Concomitant use of an active boosted protease inhibitor with enfuvirtide in treatment-experienced, HIV-infected individuals: recent data and consensus recommendations.
Recent data from clinical trials investigating the efficacy of enfuvirtide, a fusion inhibitor, in treatment-experienced patients have revealed that the addition of enfuvirtide (ENF) to an active boosted protease inhibitor regimen doubles the rate of virological response. At week 48 of the TORO studies, 55% of patients previously naive to and receiving lopinavir/ritonavir (LPV/r) with ENF achieved a viral load of <400 copies/mL compared with 24% of patients treated with LPV/r alone. At week 24 of the RESIST studies, 70% of previously ENF-naive patients who took both ENF and tipranavir/ritonavir (TPV/r) achieved a >or=1 log10 reduction in viral load compared with 37% of such patients treated with TPV/r alone. Similarly, concomitant use of TMC114/ritonavir (TMC114/r) with ENF, compared with TMC114/r alone, increased the number of patients with <50 copies/mL from 46% to 64% in a combined 24-week analysis from the POWER trials. Data from these trials suggest that combining one agent from a new class with a new agent from a previously exposed class offers a greater chance of achieving full virological control than either type of agent alone. Undetectable viraemia should be the primary objective for treatment-experienced patients requiring a switch in therapy, and the present data support the combination of an active boosted protease inhibitor with an agent from a new class (e.g., ENF) for triple-class-experienced patients.
Youle
Mike
M
Royal Free Hospital Centre for HIV Medicine, Royal Free Hospital, London, UK. mike@mikeyoule.com
Staszweski
Schlomo
S
Clotet
Bonaventura
B
Arribas
José Ramon
JR
Blaxhult
Anders
A
Carosi
Giampiero
G
Dejesus
Edwin
E
Di Perri
Gianni
G
Estrada
Vicente
V
Fisher
Martin
M
Kovacs
Colin
C
Kulasegaram
Ranjababu
R
Lazzarin
Adriano
A
Marriott
Debbie
D
Muñoz
Leopoldo
L
Reynes
Jacques
J
Shalit
Peter
P
Slim
Jihad
J
Tsoukas
Chris
C
Vaccaro
Anthony
A
Vera
José
J
D023241:Antiretroviral Therapy, Highly Active; D000077560:Enfuvirtide; D015700:HIV Envelope Protein gp41 / Q000627:therapeutic use*; D023581:HIV Fusion Inhibitors / Q000627:therapeutic use*; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D017320:HIV Protease Inhibitors / Q000627:therapeutic use*; D006801:Humans; D010446:Peptide Fragments / Q000627:therapeutic use*; D011725:Pyridines / Q000627:therapeutic use; D011753:Pyrones / Q000627:therapeutic use; D019438:Ritonavir / Q000627:therapeutic use; D013449:Sulfonamides; D016896:Treatment Outcome; D019562:Viral Load
D015700:HIV Envelope Protein gp41; D023581:HIV Fusion Inhibitors; D017320:HIV Protease Inhibitors; D010446:Peptide Fragments; D011725:Pyridines; D011753:Pyrones; D013449:Sulfonamides; D000077560:Enfuvirtide; D019438:Ritonavir; C107201:tipranavir