title: Maraviroc intensification of stable antiviral therapy in HIV-1-infected patients with poor immune restoration: MARIMUNO-ANRS 145 study.
abstract: OBJECTIVE
  To address the ability of a 24-week Maraviroc (MVC) intensification of a stable antiretroviral therapy (cART) to significantly increase the CD4 cell count slope.
  
  
  METHODS
  Patients were eligible if they had CD4 <350 cells/mm, a CD4 slope <50 cells/mm per year, and sustained plasma HIV-RNA <50 copies/mL over the last 2 years, while receiving a stable cART. Patients harboring pure X4-using viruses by a phenotypic tropism assay were excluded. MVC was added to cART for 24 weeks, at the recommended dosage per drug-drug interactions. The primary endpoint was a significant positive difference in CD4 slopes (with MVC- pre-MVC, paired t test).
  
  
  RESULTS
  Sixty patients (55 men), with median age 51 years, baseline CD4 238 cells/mm, and slope before intensification +14.1 cells/mm per year were included. CD4 nadir was <50/mm in 47% of the population. The full set of patients (N = 57) completed week 24, and the on-treatment patients (N = 48) did not discontinue MVC. The median CD4 slope difference from baseline was +22.6 cells/mm per year (P = 0.08) in full set and +22.6 cells/mm per year (P = 0.04) in on-treatment. Slope evolution was not different according to baseline tropism, CD4 nadir, or ongoing cART regimen. No drug-related severe adverse events were recorded during intensification. MVC plasma concentrations were significantly different depending on drug-drug interaction with ongoing cART regimen and tended to be correlated with CD4 cells increase.
  
  
  CONCLUSIONS
  In this study, MVC intensification of stable cART over 24 weeks was able to enhance CD4 cell slopes in patients with prior insufficient immune restoration despite long-term virological control.
authors.affiliation: Infectious Diseases Department, University Hospital, Toulouse, France. cuzin.l@chu-toulouse.fr
authors.forename: Lise
authors.initials: L
authors.lastname: Cuzin
authors.forename: Selma
authors.initials: S
authors.lastname: Trabelsi
authors.forename: Pierre
authors.initials: P
authors.lastname: Delobel
authors.forename: Claudine
authors.initials: C
authors.lastname: Barbuat
authors.forename: Jacques
authors.initials: J
authors.lastname: Reynes
authors.forename: Clotilde
authors.initials: C
authors.lastname: Allavena
authors.forename: Gilles
authors.initials: G
authors.lastname: Peytavin
authors.forename: Jade
authors.initials: J
authors.lastname: Ghosn
authors.forename: Caroline
authors.initials: C
authors.lastname: Lascoux-Combe
authors.forename: Christina
authors.initials: C
authors.lastname: Psomas
authors.forename: Pierre
authors.initials: P
authors.lastname: Corbeau
authors.forename: Philippe
authors.initials: P
authors.lastname: Flandre
mesh_terms: D000368:Aged; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D018791:CD4 Lymphocyte Count; D016516:CD4-CD8 Ratio; D003510:Cyclohexanes / Q000008:administration & dosage*; D004347:Drug Interactions; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology; D015497:HIV-1; D006801:Humans; D008297:Male; D000077592:Maraviroc; D008875:Middle Aged; D011446:Prospective Studies; D014230:Triazoles / Q000008:administration & dosage*; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents; D003510:Cyclohexanes; D014230:Triazoles; D000077592:Maraviroc