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- Title
Antiretroviral drug reduction in highly experienced HIV-infected patients receiving a multidrug regimen: the ECOVIR study.
- Authors
Valantin, Marc-Antoine; Durand, Lise; Wirden, Marc; Assoumou, Lambert; Caby, Fabienne; Soulié, Cathia; Nguyen, Thi Thu-Thuy; Tubiana, Roland; Kirstetter, Myriam; Junot, Helga; Marcelin, Anne-Geneviève; Peytavin, Gilles; Tilleul, Patrick; Katlama, Christine
- Abstract
<bold>Objectives: </bold>In a context of life-long therapy, we asked whether it could be possible to reduce the number of antiretroviral drugs without jeopardizing viral suppression.<bold>Methods: </bold>ECOVIR was a prospective study aiming to assess whether in patients on combination ART with ≥4 antiretrovirals for ≥24 weeks and virally suppressed for ≥48 weeks, a drug-reduced (DR) regimen could be proposed. The intervention consisted of discontinuing genotypically less susceptible drugs to reach a DR regimen with ≤3 antiretrovirals. The primary endpoint was the proportion of patients maintaining viral suppression at week (W) 24.<bold>Results: </bold>From 89 eligible individuals for the study, a DR regimen was proposed in 86 (97%) patients, of whom 71 were switched to a DR regimen. Baseline characteristics [median (IQR)] were: age 58 (53-65) years, duration of treatment 24 (21-26) years and viral suppression 8 (6-11) years. The cumulative resistance profile showed full resistance to lamivudine/emtricitabine (91%), abacavir (74%), efavirenz/nevirapine (70%), rilpivirine (56%), darunavir (q24h/q12h) (42%/29%), lopinavir (69%), atazanavir (71%) and raltegravir (24%). The final DR regimen consisted of a two-drug or three-drug regimen in 54 patients (76%) and in 17 patients (24%), respectively. The success rate of a DR regimen at W24 was 93.9% (95% CI 84.4-97.6, Kaplan-Meier estimate). Four patients experienced virological failure (at W4, W8 and W12), all with plasma viral load (pVL) <600 copies/mL and no emergence of resistance mutations. The DR strategy allowed a monthly cost saving of 36%.<bold>Conclusions: </bold>In experienced patients with high-level resistance, individualized strategies based on expert advice can offer DR regimen options with fewer drug-drug interactions and a significant economic impact while ensuring virological success.
- Subjects
RALTEGRAVIR; ANTIRETROVIRAL agents; EFAVIRENZ; VIRAL load; ECONOMIC impact; HIV infections
- Publication
Journal of Antimicrobial Chemotherapy (JAC), 2019, Vol 74, Issue 9, p2716
- ISSN
0305-7453
- Publication type
journal article
- DOI
10.1093/jac/dkz255