title: Nevirapine-raltegravir combination, an NRTI and PI/r sparing regimen, as maintenance antiretroviral therapy in virologically suppressed HIV-1-infected patients.
abstract: BACKGROUND
  Nucleoside reverse transcriptase inhibitor (NRTI) and protease inhibitor (PI)/ritonavir sparing regimens may be useful to some HIV-infected patients. Nevirapine (NVP) and raltegravir (RAL) are both potent antiretrovirals with good long-term safety profiles.
  
  
  METHODS
  We retrospectively identified from our electronic database all patients with HIV RNA<50 copies/ml for >6 months on an NVP-containing regimen and no prior exposure to integrase strand transfer inhibitors who were switched to RAL plus NVP. Data was collected for 36 months or until discontinuation of RAL plus NVP for any reason.
  
  
  RESULTS
  A total of 39 patients (30 male) were included in this analysis. Median duration of prior antiretroviral therapy was 14 years (IQR 10-17) and median duration with plasma HIV-1 RNA<50 copies/ml prior to switch was 50 months (IQR 22-96). Switched regimens included mainly a boosted PI (n=24) or tenofovir disoproxil fumarate/emtricitabine (n=12). After switching, the percentages of patients with HIV-1 RNA<50 copies/ml were 87.2% (95% CI 76.7, 97.7) and 82.1% (95% CI 70.0, 94.1) at 6 and 12 months, respectively, in the intent-to-treat-exposed analysis, 97.1% (95% CI 91.6, 100) and 94.1% (95% CI 86.2, 100), respectively, in the per-protocol analysis. All patients with follow-up to month 24 (n=22) or month 36 (n=14) had HIV-1 RNA<50 copies/ml. One virological failure was observed (related to archived non-nucleoside reverse transcriptase inhibitor resistance mutation). During follow-up, no patient experienced Grade 3 or 4 adverse events. Median values of serum creatinine and lipids significantly improved after switch.
  
  
  CONCLUSIONS
  In patients with prolonged HIV-1 RNA<50 copies/ml, switching to NVP-RAL combination maintained virological suppression throughout 36 months. This combination deserves further evaluation in patients unable to tolerate NRTI or PI/ritonavir agents.
authors.affiliation: Department of Infectious Diseases, CHU Nantes, Nantes, France. veronique.reliquet@chu-nantes.fr.
authors.forename: Véronique
authors.initials: V
authors.lastname: Reliquet
authors.forename: Catherine
authors.initials: C
authors.lastname: Chirouze
authors.forename: Clotilde
authors.initials: C
authors.lastname: Allavena
authors.forename: Patrice
authors.initials: P
authors.lastname: Muret
authors.forename: Gilles
authors.initials: G
authors.lastname: Peytavin
authors.forename: Elisabeth
authors.initials: E
authors.lastname: André-Garnier
authors.forename: Dominique
authors.initials: D
authors.lastname: Bettinger
authors.forename: Virginie
authors.initials: V
authors.lastname: Ferré
authors.forename: Bruno
authors.initials: B
authors.lastname: Hoen
authors.forename: François
authors.initials: F
authors.lastname: Raffi
mesh_terms: D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D004338:Drug Combinations; D057915:Drug Substitution; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000821:virology*; D015497:HIV-1; D006801:Humans; D008297:Male; D008875:Middle Aged; D019829:Nevirapine / Q000627:therapeutic use*; D011480:Protease Inhibitors; D011760:Pyrrolidinones / Q000627:therapeutic use*; D000068898:Raltegravir Potassium; D012189:Retrospective Studies; D018894:Reverse Transcriptase Inhibitors; D012307:Risk Factors; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D004338:Drug Combinations; D011480:Protease Inhibitors; D011760:Pyrrolidinones; D018894:Reverse Transcriptase Inhibitors; D000068898:Raltegravir Potassium; D019829:Nevirapine