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553. A Retrospective Study to Evaluate the Safety and Efficacy of a Nucleoside-Sparing Regimen of Darunavir, Ritonavir, and Dolutegravir

BACKGROUND: Nucleoside reverse transcriptase inhibitors (NRTIs) may contribute to or exacerbate cardiovascular risk, bone loss, and renal dysfunction. Darunavir (DRV) and dolutegravir (DTG) have a high barrier to resistance and proven tolerability profile, but have not been well studied as part of a...

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Autores principales: Verna, John, Austin, Stephen
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6255063/
http://dx.doi.org/10.1093/ofid/ofy210.561
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author Verna, John
Austin, Stephen
author_facet Verna, John
Austin, Stephen
author_sort Verna, John
collection PubMed
description BACKGROUND: Nucleoside reverse transcriptase inhibitors (NRTIs) may contribute to or exacerbate cardiovascular risk, bone loss, and renal dysfunction. Darunavir (DRV) and dolutegravir (DTG) have a high barrier to resistance and proven tolerability profile, but have not been well studied as part of an NRTI sparing regimen. The purpose of this study was to determine the real-world efficacy and safety of an NRTI-sparing regimen of boosted DRV and DTG. METHODS: We conducted a retrospective chart review (NCT03198884) of ~400 HIV+ patients at an urban Federally Qualified Health Center to identify those who started an NRTI-sparing regimen of ritonavir(r) boosted DRV and DTG once-daily (QD). Included subjects were (3) 18 years of age, receiving DRV/r QD + DTG QD for (3) 24 weeks, and had 48 weeks of laboratory data available. Subjects were excluded if they, missed >5 doses over 2 weeks prior study visit, or had missing laboratory data for (3) two study time points. The primary endpoints were the percent of patients with HIV-1 RNA <50 copies/mL at 48 weeks and the change in mean serum creatinine (SCr) from baseline to 48 weeks. Analysis used was the Snapshot algorithm and Wilcoxon signed rank testing, respectively. Additional secondary endpoints included changes in CD4+ cell counts, and incidence and severity of adverse events. RESULTS: Twenty subjects were identified for inclusion. The mean age of the cohort was 51 years with an average of 12.5 years of HIV seropositivity. The mean baseline CD4+ was 485 cells/mm(3) with an HIV-1 RNA of 20,000 copies/mL. The percentage of subjects with HIV-1 RNA <50 copies increased from 45% at baseline to 95% at Week 48 (P = 0.002), 95% CI [2.24; NA], with one subject not having data in the 48-week window. There were no significant differences in SCr from baseline to 48 weeks (P = 0.5753) and no significant changes in CD4+ cell count from baseline at time points 24, 36 or 48 weeks. No subjects experienced virologic failure during the study period, or required genotypic resistance testing. No patients reported adverse events that led to discontinuation of the study regimen. [Image: see text] [Image: see text] CONCLUSION: The once daily regimen of boosted DRV and DTG was effective at achieving or maintaining virologic suppression with no significant adverse events. This regimen offers another viable option for patients unable to tolerate NRTIs. DISCLOSURES: J. Verna, Janssen Pharmaceuticals, Inc.: Investigator, Research support.
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spelling pubmed-62550632018-11-28 553. A Retrospective Study to Evaluate the Safety and Efficacy of a Nucleoside-Sparing Regimen of Darunavir, Ritonavir, and Dolutegravir Verna, John Austin, Stephen Open Forum Infect Dis Abstracts BACKGROUND: Nucleoside reverse transcriptase inhibitors (NRTIs) may contribute to or exacerbate cardiovascular risk, bone loss, and renal dysfunction. Darunavir (DRV) and dolutegravir (DTG) have a high barrier to resistance and proven tolerability profile, but have not been well studied as part of an NRTI sparing regimen. The purpose of this study was to determine the real-world efficacy and safety of an NRTI-sparing regimen of boosted DRV and DTG. METHODS: We conducted a retrospective chart review (NCT03198884) of ~400 HIV+ patients at an urban Federally Qualified Health Center to identify those who started an NRTI-sparing regimen of ritonavir(r) boosted DRV and DTG once-daily (QD). Included subjects were (3) 18 years of age, receiving DRV/r QD + DTG QD for (3) 24 weeks, and had 48 weeks of laboratory data available. Subjects were excluded if they, missed >5 doses over 2 weeks prior study visit, or had missing laboratory data for (3) two study time points. The primary endpoints were the percent of patients with HIV-1 RNA <50 copies/mL at 48 weeks and the change in mean serum creatinine (SCr) from baseline to 48 weeks. Analysis used was the Snapshot algorithm and Wilcoxon signed rank testing, respectively. Additional secondary endpoints included changes in CD4+ cell counts, and incidence and severity of adverse events. RESULTS: Twenty subjects were identified for inclusion. The mean age of the cohort was 51 years with an average of 12.5 years of HIV seropositivity. The mean baseline CD4+ was 485 cells/mm(3) with an HIV-1 RNA of 20,000 copies/mL. The percentage of subjects with HIV-1 RNA <50 copies increased from 45% at baseline to 95% at Week 48 (P = 0.002), 95% CI [2.24; NA], with one subject not having data in the 48-week window. There were no significant differences in SCr from baseline to 48 weeks (P = 0.5753) and no significant changes in CD4+ cell count from baseline at time points 24, 36 or 48 weeks. No subjects experienced virologic failure during the study period, or required genotypic resistance testing. No patients reported adverse events that led to discontinuation of the study regimen. [Image: see text] [Image: see text] CONCLUSION: The once daily regimen of boosted DRV and DTG was effective at achieving or maintaining virologic suppression with no significant adverse events. This regimen offers another viable option for patients unable to tolerate NRTIs. DISCLOSURES: J. Verna, Janssen Pharmaceuticals, Inc.: Investigator, Research support. Oxford University Press 2018-11-26 /pmc/articles/PMC6255063/ http://dx.doi.org/10.1093/ofid/ofy210.561 Text en © The Author(s) 2018. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Abstracts
Verna, John
Austin, Stephen
553. A Retrospective Study to Evaluate the Safety and Efficacy of a Nucleoside-Sparing Regimen of Darunavir, Ritonavir, and Dolutegravir
title 553. A Retrospective Study to Evaluate the Safety and Efficacy of a Nucleoside-Sparing Regimen of Darunavir, Ritonavir, and Dolutegravir
title_full 553. A Retrospective Study to Evaluate the Safety and Efficacy of a Nucleoside-Sparing Regimen of Darunavir, Ritonavir, and Dolutegravir
title_fullStr 553. A Retrospective Study to Evaluate the Safety and Efficacy of a Nucleoside-Sparing Regimen of Darunavir, Ritonavir, and Dolutegravir
title_full_unstemmed 553. A Retrospective Study to Evaluate the Safety and Efficacy of a Nucleoside-Sparing Regimen of Darunavir, Ritonavir, and Dolutegravir
title_short 553. A Retrospective Study to Evaluate the Safety and Efficacy of a Nucleoside-Sparing Regimen of Darunavir, Ritonavir, and Dolutegravir
title_sort 553. a retrospective study to evaluate the safety and efficacy of a nucleoside-sparing regimen of darunavir, ritonavir, and dolutegravir
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6255063/
http://dx.doi.org/10.1093/ofid/ofy210.561
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