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Switching to boosted protease inhibitor plus a second antiretroviral drug (dual therapy) for treatment simplification: a multicenter observational study

BACKGROUND: Aim of the study was to assess predictors of discontinuation/toxicity of boosted PI-based (PI/r) dual therapy (DT). METHODS: Observational, retrospective switch study in patients successfully treated with triple drugs regimen. Patients switched to PI/r based DT [darunavir (DRV/r), lopina...

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Autores principales: Latini, Alessandra, Fabbiani, Massimiliano, Borghi, Vanni, Sterrantino, Gaetana, Giannetti, Alberto, Lorenzini, Patrizia, Loiacono, Laura, Ammassari, Adriana, Bellagamba, Rita, Colafigli, Manuela, D’Ettorre, Gabriella, Di Giambenedetto, Simona, Antinori, Andrea, Zaccarelli, Mauro
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4982404/
https://www.ncbi.nlm.nih.gov/pubmed/27515949
http://dx.doi.org/10.1186/s12879-016-1703-z
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author Latini, Alessandra
Fabbiani, Massimiliano
Borghi, Vanni
Sterrantino, Gaetana
Giannetti, Alberto
Lorenzini, Patrizia
Loiacono, Laura
Ammassari, Adriana
Bellagamba, Rita
Colafigli, Manuela
D’Ettorre, Gabriella
Di Giambenedetto, Simona
Antinori, Andrea
Zaccarelli, Mauro
author_facet Latini, Alessandra
Fabbiani, Massimiliano
Borghi, Vanni
Sterrantino, Gaetana
Giannetti, Alberto
Lorenzini, Patrizia
Loiacono, Laura
Ammassari, Adriana
Bellagamba, Rita
Colafigli, Manuela
D’Ettorre, Gabriella
Di Giambenedetto, Simona
Antinori, Andrea
Zaccarelli, Mauro
author_sort Latini, Alessandra
collection PubMed
description BACKGROUND: Aim of the study was to assess predictors of discontinuation/toxicity of boosted PI-based (PI/r) dual therapy (DT). METHODS: Observational, retrospective switch study in patients successfully treated with triple drugs regimen. Patients switched to PI/r based DT [darunavir (DRV/r), lopinavir (LPV/r) or atazanavir (ATV/r)] plus a second drug: [raltegravir (RAL), maraviroc (MVC) etravirine (ETR), lamivudine (3TC) or tenofovir (TDF)] between 2009 and 2014 were included. The effect of each drug as well as other clinical and virological cofactors over treatment discontinuation (TD) was assessed using survival analysis. RESULTS: Overall, 376 patients were included with mean follow-up of 73 weeks. The most commonly used drugs in DT were DRV/r (63.0 %) and RAL (53.7 %). TD was observed in 77 (20,4 %) patients: 38 (10,1 %) virological failure, 35 (9,3 %) toxicity/intolerance (4 deaths) and 4 (1 %) interruptions for patients decision. At Cox Model, adjusted by demographic and laboratory variables, DRV/r and ATV/r significantly reduced the likelihood of TD and longer treatment was associated with lower risk, while low CD4 count at baseline and number of previous regimens with a higher risk. Moreover, RAL and 3TC use were significantly associated with lower TD by toxicity. CONCLUSIONS: In our clinical practice experience, switching virologically suppressed patients to PI/r based DT showed adequate safety and efficacy, so that it may be used in selected patients with specific medical needs.
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spelling pubmed-49824042016-08-19 Switching to boosted protease inhibitor plus a second antiretroviral drug (dual therapy) for treatment simplification: a multicenter observational study Latini, Alessandra Fabbiani, Massimiliano Borghi, Vanni Sterrantino, Gaetana Giannetti, Alberto Lorenzini, Patrizia Loiacono, Laura Ammassari, Adriana Bellagamba, Rita Colafigli, Manuela D’Ettorre, Gabriella Di Giambenedetto, Simona Antinori, Andrea Zaccarelli, Mauro BMC Infect Dis Research Article BACKGROUND: Aim of the study was to assess predictors of discontinuation/toxicity of boosted PI-based (PI/r) dual therapy (DT). METHODS: Observational, retrospective switch study in patients successfully treated with triple drugs regimen. Patients switched to PI/r based DT [darunavir (DRV/r), lopinavir (LPV/r) or atazanavir (ATV/r)] plus a second drug: [raltegravir (RAL), maraviroc (MVC) etravirine (ETR), lamivudine (3TC) or tenofovir (TDF)] between 2009 and 2014 were included. The effect of each drug as well as other clinical and virological cofactors over treatment discontinuation (TD) was assessed using survival analysis. RESULTS: Overall, 376 patients were included with mean follow-up of 73 weeks. The most commonly used drugs in DT were DRV/r (63.0 %) and RAL (53.7 %). TD was observed in 77 (20,4 %) patients: 38 (10,1 %) virological failure, 35 (9,3 %) toxicity/intolerance (4 deaths) and 4 (1 %) interruptions for patients decision. At Cox Model, adjusted by demographic and laboratory variables, DRV/r and ATV/r significantly reduced the likelihood of TD and longer treatment was associated with lower risk, while low CD4 count at baseline and number of previous regimens with a higher risk. Moreover, RAL and 3TC use were significantly associated with lower TD by toxicity. CONCLUSIONS: In our clinical practice experience, switching virologically suppressed patients to PI/r based DT showed adequate safety and efficacy, so that it may be used in selected patients with specific medical needs. BioMed Central 2016-08-11 /pmc/articles/PMC4982404/ /pubmed/27515949 http://dx.doi.org/10.1186/s12879-016-1703-z Text en © The Author(s). 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Latini, Alessandra
Fabbiani, Massimiliano
Borghi, Vanni
Sterrantino, Gaetana
Giannetti, Alberto
Lorenzini, Patrizia
Loiacono, Laura
Ammassari, Adriana
Bellagamba, Rita
Colafigli, Manuela
D’Ettorre, Gabriella
Di Giambenedetto, Simona
Antinori, Andrea
Zaccarelli, Mauro
Switching to boosted protease inhibitor plus a second antiretroviral drug (dual therapy) for treatment simplification: a multicenter observational study
title Switching to boosted protease inhibitor plus a second antiretroviral drug (dual therapy) for treatment simplification: a multicenter observational study
title_full Switching to boosted protease inhibitor plus a second antiretroviral drug (dual therapy) for treatment simplification: a multicenter observational study
title_fullStr Switching to boosted protease inhibitor plus a second antiretroviral drug (dual therapy) for treatment simplification: a multicenter observational study
title_full_unstemmed Switching to boosted protease inhibitor plus a second antiretroviral drug (dual therapy) for treatment simplification: a multicenter observational study
title_short Switching to boosted protease inhibitor plus a second antiretroviral drug (dual therapy) for treatment simplification: a multicenter observational study
title_sort switching to boosted protease inhibitor plus a second antiretroviral drug (dual therapy) for treatment simplification: a multicenter observational study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4982404/
https://www.ncbi.nlm.nih.gov/pubmed/27515949
http://dx.doi.org/10.1186/s12879-016-1703-z
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