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Virological response and resistance profile in HIV‐1‐infected patients starting darunavir‐containing regimens
Author(s) -
Armenia D,
Di Carlo D,
Maffongelli G,
Borghi V,
Alteri C,
Forbici F,
Bertoli A,
Gori C,
Giuliani M,
Nicastri E,
Zaccarelli M,
Pinnetti C,
Cicalini S,
D'Offizi G,
CeccheriniSilberstein F,
Mussini C,
Antinori A,
Andreoni M,
Perno CF,
Santoro MM
Publication year - 2017
Publication title -
hiv medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.53
H-Index - 79
eISSN - 1468-1293
pISSN - 1464-2662
DOI - 10.1111/hiv.12388
Subject(s) - darunavir , interquartile range , medicine , ritonavir , regimen , gastroenterology , viral load , human immunodeficiency virus (hiv) , drug resistance , antiretroviral therapy , immunology , microbiology and biotechnology , biology
Objectives We evaluated the virological response in patients starting a regimen based on darunavir/ritonavir ( DRV /r), which is currently the most widely used ritonavir‐boosted protease inhibitor. Methods Data from 206 drug‐naïve and 327 PI ‐experienced patients starting DRV /r 600/100 mg twice daily ( DRV 600) or 800/100 mg once daily ( DRV 800) were examined. The probabilities of virological success ( VS ) and virological rebound ( VR ) were evaluated in survival analyses. Baseline DRV /r resistance and its evolution at failure were also examined. Results DRV 600 was preferentially administered in patients with complex requirements (older age, higher viraemia, lower CD 4 cell count and DRV / PI resistance) compared with DRV 800. By 12 months, the probability of achieving VS was 93.2% and 84.3% in drug‐naïve and PI ‐experienced patients, respectively. The higher the baseline viraemia, the longer was the time required to achieve VS , both in drug‐naïve patients [>500 000 HIV ‐1 RNA copies/ mL : median [interquartile range ( IQR )] 6.1 (5.1–10.3) months; 100 000–500 000 copies/ mL : median ( IQR ) 4.9 (3.8–6.1) months; <100 000 copies/ mL : median ( IQR ) 3.9 (3.5–4.8) months; P < 0.001] and in PI ‐experienced patients [≥100 000 copies/ mL : median ( IQR ) 7.2 (5.7–11.6) months; <100 000 copies/ mL : median ( IQR ) 2.8 (2.4–3.3) months; P < 0.001]. In PI ‐experienced patients, the probability of VR was higher for higher viraemia levels (22.3% for ≥100 000 copies/ml vs . 9.7% for <100 000 copies/mL; P = 0.007). Baseline resistance did not affect the virological response. At failure, a high percentage of patients maintained virus susceptible to all PI s (drug‐naïve: 95%; PI ‐experienced: 80%). Despite being used more often in patients with more complex requirements, DRV 600 performed as well as DRV800. Conclusions In clinical practice, use of DRV /r (with its flexible dosage) results in high rates of virological response. These data support the use of PI /r in patients whose characteristics require potent drugs with a high genetic barrier.