Genotypic tropism testing of proviral DNA to guide maraviroc initiation in aviraemic subjects: 48-week analysis of results from the PROTEST study

OBJECTIVES

Maraviroc (MVC) is a suitable drug for aviraemic subjects on antiretroviral treatment (ART) developing toxicity. Its prescription requires prior tropism testing. It is unknown if proviral DNA genotypic tropism testing is reliable for guiding MVC initiation in aviraemic subjects, so this study was carried out to address this issue.

METHODS

PROTEST was a phase 4, prospective, single-arm clinical trial carried out in 24 HIV care centres in Spain. MVC-naïve HIV-1-infected patients with HIV-1 RNA < 50 copies/mL on stable ART during the previous 6 months who required an ART change because of toxicity and who had R5 HIV, as determined by proviral DNA genotypic tropism testing, initiated MVC with two nucleoside reverse transcriptase inhibitors (NRTIs) and were followed for 48 weeks. Virological failure was defined as two consecutive viral load measurements > 50 copies/mL.

RESULTS

Tropism results were available for 141 of 175 (80.6%) subjects screened: 60% had R5 and 85% of these (n = 74) were finally included in the study. Previous ART included protease inhibitors (PIs) in 62% of subjects, nonnucleoside reverse transcriptase inhibitors (NNRTIs) in 36%, and integrase inhibitors (INIs) in 2%. Main reasons for treatment change were dyslipidaemia (42%), gastrointestinal symptoms (22%) and liver toxicity (15%). MVC was given alongside tenofovir (TDF)/emtricitabine (FTC) (54%) and abacavir (ABC)/lamivudine (3TC) (40%) in most patients. Eighty-four per cent of patients maintained a viral load < 50 copies/mL to week 48, whereas 16% discontinued treatment: two withdrew informed consent, one had an R5 to X4 shift between screening and baseline, one was lost to follow-up, one developed an adverse event (rash), two died from non-study-related causes, and five developed protocol-defined virological failure.

CONCLUSIONS

Initiation of MVC plus two NRTIs in aviraemic subjects based on genotypic tropism testing of proviral HIV-1 DNA is associated with low rates of virological failure for up to 1 year.

Trends on epidemiological, virological, and clinical features among newly diagnosed HIV-1 persons in Northwest Spain over the last 10 years

To describe temporal trend and characteristics of newly HIV-diagnosed patients in a medical care area in Northwest Spain over the last 10 years. All newly diagnosed patients for HIV-infection from 2004 to 2013 at a reference medical care area in Northwest of Spain were identified. Epidemiological, virological, immunological, and clinical data, as well as HIV genotype and drug resistance information were recorded. A total of 565 newly HIV-diagnosed patients were identified. The number of new cases increased in the last 5 years (66 cases/year). Overall, 53.1% had a median CD4 counts < 350 cells/µl and 33.6% had an AIDS defining criteria. Non-B variants were found in 34.4% of patients being subtype F (25.8%) the most common non-B subtype. The rate of transmitted drug resistance (TDR) over the study period was 3.7%, but a decreased to 2.6% was observed in the last 5 years. The most prevalent TDR mutations were: T215 revertants (1.5%), K219QENR (1.2%), for NRTIs; K103N (1.9%), for NNRTIs; L90M (0.3%), for PIs. Overall, 73.2% of patients started antiretroviral treatment and 9.9% of patients died during follow-up. The number of newly HIV diagnosed patients increased since year 2009. There is a high prevalence of late diagnosis (53%) and 33% had an AIDS defining criteria. Interestingly, the most prevalent non-B subtype in our population was F (25.8%). These findings support the need to facilitate the access for HIV testing to reduce the rate of late HIV diagnosis, improve the clinical outcome and prevent HIV transmission.

Effect of the nature of exogenous organic matter on pesticide sorption by the soil

A study was carried out on the sorption of two sparingly water-soluble pesticides (diazinon and linuron) by a sandy loam soil modified with different exogenous organic materials (EOMs) containing humic-like substances: city refuse compost (CRC), peat (P), commercial "humic" acid (HA), liquid "humic" acid (LHA), and two (nonhumic) model compounds (surfactants), tetradecyltrimethylammonium bromide (TDTMA) and sodium dodecyl sulphate (SDS), before and after 2- and 8-month incubation periods with the soil. In all cases, the isotherms fitted the Freundlich sorption equation (x/m = KCen), generally with r2 values greater than 0.99. The value of the sorption constant K for the natural soil was 8.81 for diazinon and 2.29 for linuron. These values increased significantly for EOM modified soils with respect to natural soil, with the exception of the samples modified with SDS and LHA, in which cases they decreased, possibly due to the micellar properties of these compounds. Incubation of EOMs with soil increased their sorption capacity: the Koc values were increased proportionally to the incubation time for both pesticides and for all treatments carried out. Accordingly, the sorption capacity of hydrophobic pesticides increases with the degree of evolution in the soil of EOMs with "humic"-type compounds, possibly due, among other causes, to the increase in the EOMs' colloidal properties and the modifications occurring in the hydrophobic-hydrophilic characteristics of the soil surfaces. The main conclusion is that application to the soil of carbon-rich wastes, especially those with a high degree of maturity, may offer an important strategy for reducing pesticide leaching and for eliminating pesticide residues from soil with the use of anionic surfactants.