title: Strategic use of dual regimens of boosted protease inhibitors plus maraviroc in poorly adherent subjects in view of long-acting drugs: A retrospective study.
abstract: In view of the forthcoming long-acting antiretrovirals, measures should be taken to prevent the selection of HIV drug resistance mutations. All subjects who had been switched to boosted protease inhibitors plus maraviroc (bPIs/MVC) with baseline HIV-1 RNA >50 copies/mL between June, 2014, and April, 2015, were retrospectively evaluated. HIV-1 RNA, CD4+ T-cells, serum glucose, creatinine, ALT, and adverse events were controlled every 3 to 4 months. We retrospectively analyzed 44 patients: 18 were taking darunavir/ritonavir (DRV/r) and 26 atazanavir/ritonavir (ATV/r) once daily, plus MVC 300 mg once daily. Seven subjects were in CDC stage C. All had a follow-up of at least 24 weeks, 28 exceeded 48 weeks, and 21 exceeded 72 weeks. All had experienced at least 1 viral failure and had selected at least 1 resistance-associated mutation (RAM). At baseline, 38 had plasma HIV-1 RNA 50-499 copies/mL and 6 had ≥500. At week 24, none had viremia >500 and 30 (68.2%) had suppressed HIV-1 RNA below 50 copies/mL. Of the subgroup with 48 weeks' follow-up, 23 had HIV-1 RNA 50-499 copies/mL, 5 had ≥500, and 20/28 suppressed to <50 copies/mL. Of the longest observed subgroup (72 weeks), 17 had HIV-1 RNA 50-499 copies/mL, and 4 had ≥500 copies/mL and 15/21 (71.4%) suppressed to <50 copies/mL. This combination allowed fair suppression of viral replication, with minor genotypic evolution in 6 subjects, and seems to be a feasible strategy to prevent damaging future options.
authors.affiliation: 1 Division of Infectious Diseases Pharmacy Unit, Luigi Sacco Hospital, Milano, Italy Whitwaterstrand University, Johannesburg, South Africa.
authors.forename: Amedeo Ferdinando
authors.initials: AF
authors.lastname: Capetti
authors.forename: Mariangela
authors.initials: M
authors.lastname: Micale
authors.forename: Laura
authors.initials: L
authors.lastname: Carenzi
authors.forename: Fosca
authors.initials: F
authors.lastname: Niero
authors.forename: Simona
authors.initials: S
authors.lastname: Landonio
authors.forename: Stefania
authors.initials: S
authors.lastname: Vimercati
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Dedivitiis
authors.forename: Giuliano
authors.initials: G
authors.lastname: Rizzardini
mesh_terms: D000328:Adult; D003510:Cyclohexanes / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D023581:HIV Fusion Inhibitors / Q000627:therapeutic use*; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D000077592:Maraviroc; D055118:Medication Adherence; D008875:Middle Aged; D011480:Protease Inhibitors / Q000627:therapeutic use*; D012189:Retrospective Studies; D014230:Triazoles / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D003510:Cyclohexanes; D023581:HIV Fusion Inhibitors; D011480:Protease Inhibitors; D014230:Triazoles; D000077592:Maraviroc