Boosted protease inhibitor monotherapy as a maintenance strategy:  an observational study.
OBJECTIVE
We aimed to determine the effectiveness of boosted protease inhibitor monotherapy (BPIMT) initiated as a maintenance strategy in routine care and identify predictive factors of failure.


METHODS
Observational study in the FHDH-ANRS CO4 cohort.


METHODS
Five hundred and twenty-nine virologically suppressed individuals switched to BPIMT in the period 2006-2010, 75% had at least 12 and 49% at least 24 months of follow-up. Virological failure (two consecutive HIV-RNA > 50 copies/ml or one HIV-RNA > 50 copies/ml followed by BPIMT discontinuation) and treatment failure (virological failure, antiretroviral reintensification or death) were analysed separately.


RESULTS
At baseline, 11% were protease inhibitor-naive, median duration on combined antiretroviral therapy was 84 months and median duration of suppressed viremia was 38 months. Nine percent had a history of virological failure, while on a protease inhibitor-containing regimen, and rates of virological failure were higher among those individuals [adjusted hazard ratio, 1.6; 95% confidence interval (CI), 0.9-2.9]. Compared to individuals with less than 1 year of sustained virological suppression before the switch to BPIMT, those with longer duration were less likely to experience virological failure [hazard ratio, 0.7; (95% CI, 0.4-1.2) and 0.6 (95%CI, 0.4-0.9)] for a duration of 12-23 months and 24 months or more, respectively. Rates of failure were similar for BPIMT with lopinavir-ritonavir (RTV) or darunavir-RTV, but increased for BPIMT with atazanavir-RTV. Same risk factors were associated with treatment failure.


CONCLUSIONS
The safety and efficacy of a maintenance strategy with BPIMT in a routine care setting matched the results of randomized clinical trials. A longer duration since last virological rebound before switching to BPIMT was associated with a decreased risk of subsequent failure.
INSERM, U, Paris, France. marguerite.guiguet@inserm.fr
Marguerite
M
Guiguet
Jade
J
Ghosn
Claudine
C
Duvivier
Jean-Luc
JL
Meynard
Guillaume
G
Gras
Marialuisa
M
Partisani
Elina
E
Teicher
Aba
A
Mahamat
Franck
F
Rodenbourg
Odile
O
Launay
Dominique
D
Costagliola
D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D004334:Drug Administration Schedule; D024882:Drug Resistance, Viral; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology; D017320:HIV Protease Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012367:RNA, Viral / Q000187:drug effects; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D013997:Time Factors; D017211:Treatment Failure; D019562:Viral Load / Q000187:drug effects; D016903:Drug Monitoring
D019380:Anti-HIV Agents; D017320:HIV Protease Inhibitors; D012367:RNA, Viral