title: Analysis of the virological response with respect to baseline viral phenotype and genotype in protease inhibitor-experienced HIV-1-infected patients receiving lopinavir/ritonavir therapy.
abstract: The virological response of multiple protease inhibitor-experienced, non-nucleoside reverse transcriptase inhibitor-naive, HIV-1-infected subjects was examined with respect to baseline viral phenotype and genotype through 72 weeks of therapy with lopinavir/ritonavir plus efavirenz and nucleoside reverse transcriptase inhibitors (Study M98-957). Using a 'dropouts as censored' analysis, plasma HIV RNA < or = 400 copies/ml was observed in 93% (25/27), 73% (11/15) and 25% (2/8) of subjects with <10-fold, 10- to 40-fold, and >40-fold reduced susceptibility to lopinavir at baseline, respectively. In addition, virological response was observed in 91% (21/23), 71% (15/21) and 33% (2/6) of subjects with baseline lopinavir mutation score of 0-5, 6-7 and > or = 8, respectively. Through 72 weeks, all subjects experiencing virological failure whose baseline isolates contained six or more protease inhibitor mutations had a common genotypic pattern, with mutations at positions 82, 54 and 10, along with a median of four additional mutations in protease. However, an equal number of subjects with a similar genotypic pattern experienced virological response. Further analysis revealed the baseline phenotypic susceptibility to lopinavir to be an additional covariate predicting response in this subset of subjects. In multivariate analyses, baseline susceptibility to lopinavir was associated with response at each time point examined (weeks 24, 48 and 72). These results provide guidance for clinically relevant interpretation of phenotypic and genotypic resistance tests when applied to lopinavir/ritonavir.
authors.affiliation: Global Pharmaceutica Research and Development, Abbott Laboratories, Abbott Park, Ill, USA. dale.kempf@abbott.com
authors.forename: Dale J
authors.initials: DJ
authors.lastname: Kempf
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Isaacson
authors.forename: Martin S
authors.initials: MS
authors.lastname: King
authors.forename: Scott C
authors.initials: SC
authors.lastname: Brun
authors.forename: Jacquelyn
authors.initials: J
authors.lastname: Sylte
authors.forename: Bruce
authors.initials: B
authors.lastname: Richards
authors.forename: Barry
authors.initials: B
authors.lastname: Bernstein
authors.forename: Richard
authors.initials: R
authors.lastname: Rode
authors.forename: Eugene
authors.initials: E
authors.lastname: Sun
mesh_terms: D024882:Drug Resistance, Viral; D004359:Drug Therapy, Combination; D005814:Genes, Viral; D005838:Genotype; D006678:HIV / Q000187:drug effects* / Q000201:enzymology / Q000235:genetics*; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology*; D016333:HIV Protease / Q000235:genetics / Q000378:metabolism; D017320:HIV Protease Inhibitors / Q000008:administration & dosage* / Q000627:therapeutic use*; D006801:Humans; D020128:Inhibitory Concentration 50; D016015:Logistic Models; D061466:Lopinavir; D009154:Mutation / Q000235:genetics; D010641:Phenotype; D011744:Pyrimidinones / Q000008:administration & dosage* / Q000627:therapeutic use*; D012367:RNA, Viral / Q000097:blood; D019438:Ritonavir / Q000008:administration & dosage* / Q000627:therapeutic use*; D013997:Time Factors; D019562:Viral Load
chemical_list: D017320:HIV Protease Inhibitors; D011744:Pyrimidinones; D012367:RNA, Viral; D061466:Lopinavir; D016333:HIV Protease; D019438:Ritonavir