Virological efficacy of PI monotherapy for HIV-1 in clinical practice

October 23, 2016 at 6:25 pm

Antimicrob. Chemother. November 2016 V.71 N.11 P. 3228-3234

Kate El Bouzidi, Dami Collier, Eleni Nastouli, Andrew J. Copas, Robert F. Miller, and Ravindra K. Gupta

1Research Department of Infection, Division of Infection and Immunity, University College London, London, UK

2Research Department of Infection and Population Health, University College London, London, UK

3Department of Clinical Virology, University College London Hospitals NHS Trust, London, UK

4NIHR University College London Hospitals Biomedical Research Centre, London, UK

5Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK

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.

PDF

http://jac.oxfordjournals.org/content/71/11/3228.full.pdf+html

 

Entry filed under: Antirretrovirales, HIV/SIDA, HIV/SIDA HAART, Metodos diagnosticos, REPORTS, Update. Tags: .

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