Raltegravir 800 mg once‐daily is efficacious in already virologically suppressed patients

Raltegravir is a potent, extremely well tolerated antiretroviral, and is a component of a preferred regimen in many treatment guidelines. Despite its indication as a twice‐daily (400 mg BID) drug, there has always been interest in once‐daily (800 mg QD) use of raltegravir (RTG). The “QD Merck”, however, showed a higher rate of virologic failure in subjects taking RTG QD with Truvada as opposed to twice daily (BID). This trial, however, was in treatment‐naïve patients, and the majority of virologic failures were in those with high viral loads. In patients already virologically suppressed on antiretroviral therapy a regimen including QD raltegravir is more convenient, and may still be effective for virologic suppression. This is a retrospective review of patients in a large HIV‐specialty private practice. 105 patients were identified who have been on QD RTG for at least 6 months (median 23, range 6–55 months). 70 patients were also on Truvada, 10 on Epzicom, 7 on atazanavir, and 18 on more than two additional drugs. All patients had undetectable (<200) viral loads when starting QD RTG, and had been on other treatment for a median of 117 months (range 13–276). Median CD4 count on starting QD RTG was 606 (range 154–1358). 50 patients had been previously on BID RTG for a median of 12 months; 55 started directly on a QD RTG regimen. 32 patients had a history of previous treatment failure/resistance, although mostly to drugs not included in the current regimen. All patients remain undetectable (PCR<200 copies/ml) with no treatment failures seen. In clinically stable patients already suppressed on antiretroviral therapy, including BID RTG regimens, a switch to QD RTG appears to be effective at maintaining long‐term virologic control. QD dosing is certainly more convenient, and may improve adherence.