Durability & Effectiveness of Maraviroc-Containing Regimens in HIV-1-Infected Individuals with Virological Failure in Routine Clinical Practice

Introduction

Limited data are available on the durability and effectiveness of maraviroc in routine clinical practice. We assessed the durability of maraviroc-containing regimens during a 30-month period, as well as their immunovirological and clinical efficacy, according to viral tropism in treatment-experienced individuals with viral load (VL) >50 copies/ml in the French Hospital Database on HIV.

Methods

Virological success was defined as VL<50 copies/ml, immunological success as a confirmed increase of at least 100 CD4 cells/mm³ measured twice at least one month apart, and clinical failure as hospitalization for a non-AIDS event, an AIDS event, or death. Multivariable Cox regression models adjusted for potential confounders were used to assess the influence of viral tropism on durability, the immunovirological responses, and clinical outcome.

Results

356 individuals started maraviroc with VL>50 copies/ml of whom 223 harbored R5 viruses, 44 non-R5 viruses and 89 viruses of unknown tropism. Individuals with non-R5 viruses were more likely than individuals with R5 viruses to discontinue maraviroc (75% vs 34%, p<0.0001). At 30 months, the estimated rates of virological and immunological success were respectively 89% and 51% in individuals with R5 viruses and 48% and 23% in individuals with non-R5 viruses. In multivariable analysis, non-R5 viruses were associated with a lower likelihood of both virological success (hazard ratio (HR): 0.42; 95% confidence interval (CI), 0.25–0.70) and immunological success (HR: 0.37; 95% CI, 0.18–0.77). No difference in clinical outcome was found between individuals with R5 and non-R5 viruses. The effectiveness of maraviroc-containing regimens in individuals with unknown viral tropism was not significantly different from that in individuals with R5 viruses. A limitation of the study is the absence of genotypic susceptibility score.

Conclusion

In this observational study, maraviroc-containing regimens yielded high rates of viral suppression and immunological responses in individuals with R5 viruses in whom prior regimens had failed.

Below:  Discontinuations

Full article at:   http://goo.gl/CzAKjI

By:   

Valérie Potard, Dominique Costagliola

Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Paris, France

Valérie Potard, Dominique Costagliola

INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France

Valérie Potard

Inserm Transfert, Paris, France

Jacques Reynes

Université Montpellier, Montpellier, France

Jacques Reynes

IRD, UMI233 TransVIHMI Montpellier, France

Jacques Reynes

Département de Maladies Infectieuses et Tropicales, CHU Montpellier, France

Tristan Ferry

Services de Maladies Infectieuses et Tropicales, Hospices Civils de Lyon; Université Claude Bernard Lyon1; CIRI, International Center for Infectiology Research, INSERM U1111, Lyon, France

Céline Aubin

Laboratoire GSK, Marly-Le-Roi, France

Laurent Finkielsztejn

Laboratoire ViiVHealthcare, Marly-Le-Roi, France

Yazdan Yazdanpanah

Université Paris Diderot 7, Paris, France

Yazdan Yazdanpanah

INSERM, UMR_S 1137, ATIP-Avenir Inserm: "Modélisation, Aide à la Décision, et Coût-Efficacité en Maladies Infectieuses”, Paris, France

Yazdan Yazdanpanah

Service des Maladies Infectieuses et Tropicales, Hôpital Bichat, France

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