Open AccessSwitching to darunavir/ritonavir monotherapy (DRV/r mx): effect on kidney function and lipid profile
Author(s) -
MartinezColubi M,
Pérez Elías M,
Sanz J,
Gomez C,
Estrada V,
Sepúlveda M,
Moreno A,
Muriel A,
Carranza M,
De Palacio M,
Dronda F,
GómezAyerbe C,
Casado J,
Moreno S
Publication year - 2012
Publication title -
journal of the international aids society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.724
H-Index - 62
ISSN - 1758-2652
DOI - 10.7448/ias.15.6.18348
Subject(s) - darunavir , medicine , renal function , ritonavir , regimen , gastroenterology , creatinine , urology , human immunodeficiency virus (hiv) , viral load , antiretroviral therapy , immunology
Purpose of the study DRV/r mx is proposed as a therapeutic option for patients with NNRTI toxicity. We aimed to evaluate the impact of switching to DRV/r mx in kidney function and lipid profile. Methods From March 2009 to June 2012 we conducted an observational, retrospective multicenter study evaluating patients switching to DRV/r mx. Kidney function and lipid levels were measured at baseline and at 48 weeks of DRV/r mx. Renal function was estimated by MDRD GFR. Comparative analyzes were performed using Student's t test for paired samples. Summary of results We identified 147 patients: women 30.6%, age 49±7yr, 45% IDU, 27.9% heterosexuals, AIDS 41.5%, Caucasian 58.5%, HCV‐coinfected 48%, baseline HIV‐RNA <1.7 log 93.2%, nadir and baseline CD4 count 180±150 and 663±297 cells/mm 3 , length of antiretroviral therapy 12.83±4.6 years and of HIV‐RNA <1.7 62±43 months. The rate of HIV‐RNA <1.7 at week 48 were 78.9% ITT; 92.6% OTT. Improvement was observed in kidney function after 48 w of DRV/r mx, mean 0 w vs 48 w MDRD (84.43±22.32 vs. 87.88±23.24; p=0.001). Subgroup analysis demonstrated significantly higher increases in MDRD in patients with a prior tenofovir‐based regimen (TDF), 83.14±21.86 and 48 w 88.97±21.23; p=0.000, and those with a protease inhibitor plus TDF‐based regimen (mean 0 w vs 48 w MDRD 80.66±22.53 87.09±23.37; p=0.002). Lipid profile improved significantly in terms of reduction in total cholesterol (mean 0 w col: 192.47±42.44 vs mean 48 w col 170.48±70.79; p=0.013) with an improvement in the ratio total cholesterol/ HDL (0 w 4.46±1.62 vs 48 w ratio 3.97±2.12; p=0.000). There were no significant changes in lipid profile in subgroup analysis according to previous antiretroviral treatment change. Conclusions Patients switching to DRV/r monotherapy showed significant improvement in kidney function and lipid profile at 48 w, both implied on cardiovascular risk.