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De Luca A, Pezzotti P, Boucher C, Döring M, Incardona F, Kaiser R, Lengauer T, Pfeifer N, Schülter E, Vandamme AM, Zazzi M, Geretti AM. Clinical use, efficacy, and durability of maraviroc for antiretroviral therapy in routine care: A European survey. PLoS One 2019; 14:e0225381. [PMID: 31751385 PMCID: PMC6874206 DOI: 10.1371/journal.pone.0225381] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 11/04/2019] [Indexed: 01/22/2023] Open
Abstract
Objectives The study aimed to survey maraviroc use and assess effectiveness and durability of maraviroc-containing antiretroviral treatment (ART) in routine practice across Europe. Methods Data were retrieved from 26 cohorts in 8 countries comprising adults who started maraviroc in 2005–2016 and had ≥1 follow-up visit. Available V3 sequences were re-analysed centrally for tropism determination by geno2pheno[coreceptor]. Treatment failure (TF) was defined as either virological failure (viral load >50 copies/mL) or maraviroc discontinuation for any reason over 48 weeks. Predictors of TF were explored by logistic regression analysis. Time to maraviroc discontinuation was estimated by Kaplan-Meier survival analysis. Results At maraviroc initiation (baseline), among 1,381 patients, 67.1% had experienced ≥3 ART classes and 45.6% had a viral load <50 copies/mL. Maraviroc was occasionally added to the existing regimen as a single agent (7.3%) but it was more commonly introduced alongside other new agents, and was often (70.4%) used with protease inhibitors. Accompanying drugs comprised 1 (40.2%), 2 (48.6%) or ≥3 (11.2%) ART classes. Among 1,273 patients with available tropism data, 17.6% showed non-R5 virus. Non-standard maraviroc use also comprised reported once daily dosing (20.0%) and a total daily dose of 150mg (12.1%). Over 48 weeks, 41.4% of patients met the definition of TF, although the 1-year estimated retention on maraviroc was 82.1% (95% confidence interval 79.9–84.2). Among 1,010 subjects on maraviroc at week 48, the viral load was >50 copies/mL in 19.9% and >200 copies/mL in 10.7%. Independent predictors of TF comprised a low nadir CD4 count, a detectable baseline viral load, previous PI experience, non-R5 tropism, having ≥3 active drugs in the accompanying regimen, and a more recent calendar year of maraviroc initiation. Conclusions This study reports on the largest observation cohort of patients who started maraviroc across 8 European countries. In this overall highly treatment-experienced population, with a small but appreciable subset that received maraviroc outside of standard treatment guidelines, maraviroc was safe and reasonably effective, with relatively low rates of discontinuation over 48 weeks and only 2 cases of serum transaminase elevations reported as reasons for discontinuation.
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Affiliation(s)
- Andrea De Luca
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
- Unità Operativa Complessa Malattie Infettive, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Patrizio Pezzotti
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Charles Boucher
- Department of Viroscience, Erasmus Medical Center, Rotterdam, Netherlands
| | - Matthias Döring
- Max Planck Institute for Informatics, Saarland Informatics Campus, Saarbrücken, Germany
| | | | - Rolf Kaiser
- Institute of Virology, University of Cologne, Cologne, Germany
| | - Thomas Lengauer
- Max Planck Institute for Informatics, Saarland Informatics Campus, Saarbrücken, Germany
| | - Nico Pfeifer
- Max Planck Institute for Informatics, Saarland Informatics Campus, Saarbrücken, Germany
- Department of Computer Science, University of Tübingen, Tübingen, Germany
| | - Eugen Schülter
- Institute of Virology, University of Cologne, Cologne, Germany
| | - Anne-Mieke Vandamme
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Rega Institute for Medical Research, Clinical and Epidemiological Virology, Leuven, Belgium
- Center for Global Health and Tropical Medicine, Unidade de Microbiologia, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Maurizio Zazzi
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Anna Maria Geretti
- Institute of Infection and Global Health, University of Liverpool, Liverpool, England, United Kingdom
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Pujari S, Gaikwad S, Bele V, Joshi K, Dabhade D. High Virologic Failure Rates with Maraviroc-Based Salvage Regimens Among Indian Patients: A Preliminary Analysis-Maraviroc Effectiveness in HIV-1 Subtype C. J Int Assoc Provid AIDS Care 2019; 17:2325958218759211. [PMID: 29473485 PMCID: PMC6748454 DOI: 10.1177/2325958218759211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND There is no information on the clinical effectiveness of Maraviroc (MVC) amongst People Living with HIV (PLHIV) in India infected with HIV-1 Subtype C viruses. METHODS We conducted a retrospective chart review of adult PLHIV on MVC based Antiretroviral (ARV) regimens for at least 6 months. Maraviroc was initiated amongst PLHIV with documented R5 tropic viruses (determined by in-house population sequencing of the V3 loop in triplicate and interpreted using the Geno2Pheno algorithm) in combination with an Optimized Background regimen (designed using genotypic resistance testing and past ARV history). Plasma viral loads (PVL) are performed 6 months post-initiation and annually thereafter. Primary outcome d. Median duration on MVC treatment was 1.8 years (range 1-2.9 years) while median duration of ART prior to switching to MVC was 13 years. Maraviroc was combined with Darunavir/ritonavir (DRV/r) (n=10), Atazanavir/r (ATV/r) (n=2) and Lopinavir/r (LPV/r) (n=1). All PLHIV were infected with HIV-1 Subtype C. Only 23.3% PLHIV achieved virologic suppression at 6 months and sustained it for 2.3 years. Median CD4 count change from baseline was +117 (n=13), +228 (n=10), +253 (n=9), and +331 (n=4) at 6, 12, 18 and 24 months respectively. Repeat tropism among patients with virologic failure demonstrated R5 virus. CONCLUSIONS High rates of virologic failure was seen when MVC was used amongst treatment experienced PLHIV infected with HIV-1 Subtype C in India. was the proportion of PLHIV with virologic success (PVL<50 copies/ml) at last follow up visit. RESULTS Data on 13 PLHIV were analyze.
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Affiliation(s)
- Sanjay Pujari
- 1 Institute of Infectious Diseases, Mukund Nagar, Pune, Maharashtra, India
| | - Sunil Gaikwad
- 1 Institute of Infectious Diseases, Mukund Nagar, Pune, Maharashtra, India
| | - Vivek Bele
- 1 Institute of Infectious Diseases, Mukund Nagar, Pune, Maharashtra, India
| | - Kedar Joshi
- 1 Institute of Infectious Diseases, Mukund Nagar, Pune, Maharashtra, India
| | - Digamber Dabhade
- 1 Institute of Infectious Diseases, Mukund Nagar, Pune, Maharashtra, India
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Deconinck L, Robineau O, Valette M, Choisy P, Bocket L, Meybeck A, Ajana F. Clinical impact of tropism testing in a real-life cohort of HIV infected patients: a retrospective observational study. BMC Infect Dis 2019; 19:467. [PMID: 31126239 PMCID: PMC6534926 DOI: 10.1186/s12879-019-4047-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 04/29/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The circumstances of prescription of tropism tests clinically relevant in treatment-experienced patients are unclear. METHODS We performed a monocentric retrospective analysis of all tropism tests performed between 2006 and 2015 in HIV-infected patients on antiretroviral therapy (ART) without MVC. The motivation of tropism determination was collected. Factors associated with MVC prescription were determined using logistic regression analysis. RESULTS Five hundred sixty-three tests were performed in experienced patients not receiving MVC. Reasons for tropism performance were: virological failure (44%), side effects or drug-interactions (37%), simplification or sparing strategies (11%), immunological failure (5%), and improvement of neurological diffusion (3%). MVC was prescribed in 110 cases (20%), though 366 tests (65%) revealed a tropism CCR5. MVC was more often prescribed before 2011 (OR 3.65, 95% CI 2.17-6.13) and in patients with multiple previous ART regimens (less than 4 ART regimens compare to more than 10 ART regimens (OR 0.34, 95% CI 0.15-0.74)). CONCLUSIONS In experienced patients not receiving MVC, tropism test prescription should be restricted to patients with virological failure and limited therapeutic options such as patients already treated with a wide range of ART regimens.
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Affiliation(s)
- Laurène Deconinck
- Infectious Diseases Department, Tourcoing Hospital, Tourcoing, France.
| | - Olivier Robineau
- Infectious Diseases Department, Tourcoing Hospital, Tourcoing, France
| | - Michel Valette
- Infectious Diseases Department, Tourcoing Hospital, Tourcoing, France
| | - Philippe Choisy
- Infectious Diseases Department, Tourcoing Hospital, Tourcoing, France
| | - Laurence Bocket
- Virology Department, Lille University Hospital, Lille, France
| | - Agnes Meybeck
- Infectious Diseases Department, Tourcoing Hospital, Tourcoing, France
| | - Faiza Ajana
- Infectious Diseases Department, Tourcoing Hospital, Tourcoing, France
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Dentone C, Sterrantino G, Signori A, Cenderello G, Guerra M, De Leo P, Bartolacci V, Mantia E, Orofino G, Giacomini M, Bruzzone B, Francisci D, Di Biagio A. Effectiveness, safety, durability and immune recovery in a retrospective, multicentre, observational cohort of ART-experienced, HIV-1-infected patients receiving maraviroc. Int J STD AIDS 2017; 28:1067-1073. [PMID: 28142395 DOI: 10.1177/0956462416687828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this retrospective, multicentre, observational study was to assess the durability, safety, immune recovery and effectiveness on viral suppression of antiretroviral therapy (ART) in a maraviroc (MVC)-based cohort. We collected clinical, demographical, immunological and virological parameters of adult HIV patients who were infected by CCR5-tropic virus and started an ART regimen containing MVC from 2005 to 2012. We created a longitudinal mixed model to assess the change over time of data. We enrolled 126 drug-experienced patients; the median duration of MVC treatment was 25 months. The probability of stopping ART at one year was 13.3%, and at three years was 27.3%. Statistically significant changes were observed for CD4+ cell count increase ( p < 0.001), HIV-RNA decrease ( p < 0.001) and total cholesterol decrease ( p = 0.005). Ninety-four patients (79.7%) had CD4 ≥ 200 cells/mm3 at baseline while nine of them reached this threshold at nine months (7.6%), 17 (13%) after nine months and six (5%) remained below 200 cells/mm3 at the end of the study. Overall, 114 patients (90.5%) achieved an HIV-RNA ≤ 50 cp/ml. A majority of patients maintained CD4 cell counts of ≥ 200 cells/mm3 and achieved an undetectable HIV viral load within three months. MVC-containing regimens are safe and appear to be a feasible therapeutic option for ART.
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Affiliation(s)
- C Dentone
- 1 Infectious Diseases Department, Sanremo Hospital, Sanremo, Italy
| | - G Sterrantino
- 2 Infectious and Tropical Diseases Department, Careggi Hospital, University of Florence, Florence, Italy
| | - A Signori
- 3 Department of Health Sciences (DISSAL), Section of Biostatistics, University of Genoa, Genoa, Italy
| | - G Cenderello
- 4 Infectious Diseases Department, Galliera Hospital, Genoa, Italy
| | - M Guerra
- 5 Infectious Diseases Department, La Spezia Hospital, La Spezia, Italy
| | - P De Leo
- 6 Infectious Diseases Department, San Paolo Hospital, Savona, Italy
| | - V Bartolacci
- 7 Infectious Diseases Department, Albenga Hospital, Albenga, Italy
| | - E Mantia
- 8 Infectious Diseases Department, SS. Antonio, Biagio, Cesare Arrigo Hospital, Alessandria, Italy
| | - G Orofino
- 9 Infectious Diseases Department, Amedeo di Savoia Hospital, Turin, Italy
| | - M Giacomini
- 10 Department of Informatics, Bioengineering, Robotic and System Engineering (DIBRIS), University of Genoa, Genoa, Italy
| | - B Bruzzone
- 11 DISSAL, Section of Virology, University of Genoa, Genoa, Italy
| | - D Francisci
- 12 Infectious Diseases Department, University of Perugia, Perugia, Italy
| | - A Di Biagio
- 13 Infectious Diseases Department, IRCCS San Martino Hospital, Genoa, Italy
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Ali ES, Rajapaksha H, Carr JM, Petrovsky N. Norovirus drug candidates that inhibit viral capsid attachment to human histo-blood group antigens. Antiviral Res 2016; 133:14-22. [PMID: 27421712 DOI: 10.1016/j.antiviral.2016.07.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Revised: 07/02/2016] [Accepted: 07/06/2016] [Indexed: 01/11/2023]
Abstract
Human noroviruses are the leading causative agents of epidemic and sporadic viral gastroenteritis and childhood diarrhoea worldwide. Human histo-blood group antigens (HBGA) serve as receptors for norovirus capsid protein attachment and play a critical role in infection. This makes HBGA-norovirus binding a promising target for drug development. Recently solved crystal structures of norovirus bound to HBGA have provided a structural basis for identification of potential anti-norovirus drugs and subsequently performed in silico and in vitro drug screens have identified compounds that block norovirus binding and may thereby serve as structural templates for design of therapeutic norovirus inhibitors. This review explores norovirus therapeutic options based on the strategy of blocking norovirus-HBGA binding.
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Affiliation(s)
- Eunüs S Ali
- School of Medicine, Flinders University, Adelaide, South Australia, Australia
| | - Harinda Rajapaksha
- Vaxine Pty Ltd, Flinders Medical Centre/Flinders University, Adelaide, South Australia, Australia
| | - Jillian M Carr
- Department of Microbiology & Infectious Diseases, School of Medicine, Flinders University, Adelaide, South Australia, Australia
| | - Nikolai Petrovsky
- School of Medicine, Flinders University, Adelaide, South Australia, Australia; Vaxine Pty Ltd, Flinders Medical Centre/Flinders University, Adelaide, South Australia, Australia.
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