Optimized Antiretroviral Therapy with Darunavir/Ritonavir, Etravirine and/or Raltegarvir: A Salvage Therapy Option in HIV-1 Infected Patients with Long-Term Therapeutic Failures, about 23 Cases

Vincent Guiyedi, Olivier Mounoury, Soraya Boucherit, Pascale Longuet, C. Brunet-François, Eric Kendjo, J. L. Ecobichon, Madeleine Okome-Nkoumou, Catherine Leport, F. Raffi

Centre Nationale de Référence du Paludisme, UPMC, InVS, Paris, France.
Departement de Maladies Infectieuses et Tropicales, Faculté de Médecine de Libreville, Université des Sciences de la Santé, Libreville, Gabon.
Laboratoire de Recherche en Pathologie Infectieuse, Université Diderot-Paris, Paris, France.
Service des Maladies Infectieuses et Tropicales, CHU Xavier BICHAT, APHP, Paris, France.
Service des Maladies Infectieuses et Tropicales, Hotel Dieu, CHU Nantes, France.

DOI: 10.4236/wja.2012.24040                

Abstract

Objectives: The aims of this study was to analyze the immuno-virologic response after optimised background antiretroviral therapy (OBT) associated to new active antiretroviral treatment (ART) in HIV-1 infected patients with chronic virologic failure. Methods: We conducted a descriptive analysis of the immuno-virologic responses in HIV-1 adult infected patients: 1) harbouring multiple therapeutic failures with ART; 2) with no virologic response obtained over 10 years (1997-2008); and 3) treated with OBT combined with new drugs including at least 1 of the 3 active ART among darunavir/ritonavir, etravirine and raltegravir; 4) observed between month 0 (M0), before new ART to month 12 (M12) after new ART initialisation. Results: Twenty three patients were included in the study. After OBT, the proportion of patients with undetectable viral load was significantly higher at M6 and M12 than M0 (86% and 73% versus 0%, p = 0.03, respectively). At the same period, the median HIV viral load decreased significantly in 19/23 (83%) patients from 4.3 to 1.69log₁₀ HIV-1 RNA copies/ml (p < 0.001, respectively). The median CD4-T cells count increased significantly from 171/mm³ [0 - 604] to 449/mm³ [130 - 964] between M0 and M12 (p < 0.001), while the proportion of patients with CD4-T cells count below 200/mm³ decreased from 57% to 23% (p = 0.02). Tolerability was good and no death was recorded during the 12-month' follow-up. Conclusions: These results show that the combination of OBT with the new ART can offer a salvage therapy in patients presenting a long-term history of virologic failures.

Keywords

Darunavir/Ritonavir; Etravirine; Raltegravir; HIV-1

Conflicts of Interest

The authors declare no conflicts of interest.

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