title: Virological and immunological response to antiretroviral regimens containing maraviroc in HIV type 1-infected patients in clinical practice: role of different tropism testing results and of concomitant treatments.
abstract: We assessed the immunovirological response to antiretroviral regimens containing maraviroc in HIV-infected viremic patients with viral tropism predicted by different assays. We selected antiretroviral treatment-experienced HIV-1-infected patients initiating regimens containing maraviroc after different phenotypic or genotypic viral tropism assays, with at least one HIV-1 RNA determination during follow-up. Survival analysis was employed to assess the virological response as time to HIV-1 RNA <50 copies/ml and immunological response as time to a CD4 cell count increase of ≥ 100/μl from baseline. Predictors of these outcomes were analyzed by multivariate Cox regression models. In 191 treatments with maraviroc, virological response was achieved in 65.4% and the response was modestly influenced by the baseline viral load and concomitant drug activity but not influenced by the type of tropism assay employed. Immunological response was achieved in 58.1%; independent predictors were baseline HIV-1 RNA (per log10 higher: HR 1.29, 95% CI 1.05-1.60) and concomitant therapy with enfuvirtide (HR 2.05, 0.96-4.39) but not tropism assay results. Of 17 patients with baseline R5-tropic virus and available tropism results while viremic during follow-up on maraviroc, seven (41%) showed a tropism switch to non-R5 virus. A significant proportion of experienced patients treated with regimens containing maraviroc achieved virological response. The tropism test type used was not associated with immunovirological response and concomitant treatment with enfuvirtide increased the chance of immunological response. More than half of virological failures with maraviroc were not accompanied by tropism switch.
authors: 1 Infectious Diseases Clinic, AOU , Senese, Italy .
authors: Barbara
authors: B
authors: Rossetti
authors: Claudia
authors: C
authors: Bianco
authors: Lara Ines
authors: LI
authors: Bellazzi
authors: Bianca
authors: B
authors: Bruzzone
authors: Grazia
authors: G
authors: Colao
authors: Paola
authors: P
authors: Corsi
authors: Laura
authors: L
authors: Monno
authors: Gabriella
authors: G
authors: Pagano
authors: Stefania
authors: S
authors: Paolucci
authors: Grazia
authors: G
authors: Punzi
authors: Maurizio
authors: M
authors: Setti
authors: Maurizio
authors: M
authors: Zazzi
authors: Andrea
authors: A
authors: De Luca
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D065100:CCR5 Receptor Antagonists; D018791:CD4 Lymphocyte Count; D003510:Cyclohexanes / Q000627:therapeutic use*; D000077560:Enfuvirtide; D005260:Female; D015700:HIV Envelope Protein gp41 / Q000627:therapeutic use; D023581:HIV Fusion Inhibitors / Q000627:therapeutic use; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality; D015497:HIV-1 / Q000187:drug effects; D006801:Humans; D008297:Male; D000077592:Maraviroc; D008875:Middle Aged; D010446:Peptide Fragments / Q000627:therapeutic use; D012367:RNA, Viral / Q000097:blood; D012189:Retrospective Studies; D013534:Survival; D014230:Triazoles / Q000627:therapeutic use*; D019562:Viral Load / Q000187:drug effects; D056189:Viral Tropism / Q000187:drug effects* / Q000235:genetics
chemical_list: D019380:Anti-HIV Agents; D065100:CCR5 Receptor Antagonists; D003510:Cyclohexanes; D015700:HIV Envelope Protein gp41; D023581:HIV Fusion Inhibitors; D010446:Peptide Fragments; D012367:RNA, Viral; D014230:Triazoles; D000077560:Enfuvirtide; D000077592:Maraviroc
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