title: Efficacy and safety of nucleoside-sparing regimen based on raltegravir and ritonavir-boosted darunavir in HIV-1-infected treatment-experienced patients.
abstract: To assess the efficacy and tolerability of dual therapy containing raltegravir (RAL) and ritonavir boosted darunavir (DRV/r) in HIV-1-infected treatment-experienced patients.
  
  
  
  Retrospective analysis of 81 HIV-1-infected treatment-experienced patients (56 male and 25 female, 5 Polish centers) who switched to RAL/DRV/r.
  
  
  
  The main reasons for the introduction of dual therapy were renal dysfunction (16/81 patients-19.8%) and virologic failure on previous regimens (15/81 patients-18.5%). At 48 weeks the treatment was continued in 58/81 (71.6% of patients). In three patients the therapy was discontinued because of virologic failure. However, no mutations to DRV or integrase inhibitors (InI) were detected. At 48 weeks of treatment CD4+lymphocyte count increased statistically significantly (median 121 cells/μL) P < 0.005. The main reasons for the discontinuation of therapy were treatment simplification (11/23-47.8% patients), adverse events (7/23 patients 30.4%), virologic failure (3/23 patients 13.0%). All patients who switched to RAL/DRV/r therapy because of prior renal impairment were maintained on the treatment for 48 weeks. In this group, before the introduction of dual therapy eGFR (estimated glomerular filtration rate) <60 mL/min/1.72 m2was reported in nine patients and after 48 weeks in four patients (56.3% vs 25%) (P > 0.05). We found a statistically significant decrease in the prevalence of proteinuria or eGFR <60 mL/min/1.72 m2(93.8% vs 37.5%; P = 0.004 before and after the introduction of dual therapy, respectively).
  
  
  
  Dual therapy was effective and safe for the vast majority of antiretroviral-experienced subjects. Such therapy can be recommended especially for patients with renal impairment or NRTIs intolerance.
authors.affiliation: Clinic of Infectious Diseases and Hepatology, Medical University of Lodz, Lodz, Poland.
authors.forename: Elżbieta
authors.identifier: 0000-0002-7282-1225
authors.initials: E
authors.lastname: Jabłonowska
authors.affiliation: Hospital for Infectious Diseases, HIV Out-Patient Clinic, Warsaw, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Pulik
authors.affiliation: Department of Infectious Diseases, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Anna
authors.initials: A
authors.lastname: Kalinowska
authors.affiliation: Department of Infectious Diseases, Hepatology and Acquired Immune Deficiencies, Wroclaw Medical University, Wroclaw, Poland.
authors.forename: Jacek
authors.initials: J
authors.lastname: Gąsiorowski
authors.affiliation: Department of Infectious and Tropical Diseases and Immune Deficiency, Pomeranian Medical University, Szczecin, Poland.
authors.forename: Miłosz
authors.initials: M
authors.lastname: Parczewski
authors.affiliation: Department of Infectious Diseases, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Monika
authors.initials: M
authors.lastname: Bociąga-Jasik
authors.affiliation: Hospital for Infectious Diseases, HIV Out-Patient Clinic, Warsaw, Poland.
authors.forename: Łukasz
authors.initials: Ł
authors.lastname: Pulik
authors.affiliation: Hospital for Infectious Diseases, HIV Out-Patient Clinic, Warsaw, Poland.
authors.forename: Ewa
authors.initials: E
authors.lastname: Siwak
authors.affiliation: Clinic of Infectious Diseases and Hepatology, Medical University of Lodz, Lodz, Poland.
authors.forename: Kamila
authors.initials: K
authors.lastname: Wójcik
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D000069454:Darunavir / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D017320:HIV Protease Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D015497:HIV-1 / Q000187:drug effects; D006801:Humans; D007668:Kidney / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D011507:Proteinuria / Q000209:etiology; D012367:RNA, Viral; D000068898:Raltegravir Potassium / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D012189:Retrospective Studies; D019562:Viral Load / Q000187:drug effects
chemical_list: D019380:Anti-HIV Agents; D017320:HIV Protease Inhibitors; D012367:RNA, Viral; D000068898:Raltegravir Potassium; D000069454:Darunavir
keywords: ARV; DRV/r; HIV; RAL; dual therapy; kidney; lipids