Inc., 4819 Emperor Blvd., Suite 400, Durham, NC, 27703, USA
| | - Gregory Fusco
- OPERA Clinical and Epidemiological Advisory Board, Epividian Inc., Durham, NC, USA
| | - Mike Wohlfeiler
- OPERA Clinical and Epidemiological Advisory Board, Epividian Inc., Durham, NC, USA.,AIDS Healthcare Foundation, Los Angeles, CA, USA
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Antinori A, Meraviglia P, Monforte AD, Castagna A, Mussini C, Bini T, Gianotti N, Rusconi S, Colella E, Airoldi G, Mancusi D, Termini R. Effectiveness, durability, and safety of darunavir/ritonavir in HIV-1-infected patients in routine clinical practice in Italy: a postauthorization noninterventional study. DRUG DESIGN DEVELOPMENT AND THERAPY 2016; 10:1589-603. [PMID: 27226708 PMCID: PMC4866750 DOI: 10.2147/dddt.s104875] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Current antiretroviral (ARV) therapy for the treatment of human immunodeficiency virus (HIV-1)-infected patients provides long-term control of viral load (VL). Darunavir (DRV) is a nonpeptidomimetic protease inhibitor approved for use with a ritonavir booster (DRV/r). This study evaluated the effectiveness of DRV/r in combination with other ARV agents in routine clinical practice in Italy. In this descriptive observational study, data on utilization of DRV/r, under the conditions described in the marketing authorization, were collected from June 2009 to December 2012. Effectiveness (VL <50 copies/mL), tolerability, and durability in four patient groups (two DRV/r-experienced, one ARV-experienced DRV/r-naïve, and one ARV-naïve) were analyzed. Secondary objectives included immunological response, safety, and persistence/discontinuation rates. In total, 875 of 883 enrolled patients were included in the analysis: of these, 662 (75.7%) completed the follow-up until the end of 2012 and 213 (24.3%) withdrew from the study earlier. Initial DRV dose was 600 mg twice daily (67.1%) or 800 mg once daily (32.9%). Only 16 patients (1.8%) withdrew from the study due to virological failure. Virological response proportions were higher in patients virologically suppressed at study entry versus patients with baseline VL ≥50 copies/mL in each ARV-experienced group, while there was no consistent difference across study groups and baseline VL strata according to baseline CD4+ cell count. CD4+ cell count increased from study entry to last study visit in all the four groups. DRV/r was well tolerated, with few discontinuations due to study-emergent nonfatal adverse events (3.0% overall, including 2.1% drug-related) or deaths (3.0% overall, all non-drug-related); 35.3% of patients reported ≥1 adverse events. These observational data show that DRV/r was effective and well tolerated in the whole patient population described here. The DRV/r-containing regimen provided viral suppression in a high percentage of patients in all groups, with low rates of discontinuation due to virological failure.
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Affiliation(s)
- Andrea Antinori
- Clinical Department, National Institute for Infectious Diseases "L. Spallanzani", Rome, Italy
| | - Paola Meraviglia
- Department of Infectious Disease, "L. Sacco" University Hospital, Milan, Italy
| | - Antonella d'Arminio Monforte
- Department of Health Sciences - University of Milan, Milan, Italy; Clinic of Infectious Diseases, "San Paolo" Hospital, Milan, Italy
| | - Antonella Castagna
- Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy
| | - Cristina Mussini
- Institute of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Teresa Bini
- Clinic of Infectious Diseases, "San Paolo" Hospital, Milan, Italy
| | - Nicola Gianotti
- Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy
| | - Stefano Rusconi
- Infectious Diseases Unit, DIBIC Luigi Sacco, University of Milan, Cicogna, Ghirri, Italy
| | - Elisa Colella
- Infectious Diseases Unit, DIBIC Luigi Sacco, University of Milan, Cicogna, Ghirri, Italy
| | | | - Daniela Mancusi
- Janssen-Cilag SpA, Medical Affairs, Cologno Monzese, Milan, Italy
| | - Roberta Termini
- Janssen-Cilag SpA, Medical Affairs, Cologno Monzese, Milan, Italy
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Chordia P, Dewdney TG, Keusch B, Kuiper BD, Ross K, Kovari IA, MacArthur R, Salimnia H, Kovari LC. The role of mutations at codons 32, 47, 54, and 90 in HIV-1 protease flap dynamics. Discoveries (Craiova) 2014; 2:e27. [PMID: 32309558 PMCID: PMC6941557 DOI: 10.15190/d.2014.19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Treatment of Human Immunodeficiency Virus remains challenging due to the emergence of drug resistant strains under the selective pressure produced by standard anti-retroviral therapy. To explore the structural mechanisms of drug resistance, we performed 40 ns molecular dynamics simulations on three multi-drug resistant HIV-1 protease clinical isolates from patients attending an infectious diseases clinic in Detroit, MI. We identify a novel structural role for the I47V, V32I, I54M and L90M major resistance mutations in flap opening and closure of MDR-PR isolates. Our studies suggest I47V is involved in flap opening and the interaction between I47V and V32I tethers the flaps to the active site. Also, I54M and L90M may be responsible for asymmetric movement of the protease flaps. These findings can be utilized to improve drug design strategies against MDR HIV-1 PR variants.
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Affiliation(s)
- Poorvi Chordia
- Department of Biochemistry and Molecular Biology, Wayne State University School of Medicine, Detroit, Michigan, USA.,Department of Infectious Diseases, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Tamaria G Dewdney
- Department of Biochemistry and Molecular Biology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Bradley Keusch
- Department of Biochemistry and Molecular Biology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Benjamin D Kuiper
- Department of Biochemistry and Molecular Biology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Kyla Ross
- Department of Biochemistry and Molecular Biology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Iulia A Kovari
- Department of Biochemistry and Molecular Biology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Rodger MacArthur
- Department of Infectious Diseases, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Hossein Salimnia
- Department of Pathology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Ladislau C Kovari
- Department of Biochemistry and Molecular Biology, Wayne State University School of Medicine, Detroit, Michigan, USA
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Di Biagio A, Nicolini LA, Lorenzini P, Puoti M, Antinori A, Cozzi-Lepri A, Gori A, Vecchiet J, Mussini C, Andreoni M, Viscoli C, d'Arminio Monforte A, For The Icona Foundation Study Group. Liver enzyme elevation during darunavir-based antiretroviral treatment in HIV-1-infected patients with or without hepatitis C coinfection: data from the ICONA foundation cohort. HIV CLINICAL TRIALS 2014; 15:151-60. [PMID: 25143024 DOI: 10.1310/hct1504-151] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To investigate differences in liver enzyme elevation (LEE) between HIV-infected patients with and without HCV coinfection who start a darunavir/ritonavir-containing regimen. METHODS HIV-infected patients enrolled in the Italian Cohort of Naïve to Antiretrovirals (ICONA) Foundation Study were included if they started darunavir/ritonavir for the first time. Patients were classified as not HCV coinfected, HCV active coinfected (HCV RNA positive), and HCV nonactive coinfected (HCV-Ab positive/HCV RNA negative). Time to LEE endpoint was defined using the ACTG toxicity scale, based on changes relative to baseline. Kaplan-Meier was used to estimate 1-year and 2-year probability of LEE. The incidence rate ratios (IRRs) of LEEs were estimated until the last follow-up (intention-to-treat analysis [ITT]) and up to darunavir/ritonavir discontinuation (on-treatment analysis [OT]). RESULTS Overall, 703 patients were included. Ninety-one were HCV-Ab positive; of those, 68 (9.7%) had active HCV coinfection. In 879 person-years of follow-up, 101 LEEs occurred (ITT). No severe hepatotoxicity event was registered in active HCV coinfected patients. HCV active coinfection was predictive of LEE in the overall population (OT: adjusted incidence rate ratio (IRR), 2.25; 95% CI, 0.70-7.24; P = .17; ITT: adjusted IRR, 3.62; 95% CI, 1.67-7.83; P < .001) and in naïve patients (OT: adjusted IRR, 6.29; 95% CI, 2.54-15.55; P = .00; ITT: adjusted IRR, 3.87; 95% CI, 0.99-15.16; P = .05). CONCLUSIONS No grade 3-4 LEEs occurred in HCV active coinfected patients. HCV active coinfected patients experienced low grade LEEs more frequently than HCV-Ab negative patients. Darunavir/ritonavir seems to be safe whatever the HCV status, when liver enzymes are carefully monitored.
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Affiliation(s)
- Antonio Di Biagio
- Clinica Malattie Infettive, IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genova, Italy
| | - Laura Ambra Nicolini
- Clinica Malattie Infettive, IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genova, Italy
| | | | - Massimo Puoti
- Malattie Infettive Azienda Ospedaliera Niguarda Ca' Grande, Milano, Italy
| | | | | | - Andrea Gori
- Malattie Infettive Azienda Ospedaliera Universitaria San Gerardo, Monza, Italy
| | - Jacopo Vecchiet
- Clinica Malattie Infettive Università di Chieti, Chieti, Italy
| | | | - Massimo Andreoni
- Clinica Malattie Infettive Università di Tor Vergata, Roma, Italy
| | - Claudio Viscoli
- Clinica Malattie Infettive, IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genova, Italy
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