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Lambert-Niclot S, Grude M, Chaix ML, Charpentier C, Reigadas S, Le Guillou-Guillemette H, Rodallec A, Amiel C, Maillard A, Dufayard J, Mourez T, Mirand A, Guinard J, Montes B, Vallet S, Marcelin AG, Descamps D, Flandre P, Delaugerre C, Morand-Joubert L. Emerging resistance mutations in PI-naive patients failing an atazanavir-based regimen (ANRS multicentre observational study). J Antimicrob Chemother 2019; 73:2147-2151. [PMID: 29718247 DOI: 10.1093/jac/dky142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 03/21/2018] [Indexed: 11/12/2022] Open
Abstract
Background Atazanavir is a PI widely used as a third agent in combination ART. We aimed to determine the prevalence and the patterns of resistance in PI-naive patients failing on an atazanavir-based regimen. Methods We analysed patients failing on an atazanavir-containing regimen used as a first line of PI therapy. We compared the sequences of reverse transcriptase and protease before the introduction of atazanavir and at failure [two consecutive viral loads (VLs) >50 copies/mL]. Resistance was defined according to the 2014 Agence Nationale de Recherche sur le SIDA et les Hépatites Virales (ANRS) algorithm. Results Among the 113 patients, atazanavir was used in the first regimen in 71 (62.8%) patients and in the first line of a PI-based regimen in 42 (37.2%). Atazanavir was boosted with ritonavir in 95 (84.1%) patients and combined with tenofovir/emtricitabine or lamivudine (n = 81) and abacavir/lamivudine or emtricitabine (n = 22). At failure, median VL was 3.05 log10 copies/mL and the median CD4+ T cell count was 436 cells/mm3. The median time on atazanavir was 21.2 months. At failure, viruses were considered resistant to atazanavir in four patients (3.5%) with the selection of the following major atazanavir-associated mutations: I50L (n = 1), I84V (n = 2) and N88S (n = 1). Other emergent PI mutations were L10V, G16E, K20I/R, L33F, M36I/L, M46I/L, G48V, F53L, I54L, D60E, I62V, A71T/V, V82I/T, L90M and I93L/M. Emergent NRTI substitutions were detected in 21 patients: M41L (n = 2), D67N (n = 3), K70R (n = 1), L74I/V (n = 3), M184V/I (n = 16), L210W (n = 1), T215Y/F (n = 3) and K219Q/E (n = 2). Conclusions Resistance to atazanavir is rare in patients failing the first line of an atazanavir-based regimen according to the ANRS. Emergent NRTI resistance-associated mutations were reported in 18% of patients.
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Affiliation(s)
- S Lambert-Niclot
- Sorbonne University, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Service de Virologie, APHP, Hôpital Saint-Antoine, INSERM UPMC UMR_S, Paris, France
| | - M Grude
- INSERM UPMC UMR_S, Paris, France
| | - M L Chaix
- Hôpital Saint-Louis, Université Paris Diderot, INSERM, Paris, France
| | - C Charpentier
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, AP-HP, Laboratoire de Virologie, Hôpital Bichat, AP-HP, Paris, France
| | - S Reigadas
- Hôpital Pellegrin, Centre de ressources biologiques plurithématique, CHU de Bordeaux, Bordeaux, France
| | | | | | - C Amiel
- Hôpital Tenon, UPMC, CR7, Paris, France
| | | | | | - T Mourez
- CHU Charles Nicolle, Rouen, France
| | - A Mirand
- CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - J Guinard
- Hôpital La Source-CHR Orléans, Orléans, France
| | - B Montes
- Hôpital Saint-Eloi, Montpellier, France
| | - S Vallet
- CHRU La Cavale Blanche, Brest, France
| | - A G Marcelin
- Sorbonne University, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Service de Virologie, APHP Hôpital Pitié-Salpêtrière, Paris, France
| | - D Descamps
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, AP-HP, Laboratoire de Virologie, Hôpital Bichat, AP-HP, Paris, France
| | | | - C Delaugerre
- Hôpital Saint-Louis, Université Paris Diderot, INSERM, Paris, France
| | - L Morand-Joubert
- Sorbonne University, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Service de Virologie, APHP, Hôpital Saint-Antoine, INSERM UPMC UMR_S, Paris, France
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Elliot ER, Bisdomini E, Penchala SD, Khoo S, Nwokolo N, Boffito M. Pharmacokinetics (PK) of ethinylestradiol/levonorgestrel co-administered with atazanavir/cobicistat. HIV Res Clin Pract 2019; 20:82-91. [PMID: 31335301 DOI: 10.1080/25787489.2019.1638077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background and objectives: Access to safe and reliable contraception in the context of ARVs is essential. This study aimed to investigate the steady-state pharmacokinetics (PK) of ethinylestradiol/levonorgestrel (EE/LNG) 30/150 μg (Microgynon®) and atazanavir/cobicistat (ATV/COBI) 300/150 mg (Evotaz®), co-administered in HIV negative female volunteers, and assess its safety and tolerability. Methods: This phase 1, open label, 57-day, cross over, PK study randomized participants to one of two groups: (i) group 1 received EE/LNG alone on days 1-21, EE/LNG (21 days) + ATV/COBI (14 days) in the co-administration phase (days 22-42) and ATV/COBI alone on days 43-56; (ii) group 2 followed the same sequence but started with ATV/COBI and concluding with EE/LNG. Each group underwent intensive PK sampling on days 14, 35, and 56. EE/LNG and ATV/COBI concentrations were measured using validated LC-MS/MS methods. Results: Of 14 healthy female volunteers screened, 11 attended baseline and six completed all PK phases (five withdrew secondary to side effects). Paired data were available for analysis in six subjects for EE/LNG and eight for ATV/COBI. Geometric mean ratios (GMR, with versus without ATV/COBI) and 90% confidence intervals (CI) for LNG Cmax, AUC0-24, C24 were 0.83 (0.68-1.02), 0.92 (0.71-1.18), 1.01 (0.73-1.38). GMR and 90% CI for EE Cmax, AUC0-24, C24 were 1.05 (0.92-1.19), 1.01 (0.83-1.22), 0.75 (0.60-0.93). No grade 3 or 4 adverse events or laboratory abnormalities were observed in the women who completed the study. Conclusions: Our findings showed no significant changes in LNG concentrations and a 25% decrease in EE C24 when EE/LNG was co-administered with ATV/COBI.
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Affiliation(s)
- Emilie R Elliot
- a St. Stephen's AIDS Trust-Chelsea and Westminster Hospital , London , UK
| | - Elisa Bisdomini
- a St. Stephen's AIDS Trust-Chelsea and Westminster Hospital , London , UK
| | - Sujan Dilly Penchala
- b Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool , Liverpool , UK
| | - Saye Khoo
- b Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool , Liverpool , UK
| | - Nneka Nwokolo
- a St. Stephen's AIDS Trust-Chelsea and Westminster Hospital , London , UK
| | - Marta Boffito
- a St. Stephen's AIDS Trust-Chelsea and Westminster Hospital , London , UK.,b Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool , Liverpool , UK.,c Department of Medicine, Imperial College , London , UK
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McLaughlin MM, Guerrero AJ, Merker A. Renal effects of non-tenofovir antiretroviral therapy in patients living with HIV. Drugs Context 2018; 7:212519. [PMID: 29623097 PMCID: PMC5866095 DOI: 10.7573/dic.212519] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 02/22/2018] [Accepted: 02/22/2018] [Indexed: 12/19/2022] Open
Abstract
A review of literature published regarding non-tenofovir antiretroviral agents causing renal adverse effects was conducted. The literature involving renal adverse effects and antiretroviral therapy is most robust with protease inhibitors, specifically atazanavir and indinavir, and includes reports of crystalluria, leukocyturia, nephritis, nephrolithiasis, nephropathy and urolithiasis. Several case reports describe potential nephropathy (including Fanconi syndrome) secondary to administration of abacavir, didanosine, lamivudine and stavudine. Case reports documented renal events such as acute renal failure, nephritis, proteinuria and renal stones with efavirenz administration. Regarding rilpivirine, a small increase of serum creatinine levels (SCr) was found in clinical trials; however, the clinical significance and impact on actual renal function is unknown. The integrase strand transfer inhibitors and enfuvirtide have a relatively safe renal profile, although studies have shown dolutegravir and raltegravir cause mild elevations in SCr without an impact on actual renal function. This is similar to the reaction observed with cobicistat, the pharmacokinetic enhancer frequently given with elvitegravir.
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Affiliation(s)
- Milena M McLaughlin
- Chicago College of Pharmacy, Midwestern University, 555 31st Street, Downers Grove, IL 60515, USA.,Northwestern Memorial Hospital, 251 E Huron St, Chicago, IL 60611, USA
| | - Aimee J Guerrero
- Chicago College of Pharmacy, Midwestern University, 555 31st Street, Downers Grove, IL 60515, USA
| | - Andrew Merker
- Chicago College of Pharmacy, Midwestern University, 555 31st Street, Downers Grove, IL 60515, USA.,Mount Sinai Hospital, 1500 S Fairfield Ave, Chicago, IL 60608, USA
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