Salvage therapy with ritonavir-boosted amprenavir/fosamprenavir: virological and immunological response in two years follow-up.
OBJECTIVE
To evaluate the efficacy of salvage regimens containing ritonavir-boosted amprenavir (APV/r) or fosamprenavir (FPV/r) in heavily pretreated protease inhibitor (PI)-experienced HIV-1 patients.


METHODS
Evaluation of APV/r- or FPV/r-containing antiretroviral regimens in PI-experienced HIV-1 patients with 2 or more antiretroviral failures. Follow-up continued to 96 weeks with prospective collection of data.


RESULTS
54 episodes (48 on APV/r and 6 on FPV/r) were considered in 45 patients who had received a median of 5 prior antiretroviral regimens (range, 2-13) including a median of 3 PIs (range, 2-4). Median time of treatment at analysis was 72 weeks (range, 12-210). At baseline, plasma viral load (pVL) and CD4 cell count was 67,000 copies/mL and 167 cell/mm(3), respectively. At week 96, the median pVL was < 50 copies/mL and CD4 cell count was 519 cells/mm(3). Proportion of patients with pVL below detection was 62% at week 48 and 61% at week 96. Fifteen patients stopped treatment because of virologic failure; one presented a full resistance profile to APV/r, based on the ANRS 2003 resistance algorithm. Median trough APV plasma concentration 4 weeks after treatment initiation was 1406 ng/mL (range, 452-4321); dose adaptation was required in only 7 patients.


CONCLUSIONS
This study provides long-term follow-up of APV/r and FPV/r in the setting of salvage therapy, showing a high and sustained rate of virologic and immunologic response.
Service des Maladies Infectieuses et Tropicales, Hotel-Dieu, 44093 Nantes cedex 1, France.
Romina
R
Quercia
Elisabeth
E
Garnier
Virginie
V
Ferré
Pascale
P
Morineau
Bénédicte
B
Bonnet
Claire
C
Soulard
François
F
Raffi
D000328:Adult; D018791:CD4 Lymphocyte Count; D002219:Carbamates; D015331:Cohort Studies; D024921:Drug Resistance, Multiple, Viral; D004359:Drug Therapy, Combination; D000077560:Enfuvirtide; D005260:Female; D005500:Follow-Up Studies; D005663:Furans; D015700:HIV Envelope Protein gp41 / Q000008:administration & dosage; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D017320:HIV Protease Inhibitors / Q000008:administration & dosage* / Q000097:blood; D006801:Humans; D008297:Male; D008875:Middle Aged; D010755:Organophosphates / Q000008:administration & dosage* / Q000097:blood; D010446:Peptide Fragments / Q000008:administration & dosage; D019438:Ritonavir / Q000008:administration & dosage*; D016879:Salvage Therapy; D013449:Sulfonamides / Q000008:administration & dosage* / Q000097:blood; D017211:Treatment Failure; D019562:Viral Load
D002219:Carbamates; D005663:Furans; D015700:HIV Envelope Protein gp41; D017320:HIV Protease Inhibitors; D010755:Organophosphates; D010446:Peptide Fragments; D013449:Sulfonamides; D000077560:Enfuvirtide; C095108:amprenavir; D019438:Ritonavir; C426859:fosamprenavir