title: Switching to boosted protease inhibitor plus a second antiretroviral drug (dual therapy) for treatment simplification: a multicenter observational study.
abstract: BACKGROUND
  Aim of the study was to assess predictors of discontinuation/toxicity of boosted PI-based (PI/r) dual therapy (DT).
  
  
  METHODS
  Observational, retrospective switch study in patients successfully treated with triple drugs regimen. Patients switched to PI/r based DT [darunavir (DRV/r), lopinavir (LPV/r) or atazanavir (ATV/r)] plus a second drug: [raltegravir (RAL), maraviroc (MVC) etravirine (ETR), lamivudine (3TC) or tenofovir (TDF)] between 2009 and 2014 were included. The effect of each drug as well as other clinical and virological cofactors over treatment discontinuation (TD) was assessed using survival analysis.
  
  
  RESULTS
  Overall, 376 patients were included with mean follow-up of 73 weeks. The most commonly used drugs in DT were DRV/r (63.0 %) and RAL (53.7 %). TD was observed in 77 (20,4 %) patients: 38 (10,1 %) virological failure, 35 (9,3 %) toxicity/intolerance (4 deaths) and 4 (1 %) interruptions for patients decision. At Cox Model, adjusted by demographic and laboratory variables, DRV/r and ATV/r significantly reduced the likelihood of TD and longer treatment was associated with lower risk, while low CD4 count at baseline and number of previous regimens with a higher risk. Moreover, RAL and 3TC use were significantly associated with lower TD by toxicity.
  
  
  CONCLUSIONS
  In our clinical practice experience, switching virologically suppressed patients to PI/r based DT showed adequate safety and efficacy, so that it may be used in selected patients with specific medical needs.
authors: San Gallicano Dermatologic Institute (IRCCS), Clinic of Dermatology and Infectious Diseases, Rome, Italy.
authors: Alessandra
authors: A
authors: Latini
authors: Department of Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy.|Division of Infectious Diseases, Department of Internal Medicine, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.
authors: Massimiliano
authors: M
authors: Fabbiani
authors: Azienda Ospedaliero Universitaria, Clinic of Infectious Diseases, Modena, Italy.
authors: Vanni
authors: V
authors: Borghi
authors: Division of Infectious Diseases, Careggi Hospital, Florence, Italy.
authors: Gaetana
authors: G
authors: Sterrantino
authors: Clinical Department, National Institute for the Infectious Diseases "Lazzaro Spallanzani", Rome, Italy.
authors: Alberto
authors: A
authors: Giannetti
authors: Clinical Department, National Institute for the Infectious Diseases "Lazzaro Spallanzani", Rome, Italy.
authors: Patrizia
authors: P
authors: Lorenzini
authors: Clinical Department, National Institute for the Infectious Diseases "Lazzaro Spallanzani", Rome, Italy.
authors: Laura
authors: L
authors: Loiacono
authors: Clinical Department, National Institute for the Infectious Diseases "Lazzaro Spallanzani", Rome, Italy.
authors: Adriana
authors: A
authors: Ammassari
authors: Clinical Department, National Institute for the Infectious Diseases "Lazzaro Spallanzani", Rome, Italy.
authors: Rita
authors: R
authors: Bellagamba
authors: San Gallicano Dermatologic Institute (IRCCS), Clinic of Dermatology and Infectious Diseases, Rome, Italy.
authors: Manuela
authors: M
authors: Colafigli
authors: Policlinico Universitario "Umberto I", Clinic of Infectious Diseases, Rome, Italy.
authors: Gabriella
authors: G
authors: D'Ettorre
authors: Department of Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy.
authors: Simona
authors: S
authors: Di Giambenedetto
authors: Clinical Department, National Institute for the Infectious Diseases "Lazzaro Spallanzani", Rome, Italy.
authors: Andrea
authors: A
authors: Antinori
authors: Clinical Department, National Institute for the Infectious Diseases "Lazzaro Spallanzani", Rome, Italy. mauro.zaccarelli@inmi.it.
authors: Mauro
authors: M
authors: Zaccarelli
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D000069454:Darunavir / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy*; D017320:HIV Protease Inhibitors / Q000627:therapeutic use*; D006801:Humans; D019259:Lamivudine / Q000627:therapeutic use; D061466:Lopinavir / Q000627:therapeutic use; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D016016:Proportional Hazards Models; D000068898:Raltegravir Potassium / Q000627:therapeutic use; D012189:Retrospective Studies; D012306:Risk; D000068698:Tenofovir / Q000627:therapeutic use
chemical_list: D019380:Anti-HIV Agents; D017320:HIV Protease Inhibitors; D061466:Lopinavir; D019259:Lamivudine; D000068898:Raltegravir Potassium; D000068698:Tenofovir; D000069454:Darunavir
keywords: Antiretroviral therapy; Darunavir Atazanavir; Dual therapy; Raltegravir; Treatment simplification