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Title

Salvage therapy with abacavir plus a non-nucleoside reverse transcriptase inhibitor and a protease inhibitor in heavily pre-treated HIV-1 infected patients. Swiss HIV Cohort Study

Authors
Khanna, Nina
Klimkait, T.
Schiffer, V.
Irigoyen, J.
Telenti, A.
Battegay, M.
Published in AIDS. 2000, vol. 14, no. 7, p. 791-799
Abstract BACKGROUND: Highly active antiretroviral therapy (HAART) may fail, especially in pre-treated patients. OBJECTIVE: To examine retrospectively whether heavily pre-treated patients not responding to HAART at least once respond to a salvage therapy with abacavir, a nucleoside reverse transcriptase inhibitor (NRTI) plus a non-nucleoside analogue reverse transcriptase inhibitor (NNRTI) and one or two protease inhibitors (PI). PATIENTS: We retrospectively identified and analysed patients followed in the Swiss HIV Cohort Study with > 1000 HIV RNA copies/ml on HAART, naive to abacavir who were switched to abacavir plus one NNRTI (efavirenz or nevirapine) and one or two PI which had not been used in the previous HAART. RESULTS: Of 23 identified HIV-infected patients with four (median) therapy changes before salvage, 10 patients (43%) achieved a decrease of plasma HIV RNA > 0.5 log10 at 6 months of therapy. After 6 months only two patients had an HIV-1 RNA < 500 copies/ml, one of them < 50 copies/ml. Seven patients increased their CD4 cell counts by > 30% above baseline. Three patients, all with CD4 cell counts < 100 x 10(6)/l before salvage therapy had a > 30% decline in CD4 cell count. An extended number of resistance-associated mutations was found in almost all patients at baseline. One patient had two new AIDS-defining events. Five patients (22%) discontinued treatment because of side-effects, mainly occurrence of a rash. CONCLUSION: Salvage therapy in intensively pre-treated patients has a low virological success rate despite usage of abacavir and NNRTI. Nevertheless, this did not correlate with immunological and clinical course. This study emphasizes the difficulty of second-line treatment in HIV-1 infection and stresses the need for new compounds.
Keywords AdultAnti-HIV Agents/pharmacology/ therapeutic useCD4 Lymphocyte CountCohort StudiesDideoxynucleosides/pharmacology/ therapeutic useDisease ProgressionDrug Resistance, Microbial/geneticsDrug Therapy, CombinationFemaleHIV Infections/ drug therapy/virologyHIV Protease Inhibitors/pharmacology/therapeutic useHIV Reverse Transcriptase/geneticsHIV-1/drug effects/enzymology/genetics/ physiologyHumansMaleMiddle AgedMutationRNA, Viral/bloodRetrospective StudiesReverse Transcriptase Inhibitors/pharmacology/ therapeutic useSalvage Therapy
Identifiers
PMID: 10839586
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KHANNA, Nina et al. Salvage therapy with abacavir plus a non-nucleoside reverse transcriptase inhibitor and a protease inhibitor in heavily pre-treated HIV-1 infected patients. Swiss HIV Cohort Study. In: AIDS, 2000, vol. 14, n° 7, p. 791-799. https://archive-ouverte.unige.ch/unige:7381

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Deposited on : 2010-06-21

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