OBJECTIVES: We aimed to determine the effectiveness of boosted protease inhibitor monotherapy (BPIMT) initiated as a maintenance strategy in routine care and identify predictive factors of failure. DESIGN: Observational study in the FHDH-ANRS CO4 cohort. METHODS: Five hundred and twenty-nine virologically suppressed individuals switched to BPIMT in the period 2006-2010, 75% had at least 12 and 49% at least 24 months of follow-up. Virological failure (two consecutive HIV-RNA > 50 copies/ml or one HIV-RNA > 50 copies/ml followed by BPIMT discontinuation) and treatment failure (virological failure, antiretroviral reintensification or death) were analysed separately. RESULTS: At baseline, 11% were protease inhibitor-naive, median duration on combined antiretroviral therapy was 84 months and median duration of suppressed viremia was 38 months. Nine percent had a history of virological failure, while on a protease inhibitor-containing regimen, and rates of virological failure were higher among those individuals [adjusted hazard ratio, 1.6; 95% confidence interval (CI), 0.9-2.9]. Compared to individuals with less than 1 year of sustained virological suppression before the switch to BPIMT, those with longer duration were less likely to experience virological failure [hazard ratio, 0.7; (95% CI, 0.4-1.2) and 0.6 (95%CI, 0.4-0.9)] for a duration of 12-23 months and 24 months or more, respectively. Rates of failure were similar for BPIMT with lopinavir-ritonavir (RTV) or darunavir-RTV, but increased for BPIMT with atazanavir-RTV. Same risk factors were associated with treatment failure. CONCLUSION: The safety and efficacy of a maintenance strategy with BPIMT in a routine care setting matched the results of randomized clinical trials. A longer duration since last virological rebound before switching to BPIMT was associated with a decreased risk of subsequent failure.
OBJECTIVES: We aimed to determine the effectiveness of boosted protease inhibitor monotherapy (BPIMT) initiated as a maintenance strategy in routine care and identify predictive factors of failure. DESIGN: Observational study in the FHDH-ANRS CO4 cohort. METHODS: Five hundred and twenty-nine virologically suppressed individuals switched to BPIMT in the period 2006-2010, 75% had at least 12 and 49% at least 24 months of follow-up. Virological failure (two consecutive HIV-RNA > 50 copies/ml or one HIV-RNA > 50 copies/ml followed by BPIMT discontinuation) and treatment failure (virological failure, antiretroviral reintensification or death) were analysed separately. RESULTS: At baseline, 11% were protease inhibitor-naive, median duration on combined antiretroviral therapy was 84 months and median duration of suppressed viremia was 38 months. Nine percent had a history of virological failure, while on a protease inhibitor-containing regimen, and rates of virological failure were higher among those individuals [adjusted hazard ratio, 1.6; 95% confidence interval (CI), 0.9-2.9]. Compared to individuals with less than 1 year of sustained virological suppression before the switch to BPIMT, those with longer duration were less likely to experience virological failure [hazard ratio, 0.7; (95% CI, 0.4-1.2) and 0.6 (95%CI, 0.4-0.9)] for a duration of 12-23 months and 24 months or more, respectively. Rates of failure were similar for BPIMT with lopinavir-ritonavir (RTV) or darunavir-RTV, but increased for BPIMT with atazanavir-RTV. Same risk factors were associated with treatment failure. CONCLUSION: The safety and efficacy of a maintenance strategy with BPIMT in a routine care setting matched the results of randomized clinical trials. A longer duration since last virological rebound before switching to BPIMT was associated with a decreased risk of subsequent failure.
Authors: Soo-Yon Rhee; Michael R Jordan; Elliot Raizes; Arlene Chua; Neil Parkin; Rami Kantor; Gert U Van Zyl; Irene Mukui; Mina C Hosseinipour; Lisa M Frenkel; Nicaise Ndembi; Raph L Hamers; Tobias F Rinke de Wit; Carole L Wallis; Ravindra K Gupta; Joseph Fokam; Clement Zeh; Jonathan M Schapiro; Sergio Carmona; David Katzenstein; Michele Tang; Avelin F Aghokeng; Tulio De Oliveira; Annemarie M J Wensing; Joel E Gallant; Mark A Wainberg; Douglas D Richman; Joseph E Fitzgibbon; Marco Schito; Silvia Bertagnolio; Chunfu Yang; Robert W Shafer Journal: PLoS One Date: 2015-12-30 Impact factor: 3.240
Authors: Kate El Bouzidi; Dami Collier; Eleni Nastouli; Andrew J Copas; Robert F Miller; Ravindra K Gupta Journal: J Antimicrob Chemother Date: 2016-07-07 Impact factor: 5.790