BACKGROUND: Clinical use of protease inhibitors (PIs) and nucleoside reverse transcriptase inhibitors (NRTIs) may be hampered by toxicity, interactions or resistance issues. Simple and effective antiretroviral regimens avoiding both drug classes may be needed for selected patients. METHODS: This was a prospective cohort study. Virologically suppressed patients on PI or NRTI regimens, with problems of tolerability, safety concerns due to comorbidities or risk of drug interactions for both PIs and NRTIs, were given the opportunity to switch their regimen to etravirine plus raltegravir. Patients were required not to have prior virological failure to raltegravir and if there was prior non-nucleoside reverse transcriptase inhibitor (NNRTI) virological failure, only patients in whom efficacy of etravirine could be anticipated through the Stanford Drug Resistance Database were included. Follow-up was scheduled for at least 48 weeks, unless the patient was lost to follow-up or discontinued therapy. RESULTS: Twenty-five patients were included. Their median age was 54 years; they had a median of 16 years on antiretroviral therapy and a median of nine previous regimens; 21 (84%) patients had previous virological failure; and 15 (60%) patients had a genotypic test that showed three or more NRTI mutations in 9 (36%), four or more PI mutations in 11 (44%) and at least one NNRTI mutation in 8 (32%) patients. At 48 weeks efficacy was 84% (95% CI 65.3%-93.6%) by intent-to-treat analysis and 91.3% (95% CI 73.2%-97.6%) by per-protocol analysis. One (4%) patient died, two (8%) discontinued due to intolerance and one (4%) experienced virological failure. The CD4/CD8 ratio and plasma lipids improved. CONCLUSIONS: Dual therapy with etravirine plus raltegravir was well tolerated and maintained durable viral suppression in selected virologically suppressed patients for whom both PI and NRTI therapy was challenging.
BACKGROUND: Clinical use of protease inhibitors (PIs) and nucleoside reverse transcriptase inhibitors (NRTIs) may be hampered by toxicity, interactions or resistance issues. Simple and effective antiretroviral regimens avoiding both drug classes may be needed for selected patients. METHODS: This was a prospective cohort study. Virologically suppressed patients on PI or NRTI regimens, with problems of tolerability, safety concerns due to comorbidities or risk of drug interactions for both PIs and NRTIs, were given the opportunity to switch their regimen to etravirine plus raltegravir. Patients were required not to have prior virological failure to raltegravir and if there was prior non-nucleoside reverse transcriptase inhibitor (NNRTI) virological failure, only patients in whom efficacy of etravirine could be anticipated through the Stanford Drug Resistance Database were included. Follow-up was scheduled for at least 48 weeks, unless the patient was lost to follow-up or discontinued therapy. RESULTS: Twenty-five patients were included. Their median age was 54 years; they had a median of 16 years on antiretroviral therapy and a median of nine previous regimens; 21 (84%) patients had previous virological failure; and 15 (60%) patients had a genotypic test that showed three or more NRTI mutations in 9 (36%), four or more PI mutations in 11 (44%) and at least one NNRTI mutation in 8 (32%) patients. At 48 weeks efficacy was 84% (95% CI 65.3%-93.6%) by intent-to-treat analysis and 91.3% (95% CI 73.2%-97.6%) by per-protocol analysis. One (4%) patient died, two (8%) discontinued due to intolerance and one (4%) experienced virological failure. The CD4/CD8 ratio and plasma lipids improved. CONCLUSIONS: Dual therapy with etravirine plus raltegravir was well tolerated and maintained durable viral suppression in selected virologically suppressed patients for whom both PI and NRTI therapy was challenging.
Authors: Michelle A Floris-Moore; Katie Mollan; Aimee M Wilkin; Marc A Johnson; Angela Dm Kashuba; David A Wohl; Kristine B Patterson; Owen Francis; Catherine Kronk; Joseph J Eron Journal: Antivir Ther Date: 2015-08-11
Authors: Sabina Herrera; Borja M Fernandez-Felix; Peter W Hunt; Steven G Deeks; Talía Sainz; Sonya L Heath; Chad J Achenbach; Benigno Rodríguez; Christopher Mathews; Katerina Christopoulos; Kenneth Mayer; Sonia Napravnik; Santiago Moreno; Sergio Serrano-Villar Journal: J Antimicrob Chemother Date: 2020-06-01 Impact factor: 5.790
Authors: F De Salvador-Guillouët; C Sakarovitch; J Durant; K Risso; E Demonchy; P M Roger; E Fontas Journal: PLoS One Date: 2015-10-20 Impact factor: 3.240
Authors: Amit C Achhra; Mark A Boyd; Matthew G Law; Gail V Matthews; Anthony D Kelleher; David A Cooper Journal: PLoS One Date: 2014-06-26 Impact factor: 3.240
Authors: Jan van Lunzen; Anton Pozniak; Jose M Gatell; Andrea Antinori; Isabelle Klauck; Oscar Serrano; Adyb Baakili; Olayemi Osiyemi; Heather Sevinsky; Pierre-Marie Girard Journal: J Acquir Immune Defic Syndr Date: 2016-04-15 Impact factor: 3.731