title: Responses to switching to maraviroc-based antiretroviral therapy in treated patients with suppressed plasma HIV-1-RNA load.
abstract: BACKGROUND
  Maraviroc (MVC) has shown good efficacy and tolerability in treatment-naive and treatment-experienced HIV-1-infected patients with CCR5-tropic virus. Data on patients switching to MVC while on suppressive antiretroviral therapy (ART) are limited. The aim of this study was to evaluate patients on suppressive ART switching to an MVC-containing regimen (MVC-CR), and test the hypothesis that the switch may have an impact on T cell activation.
  
  
  METHODS
  The study population comprised 20 treated adults who started MVC with a plasma HIV-1-RNA load (viral load, VL) of <50 copies/ml. Viral tropism was assessed by V3 loop sequencing using proviral DNA from peripheral blood mononuclear cells (PBMCs). Changes in clinical and laboratory parameters were evaluated at a median of 2 and 6 months of follow-up. T cell activation was determined by measuring soluble CD30 in plasma.
  
  
  RESULTS
  Reasons for switching to a MVC-CR were drug toxicity and tolerability, low CD4 cell count and ART simplification. Over median 7.5 months of follow-up, 3/20 patients discontinued MVC due to severe headache, fatigue and VL rebound. A significant reduction in soluble CD30 levels in MVC-treated patients was observed during follow-up at both 2 (p = 0.027) and 6 months (p = 0.001).
  
  
  CONCLUSIONS
  Switching suppressive ART to a MVC-CR based upon genotypic tropism prediction from proviral DNA improves tolerability. The observed impact on T cell activation warrants further investigation.
authors.affiliation: UCL Medical School, London, UK. paolavitiello@yahoo.it
authors.forename: Paola
authors.initials: P
authors.lastname: Vitiello
authors.forename: Daniel
authors.initials: D
authors.lastname: Brudney
authors.forename: Malcolm
authors.initials: M
authors.lastname: MacCartney
authors.forename: Ana
authors.initials: A
authors.lastname: Garcia
authors.forename: Colette
authors.initials: C
authors.lastname: Smith
authors.forename: Neal
authors.initials: N
authors.lastname: Marshall
authors.forename: Margaret
authors.initials: M
authors.lastname: Johnson
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Geretti
mesh_terms: D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000009:adverse effects; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects / Q000379:methods*; D003510:Cyclohexanes / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D015497:HIV-1 / Q000302:isolation & purification*; D006801:Humans; D017730:Ki-1 Antigen / Q000097:blood; D008213:Lymphocyte Activation; D008297:Male; D000077592:Maraviroc; D008875:Middle Aged; D010949:Plasma / Q000821:virology; D012367:RNA, Viral / Q000302:isolation & purification; D016896:Treatment Outcome; D014230:Triazoles / Q000008:administration & dosage* / Q000009:adverse effects; D019562:Viral Load; D056189:Viral Tropism
chemical_list: D019380:Anti-HIV Agents; D003510:Cyclohexanes; D017730:Ki-1 Antigen; D012367:RNA, Viral; D014230:Triazoles; D000077592:Maraviroc