Response to Antiretroviral Treatment After Failure of NNRTI Plus NRTIs-Based Therapy. Data from the ARCA Collaborative Group

Title:Response to Antiretroviral Treatment After Failure of NNRTI Plus NRTIs-Based Therapy. Data from the ARCA Collaborative Group

Volume: 10 Issue: 4

Author(s): Elena Seminari, Annalisa De Silvestri, Genny Meini, Annapaola Callegaro, Enzo Boeri, Grazia Punzi, Nicola Gianotti, Bianca Bruzzone, Carmine Tinelli and Paolo Grossi

Affiliation:

Keywords: Drug resistance, genotypic susceptibility score, HIV infection, NNRTI failure, rescue therapy, viral rebound, antiretroviral, virological failure, CD4+, regimen

Abstract: Objective: The aim of the present study was to evaluate the virological response to a new antiretroviral treatment (ART2) after failure of a nonnucleoside reverse transcriptase inhibitor (NNRTI) plus two nucleoside reverse transcriptase inhibitors (NRTIs)-containing regimen.

Design: Retrospective observational study based on the Italian ARCA cohort database. Adult patients were included if they had a virological failure (defined as plasma viral load above 500 copies/ml in two subsequent visits) while on a treatment with one NNRTI plus 2 NRTIs, had an available HIV genotype.

Results: Patients on ART2 were followed up for 791 person/year and median follow up was 10.8 months(IQR 5.2-26). Variables associated with reduced risk of ART2 virological failure at univariable analysis had started the treatment in recent years (HR 0.90; 95% CI 0.86-0.94, p<0.0001) and duration of previous NNRTI treatment (HR 0.995; 95%CI 0.990-0.990, p=0.045). Variables associated with increased risk of virological failure of ART2 were a higher plasma viral load (pVL) at baseline(HR 1.2; 95% CI 1.07-1.34, p=0.002) and the type of treatment, in particular an unboosted PIcontaining regimen vs. a boosted PI-containing regimen(HR 1.6; 95%CI 1.25-2.04 p<0.0001) and a non–PI-containing vs. a boosted PI-containing regimen (HR 1.56; 95% CI 1.25-1.96, p<0.0001). At multivariable analysis, year of ART2 start, pVL at NNRTI failure as well as using a boosted PI remained statistically significant predictors.

Conclusion: This study highlights the role of drugs with high genetic barrier, such as boosted PI as a cornerstone to build a new antiretroviral treatment in patients failing a NNRTI based regimen.

Cite this article as:

Seminari Elena, De Silvestri Annalisa, Meini Genny, Callegaro Annapaola, Boeri Enzo, Punzi Grazia, Gianotti Nicola, Bruzzone Bianca, Tinelli Carmine and Grossi Paolo, Response to Antiretroviral Treatment After Failure of NNRTI Plus NRTIs-Based Therapy. Data from the ARCA Collaborative Group, Current HIV Research 2012; 10 (4) . https://dx.doi.org/10.2174/157016212800792469