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Pellegrin I, Wittkop L, Joubert LM, Neau D, Bollens D, Bonarek M, Girard PM, Fleury H, Winters B, Saux MC, Pellegrin JL, Thiébaut R, Breilh D. Virological Response to Darunavir/Ritonavir-Based Regimens in Antiretroviral-Experienced Patients (PREDIZISTA Study). Antivir Ther 2008. [DOI: 10.1177/135965350801300214] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background We assessed the association of baseline HIV-1 mutations, phenotypic sensitivity and pharmacokinetics with virological failure (VF) at week 12 (W12) after onset of a darunavir/ritonavir (DRV/r)-based regimen in a cohort of 67 antiretroviral-experienced HIV-patients failing on highly active antiretroviral therapy (HAART). Methods VF was defined as HIV RNA >2.3 log10copies/ml at W12. HIV reverse transcriptase and protease sequencing was performed at W0; mutations with a P-value <0.25 in univariable analyses were used for a backward selection to find the best mutation set for VF prediction. Genotypic and phenotypic sensitivity scores were calculated and virtual phenotype predicted fold change (FC) assessed. DRV Cmin, Cmax, AUC0→12 h and genotypic inhibitory quotient (GIQ) were determined. Results Patients had a median of 15 previous treatments for 10 years. Median W0 values included a T-cell count of 129 cells/μl, 4.7 log10 HIV RNA copies/ml, four major protease and six nucleoside reverse transcriptase inhibitor resistance mutations. At W12, median HIV RNA decrease was -2.1 log10 copies/ml with a gain of +67 CD4+ T-cells/μl; 40% of patients failed. We determined the genotypic score I13V+V32I+L33F/I/V+E35D+ M36I/L/V+I47V+F53L+I62V According to <4, 4–5 and >5 mutations, failure occurred in 11%, 48% and 100% of patients. Failure was associated with CDC stage, baseline CD4+ T-cell count, number of major protease inhibitor resistance mutations, FC and DRV/r score. Pharmacokinetics were not associated with failure, but GIQ was. Conclusion At W12, 60% of heavily pretreated patients responded on DRV/r-based HAART. Genotypic and phenotypic information constituted the main virological response determinant in patients with optimal drug concentrations.
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Affiliation(s)
| | | | - Linda Wittkop
- INSERM U875 (Biostatistics) and U593, Bordeaux, France
| | | | - Didier Neau
- Internal Medicine and Infectious Diseases Departments, Bordeaux University Hospital, Bordeaux, France
| | - Diane Bollens
- Department of Virology, Hopital Saint-Antoine, Paris, France
| | - Mojgan Bonarek
- Internal Medicine and Infectious Diseases Departments, Bordeaux University Hospital, Bordeaux, France
| | | | - Hervé Fleury
- Department of Virology, Bordeaux University Hospital, Bordeaux, France
| | | | - Marie-Claude Saux
- Clinical Pharmacokinetics and Pharmacy Department, Bordeaux University Hospital, Bordeaux, France
| | - Jean-Luc Pellegrin
- Internal Medicine and Infectious Diseases Departments, Bordeaux University Hospital, Bordeaux, France
| | | | - Dominique Breilh
- Clinical Pharmacokinetics and Pharmacy Department, Bordeaux University Hospital, Bordeaux, France
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