Background. Virologic failure (VF) on a first-line ritonavir-boosted protease inhibitor (PI/r) regimen is associated with low rates of resistance, but optimal management after failure is unknown

Benson, Constance A.

Campbell, Thomas B.

Currier, Judith S.

Daar, Eric S.

Gulick, Roy M.

Haubrich, Richard

Hosseinipour, Mina C.

Hughes, Michael D.

Lockman, Shahin

Riddler, Sharon A.

Salata, Robert A.

Sax, Paul E.

Zheng, Yu

PubMed

BackgroundVirologic failure (VF) on a first-line ritonavir-boosted protease inhibitor (PI/r) regimen is associated with low rates of resistance, but optimal management after failure is unknown.MethodsThe analysis included participants in randomized trials who experienced VF on a first-line regimen of PI/r plus 2 nucleoside reverse transcriptase inhibitors (NRTIs) and had at least 24 weeks of follow-up after VF. Antiretroviral management and virologic suppression (human immunodeficiency virus type 1 [HIV-1] RNA &lt;400 copies/mL) after VF were assessed.ResultsOf 209 participants, only 1 participant had major PI-associated treatment-emergent mutations at first-line VF. The most common treatment approach after VF (66%) was to continue the same regimen. The virologic suppression rate 24 weeks after VF was 64% for these participants, compared with 72% for those who changed regimens (P = .19). Participants remaining on the same regimen had lower NRTI resistance rates (11% vs 30%; P = .003) and higher CD4(+) cell counts (median, 275 vs 213 cells/µL; P = .005) at VF than those who changed. Among participants remaining on their first-line regimen, factors at or before VF significantly associated with subsequent virologic suppression were achieving HIV-1 RNA &lt;400 copies/mL before VF (odds ratio [OR], 3.39 [95% confidence interval {CI}, 1.32-8.73]) and lower HIV-1 RNA at VF (OR for &lt;10 000 vs ≥10 000 copies/mL, 3.35 [95% CI, 1.40-8.01]). Better adherence after VF was also associated with subsequent suppression (OR for &lt;100% vs 100%, 0.38 [95% CI, .15-.97]). For participants who changed regimens, achieving HIV-1 RNA &lt;400 copies/mL before VF also predicted subsequent suppression.ConclusionsFor participants failing first-line PI/r with no or limited drug resistance, remaining on the same regimen is a reasonable approach. Improving adherence is important to subsequent treatment success

Hughes, Michael D

Benson, Constance A

Hosseinipour, Mina C

Campbell, Thomas B

Gulick, Roy M

Daar, Eric S

Sax, Paul E

Riddler, Sharon A

Salata, Robert A

Currier, Judith S

eScholarship - University of California

Antiretroviral Therapy and Efficacy After Virologic Failure on First-line Boosted Protease Inhibitor Regimens

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https://cdr.lib.unc.edu/downloads/z890s147h

Antiretroviral Therapy and Efficacy After Virologic Failure on First-line Boosted Protease Inhibitor Regimens

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