title: Factors associated with virological failure in HIV-1-infected patients receiving darunavir/ritonavir monotherapy.
abstract: BACKGROUND
  Our objective was to determine virological and clinical characteristics associated with virological failure in human immunodeficiency virus (HIV)-infected patients switching to darunavir/ritonavir (DRV/r) monotherapy.
  
  
  METHODS
  The main outcome was virologic rebound, defined as 2 consecutive measurements of HIV-1 plasma RNA viral load (VL) >50 copies/mL. A logistic model was used to investigate which variables were predictive of a virologic rebound at weeks 48 (W48) and 96 (W96).
  
  
  RESULTS
  Receiving DRV/r monotherapy was associated with virologic rebound at W48 (P = .016) and W96 (P = .002), comparable to triple therapy. In the DRV/r monotherapy group, at W48, having a VL >50 copies/mL at day 0 and even a baseline ultrasensitive VL >1 copy/mL were predictive factors to virologic rebound (P = .042 and P = .025, respectively). At W96, shorter time of prior antiretrovial therapy (ART) exposure (odds ratio [OR] = 2.93 per 5 years decrease; P = .006), higher HIV-1 DNA at day 0 (OR = 2.66 per 1 log(10) copies/10(6) cells increase; P = .04) and adherence <100% (OR = 3.84 vs 100%; P = .02) were associated with an increased risk of rebound.
  
  
  CONCLUSIONS
  Factors associated with virological failure in patients receiving DRV/r monotherapy were having an initial blip, shorter time of antiretroviral treatment before monotherapy, and an adherence <100% during monotherapy. The importance of prior duration exposure to ART was in agreement with the impact of HIV-1 blood reservoir and VL level at baseline.
authors.affiliation: Department of Virology and Infectious Diseases, AP-HP, Pitié-Salpêtrière Hospital, INSERM U 943 and Pierre et Marie Curie University, Paris, France. sidonie.lambert@psl.aphp.fr
authors.forename: Sidonie
authors.initials: S
authors.lastname: Lambert-Niclot
authors.forename: Philippe
authors.initials: P
authors.lastname: Flandre
authors.forename: Marc-Antoine
authors.initials: MA
authors.lastname: Valantin
authors.forename: Gilles
authors.initials: G
authors.lastname: Peytavin
authors.forename: Claudine
authors.initials: C
authors.lastname: Duvivier
authors.forename: Stephanie
authors.initials: S
authors.lastname: Haim-Boukobza
authors.forename: Michele
authors.initials: M
authors.lastname: Algarte-Genin
authors.forename: Yazdan
authors.initials: Y
authors.lastname: Yazdanpanah
authors.forename: Pierre-Marie
authors.initials: PM
authors.lastname: Girard
authors.forename: Christine
authors.initials: C
authors.lastname: Katlama
authors.forename: Vincent
authors.initials: V
authors.lastname: Calvez
authors.forename: Anne-Genevieve
authors.initials: AG
authors.lastname: Marcelin
mesh_terms: D000328:Adult; D000069454:Darunavir; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology*; D017320:HIV Protease Inhibitors / Q000008:administration & dosage*; D015497:HIV-1 / Q000235:genetics / Q000502:physiology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D012367:RNA, Viral / Q000097:blood; D019438:Ritonavir / Q000008:administration & dosage*; D013449:Sulfonamides / Q000008:administration & dosage*; D019562:Viral Load
chemical_list: D017320:HIV Protease Inhibitors; D012367:RNA, Viral; D013449:Sulfonamides; D019438:Ritonavir; D000069454:Darunavir