title: Concomitant use of an active boosted protease inhibitor with enfuvirtide in treatment-experienced, HIV-infected individuals: recent data and consensus recommendations.
abstract: 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.
authors.affiliation: Royal Free Hospital Centre for HIV Medicine, Royal Free Hospital, London, UK. mike@mikeyoule.com
authors.forename: Mike
authors.initials: M
authors.lastname: Youle
authors.forename: Schlomo
authors.initials: S
authors.lastname: Staszweski
authors.forename: Bonaventura
authors.initials: B
authors.lastname: Clotet
authors.forename: José Ramon
authors.initials: JR
authors.lastname: Arribas
authors.forename: Anders
authors.initials: A
authors.lastname: Blaxhult
authors.forename: Giampiero
authors.initials: G
authors.lastname: Carosi
authors.forename: Edwin
authors.initials: E
authors.lastname: Dejesus
authors.forename: Gianni
authors.initials: G
authors.lastname: Di Perri
authors.forename: Vicente
authors.initials: V
authors.lastname: Estrada
authors.forename: Martin
authors.initials: M
authors.lastname: Fisher
authors.forename: Colin
authors.initials: C
authors.lastname: Kovacs
authors.forename: Ranjababu
authors.initials: R
authors.lastname: Kulasegaram
authors.forename: Adriano
authors.initials: A
authors.lastname: Lazzarin
authors.forename: Debbie
authors.initials: D
authors.lastname: Marriott
authors.forename: Leopoldo
authors.initials: L
authors.lastname: Muñoz
authors.forename: Jacques
authors.initials: J
authors.lastname: Reynes
authors.forename: Peter
authors.initials: P
authors.lastname: Shalit
authors.forename: Jihad
authors.initials: J
authors.lastname: Slim
authors.forename: Chris
authors.initials: C
authors.lastname: Tsoukas
authors.forename: Anthony
authors.initials: A
authors.lastname: Vaccaro
authors.forename: José
authors.initials: J
authors.lastname: Vera
mesh_terms: 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
chemical_list: 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