1
|
Ruiz-Algueró M, Alejos B, García Yubero C, Riera Jaume M, Antonio Iribarren J, Asensi V, Pasquau F, Galera CE, Pascual-Carrasco M, Muñoz A, Jarrín I, Suárez-García I, Moreno S, Jarrín I, Dalmau D, Navarro ML, González MI, Blanco JL, Garcia F, Rubio R, Iribarren JA, Gutiérrez F, Vidal F, Berenguer J, González J, Alejos B, Hernando V, Moreno C, Iniesta C, Garcia Sousa LM, Perez NS, Muñoz-Fernández MÁ, García-Merino IM, Fernández IC, Rico CG, de la Fuente JG, Concejo PP, Portilla J, Merino E, Reus S, Boix V, Giner L, Gadea C, Portilla I, Pampliega M, Díez M, Rodríguez JC, Sánchez-Payá J, Gómez JL, Hernández J, Alemán MR, del Mar Alonso M, Inmaculada Hernández M, Díaz-Flores F, García D, Pelazas R, Lirola AL, Moreno JS, Caso AA, Hernández Gutiérrez C, Novella Mena M, Rubio R, Pulido F, Bisbal O, Hernando A, Domínguez L, Crestelo DR, Bermejo L, Santacreu M, Antonio Iribarren J, Arrizabalaga J, Aramburu MJ, Camino X, Rodríguez-Arrondo F, von Wichmann MÁ, Tomé LP, Goenaga MÁ, Bustinduy MJ, Azkune H, Ibarguren M, Lizardi A, Kortajarena X, Gutiérrez F, Masiá M, Padilla S, Navarro A, Montolio F, Robledano C, Gregori Colomé J, Adsuar A, Pascual R, Fernández M, García E, García JA, Barber X, Muga R, Sanvisens A, Fuster D, Berenguer J, de Quirós JCLB, Gutiérrez I, Ramírez M, Padilla B, Gijón P, Aldamiz-Echevarría T, Tejerina F, José Parras F, Balsalobre P, Diez C, Latorre LP, Vidal F, Peraire J, Viladés C, Veloso S, Vargas M, López-Dupla M, Olona M, Rull A, Rodríguez-Gallego E, Alba V, Montero Alonso M, López Aldeguer J, Blanes Juliá M, Tasias Pitarch M, Hernández IC, Calabuig Muñoz E, Cuéllar Tovar S, Salavert Lletí M, Navarro JF, González-Garcia J, Arnalich F, Arribas JR, de la Serna JIB, Castro JM, Escosa L, Herranz P, Hontañón V, García-Bujalance S, López-Hortelano MG, González-Baeza A, Martín-Carbonero ML, Mayoral M, Mellado MJ, Micán RE, Montejano R, Luisa Montes M, Moreno V, Pérez-Valero I, Rodés B, Sainz T, Sendagorta E, Stella Alcáriz N, Valencia E, Ramón Blanco J, Antonio Oteo J, Ibarra V, Metola L, Sanz M, Pérez-Martínez L, Arazo P, Sampériz G, Dalmau D, Jaén A, Sanmartí M, Cairó M, Martinez-Lacasa J, Velli P, Font R, Xercavins M, Alonso N, Repáraz J, de Alda MGR, de León Cano MT, de Galarreta BPR, Segura F, José Amengual M, Navarro G, Sala M, Cervantes M, Pineda V, Calzado S, Navarro M, de los Santos I, Sanz Sanz J, Aparicio AS, Sarriá Cepeda C, Garcia-Fraile Fraile L, Martín Gayo E, Moreno S, Luis Casado J, Dronda F, Moreno A, Jesús Pérez Elías M, Gómez Ayerbe C, Gutiérrez C, Madrid N, del Campo Terrón S, Martí P, Ansa U, Serrano S, Jesús Vivancos M, Cano A, García AA, Bravo Urbieta J, Muñoz Á, Jose Alcaraz M, Villalba MDC, García F, Hernández J, Peña A, Muñoz L, Casas P, Alvarez M, Chueca N, Vinuesa D, Martinez-Montes C, Romero JD, Rodríguez C, Puerta T, Carlos Carrió J, Vera M, Ballesteros J, Ayerdi O, Antela A, Losada E, Riera M, Peñaranda M, Leyes M, Ribas MA, Campins AA, Vidal C, Fanjul F, Murillas J, Homar F, Santos J, Ayerbe CG, Viciana I, Palacios R, González CM, Viciana P, Espinosa N, López-Cortés LF, Podzamczer D, Ferrer E, Imaz A, Tiraboschi J, Silva A, Saumoy M, Ribera E, Curran A, Olalla J, del Arco A, de la torre J, Prada JL, de Lomas Guerrero JMG, Stachowski JP, Martínez OJ, Vera FJ, Martínez L, García J, Alcaraz B, Jimeno A, Iglesias AC, Souto BP, de Cea AM, Muñoz J, Zubero MZ, Baraia-Etxaburu JM, Ugarte SI, Beneitez OLF, de Munain JL, López MMC, de la Peña M, Lopez M, Galera C, Albendin H, Pérez A, Iborra A, Moreno A, Merlos MA, Vidal A, Amador C, Pasquau F, Ena J, Benito C, Fenoll V, Anguita CG, Rabasa JTA, Suárez-García I, Malmierca E, González-Ruano P, Rodrigo DM, Seco MPR, Vidal MAG, de Zarraga MA, Pérez VE, Molina MJT, García JV, Moreno JPS, Górgolas M, Cabello A, Álvarez B, Prieto L, Sanz Moreno J, Arranz Caso A, Gutiérrez CH, Novella Mena M, Galindo Puerto MJ, Fernando Vilalta R, Ferrer Ribera A, Román AR, Brieva Herrero MT, Juárez AR, López PL, Sánchez IM, Martínez JP, Jiménez MC, Perea RT, Ruiz-Capillas JJJ, Pineda JA. Use of Generic Antiretroviral Drugs and Single-Tablet Regimen De-Simplification for the Treatment of HIV Infection in Spain. AIDS Res Hum Retroviruses 2022; 38:433-440. [PMID: 35357907 DOI: 10.1089/aid.2021.0122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The present study sought to describe the use of generic drugs and single-tablet regimen (STR) de-simplification for the treatment of human immunodeficiency virus (HIV) infection among 41 hospitals from the cohort of the Spanish HIV/AIDS Research Network (CoRIS). In June 2018, we collected information on when generic antiretroviral drugs (ARVs) were introduced in the different hospitals, how the decisions to use them were made, and how the information was provided to the patients. Most of the nine available generic ARVs in Spain by June 2018 had been introduced in at least 85% of the participating hospitals, except for zidovudine (AZT)/lamivudine (3TC) and AZT. The time difference between the effective marketing date of each generic ARV and its first dispensing date in the hospitals was much shorter for the more recently approved generic ARV since the year 2017. However, only up to 20% of the hospitals de-simplified efavirenz (EFV)/tenofovir disoproxil (TDF)/emtricitabine (FTC), dolutegravir (DTG)/abacavir (ABC)/3TC, and rilpivirine (RPV)/TDF/FTC (to generic EFV+TDF/FTC, DTG+generic ABC/3TC, and RPV+generic TDF/FTC, respectively), whereas the generic STR EFV/TDF/FTC was introduced in 87.8% of the centers. The median times between the date of effective marketing of generic TDF/FTC and the date of de-simplification of EFV/TDF/FTC and RPV/TDF/FTC were 723 [interquartile range (IQR): 369-1,119] and 234 (IQR: 142-264) days, respectively; this time was 155 (IQR: 28-287) days for de-simplification of DTG/ABC/3TC. In conclusion, despite the widespread use of generic ARVs, STRs de-simplification was only undertaken in <20% of the hospitals. There was wide variability in the timing of the introduction of each generic ARV after they were available in the market.
Collapse
Affiliation(s)
- Marta Ruiz-Algueró
- National Center for Epidemiology, Institute of Health Carlos, Madrid, Spain
- CIBER de Enfermedades Infecciosas, Institute of Health CArlos III, Madrid, Spain
| | - Belén Alejos
- National Center for Epidemiology, Institute of Health Carlos, Madrid, Spain
| | | | | | - José Antonio Iribarren
- Servicio de Enfermedades Infecciosas, Hospital Universitario Donostia, Instituto de Investigación BioDonostia, San Sebastián, Spain
| | - Víctor Asensi
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | | | - Mario Pascual-Carrasco
- CIBER de Enfermedades Infecciosas, Institute of Health CArlos III, Madrid, Spain
- Unidad de Investigación en Telemedicina y Salud Digital (UITes), Instituto de Salud Carlos III, Madrid, Spain
| | - Adolfo Muñoz
- CIBER de Enfermedades Infecciosas, Institute of Health CArlos III, Madrid, Spain
- Unidad de Investigación en Telemedicina y Salud Digital (UITes), Instituto de Salud Carlos III, Madrid, Spain
| | - Inmaculada Jarrín
- National Center for Epidemiology, Institute of Health Carlos, Madrid, Spain
- CIBER de Enfermedades Infecciosas, Institute of Health CArlos III, Madrid, Spain
| | - Inés Suárez-García
- CIBER de Enfermedades Infecciosas, Institute of Health CArlos III, Madrid, Spain
- Infectious Diseases Unit, Department of Internal Medicine, Hospital Universitario Infanta Sofía, Madrid, Spain
- Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Madrid, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
2
|
González Guembe M, Tisner Pensado Y, Tejerina Picado F, Diez C, Pérez Latorre L, Fanciulli C, Parras Vázquez F, López Bernaldo de Quirós JC, Berenguer J, Padilla Ortega B, Machado M, Valerio Minero M, Muñoz Garcia P, Bouza Santiago E, Galar A, Catalan P, Alonso R, Bellón JM, Aldámiz-Echevarría Lois T, (Javier) AJ, (Luis) A, (Teresa) A, (Roberto) A, (Beatriz) Á, (Ana) ÁU, (Alexi) A, (Luis Antonio) A, (Juan) B, (Elena) B, (Emilio) B, (Almudena) B, (Ana) C, (Raquel) C, (Pilar) C, (Emilia) C, (Alejandro) C, (Cristina) D, (Pilar) E, (Agustín) E, (Chiara) F, (Alicia) G, (Ma Dolores) G, (Darío) GDV, (Paloma) G, (Adolfo) G, (Helmuth) G, (Jesús) G, (Laura Vanessa) H, (Marta) H, (Martha) K, (Juan Carlos) L, (Carmen Narcisa) L, (Marina) M, (Mercedes) M, (Pablo) M, (Pedro) M, (Zaira) M, (Patricia) M, (María) O, (Belén) P, (María) P, (Francisco) P, (María Jesús) PG, (Laura) PL, (Leire) P, (Paula) P, (Sandra) RM, (Elena) R, (Cristina) R, (Belén) R, (Sara) R, (Cristina) RG, (Adriana) R, (María Jesús) RS, (Carlos) S, (Mar) S, (Julia) S, (Pedro J) SC, (Francisco) T, (Maricela) V, (Ma Cristina) V, (Lara) V, (Teresa) V, (Sofía) ADLV. SARS-COV-2 Infection in People Living with HIV: Experience from a Tertiary Hospital in Madrid. AIDS Res Hum Retroviruses 2022; 38:394-398. [PMID: 34969259 DOI: 10.1089/aid.2021.0159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Since SAR-COV-2 infection emerged and spread worldwide, little is known about its impact on people living with human immunodeficiency virus (HIV). We performed a single-center retrospective study to describe the potential particularities and risk factors for respiratory failure (RF) in that population. This single-center retrospective study included patients infected with HIV, whose current follow-up is run in this center, above18 years of age, with diagnosis of SARS-CoV-2 infection between March 5, 2020 and April 15, 2021. We collected data regarding HIV immunological and virological status, main epidemiological characteristics, as well as those conditions considered to potentially influence in SARS-CoV-2 evolution; and clinical, microbiological, radiological, respiratory status, and survival concerning coronavirus disease 2019 (COVID-19). We compared all that, for patients with and without RF and performed a logistic regression for suspected risk factors for RF. One hundred seventy-seven HIV patients were diagnosed from COVID-19 (mean age 53.8 years, 81.3% male). At diagnosis, 95.5% were receiving ART and 91.3% had undetectable viral load, with median CD4 count of 569 cells/μL. One hundred thirty-eight patients (78.4%) had symptoms, 44 (25%) developed RF and 53 (31%) developed bilateral pneumonia. The most commonly used treatments were: steroids (26.7%) and hydroxychloroquine (13.1%). When comparing patients with and without RF, we found statistically significant differences for 20 of the analyzed variables such as age (p < .001) and CD4 (p 0.002), and route of HIV transmission by intravenous drug users IVDU (p 0.002) were determined. In multivariate analysis, age [odds ratio (OR) 1.095] and CD4 count less than 350 cells/μL (OR 3.36) emerged as risk factor for RF. People living with HIV whose CD4 count is <350 cells are at higher risk of developing RF when infected by SARS-CoV-2.
Collapse
Affiliation(s)
| | | | - Francisco Tejerina Picado
- Microbiology and Infectious Diseases Department, Gregorio Marañón Hospital, Madrid, Spain
- Instituto Investigacion Biomedica, Gregorio Marañón Hospital, Madrid, Spain
| | - Cristina Diez
- Microbiology and Infectious Diseases Department, Gregorio Marañón Hospital, Madrid, Spain
- Instituto Investigacion Biomedica, Gregorio Marañón Hospital, Madrid, Spain
| | - Leire Pérez Latorre
- Microbiology and Infectious Diseases Department, Gregorio Marañón Hospital, Madrid, Spain
- Instituto Investigacion Biomedica, Gregorio Marañón Hospital, Madrid, Spain
| | - Chiara Fanciulli
- Microbiology and Infectious Diseases Department, Gregorio Marañón Hospital, Madrid, Spain
- Instituto Investigacion Biomedica, Gregorio Marañón Hospital, Madrid, Spain
| | - Francisco Parras Vázquez
- Microbiology and Infectious Diseases Department, Gregorio Marañón Hospital, Madrid, Spain
- Instituto Investigacion Biomedica, Gregorio Marañón Hospital, Madrid, Spain
| | - Juan Carlos López Bernaldo de Quirós
- Microbiology and Infectious Diseases Department, Gregorio Marañón Hospital, Madrid, Spain
- Instituto Investigacion Biomedica, Gregorio Marañón Hospital, Madrid, Spain
| | - Juan Berenguer
- Microbiology and Infectious Diseases Department, Gregorio Marañón Hospital, Madrid, Spain
- Instituto Investigacion Biomedica, Gregorio Marañón Hospital, Madrid, Spain
| | - Belen Padilla Ortega
- Microbiology and Infectious Diseases Department, Gregorio Marañón Hospital, Madrid, Spain
- Instituto Investigacion Biomedica, Gregorio Marañón Hospital, Madrid, Spain
| | - Marina Machado
- Microbiology and Infectious Diseases Department, Gregorio Marañón Hospital, Madrid, Spain
- Instituto Investigacion Biomedica, Gregorio Marañón Hospital, Madrid, Spain
| | - Maricela Valerio Minero
- Microbiology and Infectious Diseases Department, Gregorio Marañón Hospital, Madrid, Spain
- Instituto Investigacion Biomedica, Gregorio Marañón Hospital, Madrid, Spain
| | - Patricia Muñoz Garcia
- Microbiology and Infectious Diseases Department, Gregorio Marañón Hospital, Madrid, Spain
- Instituto Investigacion Biomedica, Gregorio Marañón Hospital, Madrid, Spain
| | - Emilio Bouza Santiago
- Microbiology and Infectious Diseases Department, Gregorio Marañón Hospital, Madrid, Spain
- Instituto Investigacion Biomedica, Gregorio Marañón Hospital, Madrid, Spain
| | - Alicia Galar
- Microbiology and Infectious Diseases Department, Gregorio Marañón Hospital, Madrid, Spain
- Instituto Investigacion Biomedica, Gregorio Marañón Hospital, Madrid, Spain
| | - Pilar Catalan
- Microbiology and Infectious Diseases Department, Gregorio Marañón Hospital, Madrid, Spain
- Instituto Investigacion Biomedica, Gregorio Marañón Hospital, Madrid, Spain
| | - Roberto Alonso
- Microbiology and Infectious Diseases Department, Gregorio Marañón Hospital, Madrid, Spain
- Instituto Investigacion Biomedica, Gregorio Marañón Hospital, Madrid, Spain
| | - Jose M Bellón
- Instituto Investigacion Biomedica, Gregorio Marañón Hospital, Madrid, Spain
| | - Teresa Aldámiz-Echevarría Lois
- Microbiology and Infectious Diseases Department, Gregorio Marañón Hospital, Madrid, Spain
- Instituto Investigacion Biomedica, Gregorio Marañón Hospital, Madrid, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Suárez-García I, Moreno C, Ruiz-Algueró M, Pérez-Elías MJ, Navarro M, Díez Martínez M, Viciana P, Pérez-Martínez L, Górgolas M, Amador C, de Zárraga MA, Jarrín I, Moreno S, Jarrín I, Dalmau D, Navarro ML, González MI, Garcia F, Poveda E, Iribarren JA, Gutiérrez F, Rubio R, Vidal F, Berenguer J, González J, Muñoz-Fernández MÁ, Jarrin I, Alejos B, Moreno C, Iniesta C, Sousa LMG, Perez NS, Rava M, Muñoz-Fernández MÁ, Fernández IC, Merino E, García G, Portilla I, Agea I, Portilla J, Sánchez-Payá J, Rodríguez JC, Gimeno L, Giner L, Díez M, Carreres M, Reus S, Boix V, Torrús D, Lirola AL, García D, Díaz-Flores F, Gómez JL, del Mar Alonso M, Pelazas R, Hernández J, Alemán MR, Hernández MI, Asensi V, Valle E, Carmenado MER, Secades TSZ, Is LP, Rubio R, Pulido F, Bisbal O, Hernando A, Domínguez L, Crestelo DR, Bermejo L, Santacreu M, Iribarren JA, Arrizabalaga J, Aramburu MJ, Camino X, Rodríguez-Arrondo F, von Wichmann MÁ, Tomé LP, Goenaga MÁ, Bustinduy MJ, Azkune H, Ibarguren M, Lizardi A, Kortajarena X, Oyaga MPC, Igartua MU, Gutiérrez F, Masiá M, Padilla S, Navarro A, Montolio F, Robledano C, Colomé JG, Adsuar A, Pascual R, Fernández M, García E, García JA, Barber X, Muga R, Sanvisens A, Fuster D, Berenguer J, de Quirós JCLB, Gutiérrez I, Ramírez M, Padilla B, Gijón P, Aldamiz-Echevarría T, Tejerina F, Parras FJ, Balsalobre P, Diez C, Latorre LP, Fanciulli C, Vidal F, Peraire J, Viladés C, Veloso S, Vargas M, Olona M, Rull A, Rodríguez-Gallego E, Alba V, Castellanos AJ, López-Dupla M, Alonso MM, Aldeguer JL, Juliá MB, Pitarch MT, Hernández IC, Muñoz EC, Tovar SC, Lletí MS, Navarro JF, González-Garcia J, Arnalich F, Arribas JR, de la Serna JIB, Castro JM, Escosa L, Herranz P, Hontañón V, García-Bujalance S, López-Hortelano MG, González-Baeza A, Martín-Carbonero ML, Mayoral M, Mellado MJ, Micán RE, Montejano R, Montes ML, Moreno V, Pérez-Valero I, Rodés B, Sainz T, Sendagorta E, Alcáriz NS, Valencia E, Blanco JR, Oteo JA, Ibarra V, Metola L, Sanz M, Pérez-Martínez L, Arazo P, Sampériz G, Dalmau D, Jaén A, Sanmartí M, Cairó M, Martinez-Lacasa J, Velli P, Font R, Xercavins M, Alonso N, Marcotegui MR, Repáraz J, de Alda MGR, de León Cano MT, de Galarreta BPR, Amengual MJ, Navarro G, Garcia MC, Isbert SC, Vilasaro MN, de los Santos I, Sanz JS, Aparicio AS, Cepeda CS, Fraile LGF, Gayo EM, Moreno S, Osorio JLC, Nuñez FD, Zamora AM, Elías MJP, Gutiérrez C, Madrid N, del Campo Terrón S, Villar SS, Gallego MJV, Sanz JM, Urroz UA, Velasco T, Bernal E, Sanchez AC, García AA, Urbieta JB, Perez AM, Alcaraz MJ, del Carmen Villalba M, García F, Quero JH, Medina LM, Alvarez M, Chueca N, García DV, Martinez-Montes C, Beltran CG, de Salazar Gonzalerz A, Lopez AF, Utrilla MR, Del Romero J, Rodríguez C, Puerta T, Carrió JC, Vera M, Ballesteros J, Ayerdi O, Antela A, Losada E, Riera M, Peñaranda M, Leyes M, Ribas MA, Campins AA, Vidal C, Fanjul F, Murillas J, Homar F, Santos J, Ayerbe CG, Viciana I, Palacios R, López CP, Gonzalez-Domenec CM, Viciana P, Espinosa N, López-Cortés LF, Podzamczer D, Imaz A, Tiraboschi J, Silva A, Saumoy M, Prieto P, Ribera E, Curran A, Sierra JO, Stachowski JP, del Arco A, de la torre J, Prada JL, de Lomas Guerrero JMG, Martínez OJ, Vera FJ, Martínez L, García J, Alcaraz B, Jimeno A, Iglesias AC, Souto BP, de Cea AM, Muñoz J, Zubero MZ, Baraia-Etxaburu JM, Ugarte SI, Beneitez OLF, de Munain JL, López MMC, de la Peña M, Lopez M, Azkarreta IL, Galera C, Albendin H, Pérez A, Iborra A, Moreno A, Merlos MA, Vidal A, Meca M, Amador C, Pasquau F, Ena J, Benito C, Fenoll V, Anguita CG, Rabasa JTA, Suárez-García I, Malmierca E, González-Ruano P, Rodrigo DM, Seco MPR, Mohamed-Balghata MO, Vidal MAG, de Zarraga MA, Pérez VE, Molina MJT, García JV, Moreno JPS, Górgolas M, Cabello A, Álvarez B, Prieto L, Moreno JS, Caso AA, Gutiérrez CH, Mena MN, Puerto MJG, Vilalta RF, Ribera AF, Román AR, Juárez AR, López PL, Sánchez IM, Casas MF, Espejo AC, Jiménez MC, Perea RT, Pineda JA, Mayo PR, Sanchez JM, Gutierrez NM, Real LM, Gomez AC, Fuertes MF, Gonzalez-Serna A, Poveda E, Pérez A, Crespo M, Morano L, Miralles C, Ocampo A, Pousada G. Effectiveness of the combination elvitegravir/cobicistat/tenofovir/emtricitabine (EVG/COB/TFV/FTC) plus darunavir among treatment-experienced patients in clinical practice: a multicentre cohort study. AIDS Res Ther 2020; 17:45. [PMID: 32690099 PMCID: PMC7372769 DOI: 10.1186/s12981-020-00302-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 07/13/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate the effectiveness and tolerability of the combination elvitegravir/cobicistat/tenofovir/emtricitabine plus darunavir (EVG/COB/TFV/FTC + DRV) in treatment-experienced patients from the cohort of the Spanish HIV/AIDS Research Network (CoRIS). METHODS Treatment-experienced patients starting treatment with EVG/COB/TFV/FTC + DRV during the years 2014-2018 and with more than 24 weeks of follow-up were included. TFV could be administered either as tenofovir disoproxil fumarate or tenofovir alafenamide. We evaluated virological response, defined as viral load (VL) < 50 copies/ml and < 200 copies/ml at 24 and 48 weeks after starting this regimen, stratified by baseline VL (< 50 or ≥ 50 copies/ml at the start of the regimen). RESULTS We included 39 patients (12.8% women). At baseline, 10 (25.6%) patients had VL < 50 copies/ml and 29 (74.4%) had ≥ 50 copies/ml. Among patients with baseline VL < 50 copies/ml, 85.7% and 80.0% had VL < 50 copies/ml at 24 and 48 weeks, respectively, and 100% had VL < 200 copies/ml at 24 and 48 weeks. Among patients with baseline VL ≥ 50 copies/ml, 42.3% and 40.9% had VL < 50 copies/ml and 69.2% and 68.2% had VL < 200 copies/ml at 24 and 48 weeks. During the first 48 weeks, no patients changed their treatment due to toxicity, and 4 patients (all with baseline VL ≥ 50 copies/ml) changed due to virological failure. CONCLUSIONS EVG/COB/TFV/FTC + DRV was well tolerated and effective in treatment-experienced patients with undetectable viral load as a simplification strategy, allowing once-daily, two-pill regimen with three antiretroviral drug classes. Effectiveness was low in patients with detectable viral loads.
Collapse
|
4
|
Couto E, Diaz-Brito V, Mothe B, Guardo AC, Fernandez I, Ugarte A, Etcheverry F, Gómez CE, Esteban M, Pich J, Arnaiz JA, López Bernaldo de Quirós JC, Brander C, Plana M, García F, Leal L. Comparison of Safety and Vector-Specific Immune Responses in Healthy and HIV-Infected Populations Vaccinated with MVA-B. Vaccines (Basel) 2019; 7:vaccines7040178. [PMID: 31703287 PMCID: PMC6963361 DOI: 10.3390/vaccines7040178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 11/01/2019] [Accepted: 11/04/2019] [Indexed: 11/16/2022] Open
Abstract
There are few studies comparing the safety and immunogenicity of the same HIV immunogen in healthy volunteers and HIV-infected individuals. We analyzed demographics, adverse events (AEs), and immunogenicity against vaccinia virus in preventive (RISVAC02, n = 24 low-risk HIV-negative volunteers) and therapeutic (RISVAC03, n = 20 successfully treated chronically HIV-1-infected individuals) vaccine phase-I clinical trials that were performed with the same design and the same immunogen (modified vaccinia virus Ankara-B: MVA-B). Total AEs were significantly higher in HIV-infected patients (mean AEs/patient 6.6 vs. 12.8 (p < 0.01)). Conversely, the number of AEs related to vaccination (AEsRV) was similar between both groups. No grade III or IV AEsRV were observed in either clinical trial. Regarding the immunogenicity, the proportion of anti-vaccinia virus antibody responders was similar in both studies. Conversely, the magnitude of response was significantly higher in HIV-infected patients (median binding antibodies at w8 267 vs. 1600 U/mL (p = 0.002) and at w18 666 vs. 3200 U/mL (p = 0.003)). There was also a trend towards higher anti-vaccinia virus neutralizing activity in HIV-infected individuals (proportion of responders 37% vs. 63% (p = 0.09); median IC50 32 vs. 64 (p = 0.054)). This study confirms the safety of MVA-B independent of HIV serostatus. HIV-infected patients showed higher immune responses against vaccinia virus.
Collapse
Affiliation(s)
- Elvira Couto
- Infectious Diseases Department, Hospital Clínic-HIVACAT, IDIBAPS, University of Barcelona, 08036 Barcelona, Spain
| | - Vicenç Diaz-Brito
- Infectious Diseases Unit, Parc Sanitari Sant Joan de Deu, 08830 Sant Boi de Llobregat, Spain
| | - Beatriz Mothe
- Irsicaixa AIDS Research Institute-HIVACAT, Hospital Germans Trias i Pujol, 08916 Badalona, Spain
| | - Alberto C Guardo
- Infectious Diseases Department, Hospital Clínic-HIVACAT, IDIBAPS, University of Barcelona, 08036 Barcelona, Spain
| | - Irene Fernandez
- Infectious Diseases Department, Hospital Clínic-HIVACAT, IDIBAPS, University of Barcelona, 08036 Barcelona, Spain
| | - Ainoa Ugarte
- Infectious Diseases Department, Hospital Clínic-HIVACAT, IDIBAPS, University of Barcelona, 08036 Barcelona, Spain
| | - Flor Etcheverry
- Infectious Diseases Department, Hospital Clínic-HIVACAT, IDIBAPS, University of Barcelona, 08036 Barcelona, Spain
| | - Carmen E Gómez
- Department of Molecular and Cellular Biology, Centro Nacional de Biotecnología, Consejo Superior de Investigaciones Científicas (CNB-CSIC), Campus de Cantoblanco, 28049 Madrid, Spain
| | - Mariano Esteban
- Department of Molecular and Cellular Biology, Centro Nacional de Biotecnología, Consejo Superior de Investigaciones Científicas (CNB-CSIC), Campus de Cantoblanco, 28049 Madrid, Spain
| | - Judit Pich
- Clinical Trial Unit, Hospital Clínic, 08036 Barcelona, Spain
| | | | | | - Christian Brander
- Irsicaixa AIDS Research Institute-HIVACAT, Hospital Germans Trias i Pujol, 08916 Badalona, Spain
| | - Montserrat Plana
- Retrovirology and Viral Immunopathology, AIDS Research Group, IDIBAPS, Hospital Clinic, University of Barcelona, 08036 Barcelona, Spain
| | - Felipe García
- Infectious Diseases Department, Hospital Clínic-HIVACAT, IDIBAPS, University of Barcelona, 08036 Barcelona, Spain
| | - Lorna Leal
- Infectious Diseases Department, Hospital Clínic-HIVACAT, IDIBAPS, University of Barcelona, 08036 Barcelona, Spain
| |
Collapse
|
5
|
C. Guardo A, Gómez CE, Díaz-Brito V, Pich J, Arnaiz JA, Perdiguero B, García-Arriaza J, González N, Sorzano COS, Jiménez L, Jiménez JL, Muñoz-Fernández MÁ, Gatell JM, Alcamí J, Esteban M, López Bernaldo de Quirós JC, García F, Plana M. Safety and vaccine-induced HIV-1 immune responses in healthy volunteers following a late MVA-B boost 4 years after the last immunization. PLoS One 2017; 12:e0186602. [PMID: 29065142 PMCID: PMC5655491 DOI: 10.1371/journal.pone.0186602] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 09/10/2017] [Indexed: 11/18/2022] Open
Abstract
Background We have previously shown that an HIV vaccine regimen including three doses of HIV-modified vaccinia virus Ankara vector expressing HIV-1 antigens from clade B (MVA-B) was safe and elicited moderate and durable (1 year) T-cell and antibody responses in 75% and 95% of HIV-negative volunteers (n = 24), respectively (RISVAC02 study). Here, we describe the long-term durability of vaccine-induced responses and the safety and immunogenicity of an additional MVA-B boost. Methods 13 volunteers from the RISVAC02 trial were recruited to receive a fourth dose of MVA-B 4 years after the last immunization. End-points were safety, cellular and humoral immune responses to HIV-1 and vector antigens assessed by ELISPOT, intracellular cytokine staining (ICS) and ELISA performed before and 2, 4 and 12 weeks after receiving the boost. Results Volunteers reported 64 adverse events (AEs), although none was a vaccine-related serious AE. After 4 years from the 1st dose of the vaccine, only 2 volunteers maintained low HIV-specific T-cell responses. After the late MVA-B boost, a modest increase in IFN-γ T-cell responses, mainly directed against Env, was detected by ELISPOT in 5/13 (38%) volunteers. ICS confirmed similar results with 45% of volunteers showing that CD4+ T-cell responses were mainly directed against Env, whereas CD8+ T cell-responses were similarly distributed against Env, Gag and GPN. In terms of antibody responses, 23.1% of the vaccinees had detectable Env-specific binding antibodies 4 years after the last MVA-B immunization with a mean titer of 96.5. The late MVA-B boost significantly improved both the response rate (92.3%) and the magnitude of the systemic binding antibodies to gp120 (mean titer of 11460). HIV-1 neutralizing antibodies were also enhanced and detected in 77% of volunteers. Moreover, MVA vector-specific T cell and antibody responses were boosted in 80% and 100% of volunteers respectively. Conclusions One boost of MVA-B four years after receiving 3 doses of the same vaccine was safe, induced moderate increases in HIV-specific T cell responses in 38% of volunteers but significantly boosted the binding and neutralizing antibody responses to HIV-1 and to the MVA vector. Trial registration ClinicalTrials.gov NCT01923610.
Collapse
Affiliation(s)
- Alberto C. Guardo
- Immunopathology and Cellular Immunology, AIDS Research Group, IDIBAPS, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | | | - Vicens Díaz-Brito
- Infectious Diseases Unit, Hospital Clínic, IDIBAPS, University of Barcelona, Spain
| | - Judit Pich
- Infectious Diseases Unit, Hospital Clínic, IDIBAPS, University of Barcelona, Spain
| | - Joan Albert Arnaiz
- Infectious Diseases Unit, Hospital Clínic, IDIBAPS, University of Barcelona, Spain
| | | | | | - Nuria González
- AIDS Immunopathogenesis Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Laura Jiménez
- AIDS Immunopathogenesis Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - José Luis Jiménez
- Sección Inmunología, Laboratorio InmunoBiología Molecular, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Spanish HIV HGM Biobank, Networking Research Center on Bioengineering, Biomaterials & Nanomedicine (CIBERBBN), Madrid, Spain
| | - María Ángeles Muñoz-Fernández
- Sección Inmunología, Laboratorio InmunoBiología Molecular, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Spanish HIV HGM Biobank, Networking Research Center on Bioengineering, Biomaterials & Nanomedicine (CIBERBBN), Madrid, Spain
| | - José M Gatell
- Infectious Diseases Unit, Hospital Clínic, IDIBAPS, University of Barcelona, Spain
| | - José Alcamí
- AIDS Immunopathogenesis Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Juan Carlos López Bernaldo de Quirós
- Sección Inmunología, Laboratorio InmunoBiología Molecular, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Spanish HIV HGM Biobank, Networking Research Center on Bioengineering, Biomaterials & Nanomedicine (CIBERBBN), Madrid, Spain
| | - Felipe García
- Infectious Diseases Unit, Hospital Clínic, IDIBAPS, University of Barcelona, Spain
| | - Montserrat Plana
- Immunopathology and Cellular Immunology, AIDS Research Group, IDIBAPS, Hospital Clínic, University of Barcelona, Barcelona, Spain
- * E-mail:
| | | |
Collapse
|
6
|
Gómez CE, Perdiguero B, García-Arriaza J, Cepeda V, Sánchez-Sorzano CÓ, Mothe B, Jiménez JL, Muñoz-Fernández MÁ, Gatell JM, López Bernaldo de Quirós JC, Brander C, García F, Esteban M. A Phase I Randomized Therapeutic MVA-B Vaccination Improves the Magnitude and Quality of the T Cell Immune Responses in HIV-1-Infected Subjects on HAART. PLoS One 2015; 10:e0141456. [PMID: 26544853 PMCID: PMC4636254 DOI: 10.1371/journal.pone.0141456] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 10/08/2015] [Indexed: 11/29/2022] Open
Abstract
Trial Design Previous studies suggested that poxvirus-based vaccines might be instrumental in the therapeutic HIV field. A phase I clinical trial was conducted in HIV-1-infected patients on highly active antiretroviral therapy (HAART), with CD4 T cell counts above 450 cells/mm3 and undetectable viremia. Thirty participants were randomized (2:1) to receive either 3 intramuscular injections of MVA-B vaccine (coding for clade B HIV-1 Env, Gag, Pol and Nef antigens) or placebo, followed by interruption of HAART. Methods The magnitude, breadth, quality and phenotype of the HIV-1-specific T cell response were assayed by intracellular cytokine staining (ICS) in 22 volunteers pre- and post-vaccination. Results MVA-B vaccine induced newly detected HIV-1-specific CD4 T cell responses and expanded pre-existing responses (mostly against Gag, Pol and Nef antigens) that were high in magnitude, broadly directed and showed an enhanced polyfunctionality with a T effector memory (TEM) phenotype, while maintaining the magnitude and quality of the pre-existing HIV-1-specific CD8 T cell responses. In addition, vaccination also triggered preferential CD8+ T cell polyfunctional responses to the MVA vector antigens that increase in magnitude after two and three booster doses. Conclusion MVA-B vaccination represents a feasible strategy to improve T cell responses in individuals with pre-existing HIV-1-specific immunity. Trial Registration ClinicalTrials.gov NCT01571466
Collapse
Affiliation(s)
- Carmen Elena Gómez
- Department of Molecular and Cellular Biology, Centro Nacional de Biotecnología, Consejo Superior de Investigaciones Científicas (CSIC), Madrid, Spain
| | - Beatriz Perdiguero
- Department of Molecular and Cellular Biology, Centro Nacional de Biotecnología, Consejo Superior de Investigaciones Científicas (CSIC), Madrid, Spain
| | - Juan García-Arriaza
- Department of Molecular and Cellular Biology, Centro Nacional de Biotecnología, Consejo Superior de Investigaciones Científicas (CSIC), Madrid, Spain
| | - Victoria Cepeda
- Department of Molecular and Cellular Biology, Centro Nacional de Biotecnología, Consejo Superior de Investigaciones Científicas (CSIC), Madrid, Spain
| | - Carlos Óscar Sánchez-Sorzano
- Department of Molecular and Cellular Biology, Centro Nacional de Biotecnología, Consejo Superior de Investigaciones Científicas (CSIC), Madrid, Spain
| | - Beatriz Mothe
- IrsiCaixa-HIVACAT, Hospital Universitari Germans Trias i Pujol, Autonomous University of Barcelona, Badalona, Spain
| | | | | | | | | | - Christian Brander
- IrsiCaixa-HIVACAT, Hospital Universitari Germans Trias i Pujol, Autonomous University of Barcelona, Badalona, Spain
- Institució Catalana de Recerca i Estudis Avancats (ICREA), Barcelona, and University of Vic and Central Catalonia, Vic, Spain
| | | | - Mariano Esteban
- Department of Molecular and Cellular Biology, Centro Nacional de Biotecnología, Consejo Superior de Investigaciones Científicas (CSIC), Madrid, Spain
- * E-mail:
| |
Collapse
|
7
|
Mothe B, Climent N, Plana M, Rosàs M, Jiménez JL, Muñoz-Fernández MÁ, Puertas MC, Carrillo J, Gonzalez N, León A, Pich J, Arnaiz JA, Gatell JM, Clotet B, Blanco J, Alcamí J, Martinez-Picado J, Alvarez-Fernández C, Sánchez-Palomino S, Guardo AC, Peña J, Benito JM, Rallón N, Gómez CE, Perdiguero B, García-Arriaza J, Esteban M, López Bernaldo de Quirós JC, Brander C, García F. Safety and immunogenicity of a modified vaccinia Ankara-based HIV-1 vaccine (MVA-B) in HIV-1-infected patients alone or in combination with a drug to reactivate latent HIV-1. J Antimicrob Chemother 2015; 70:1833-42. [PMID: 25724985 DOI: 10.1093/jac/dkv046] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 02/03/2015] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES The safety, immunogenicity, impact on the latent reservoir and rebound of viral load after therapeutic HIV-1 vaccination with recombinant modified vaccinia Ankara-based (MVA-B) HIV-1 vaccine expressing monomeric gp120 and the fused Gag-Pol-Nef polyprotein of clade B with or without a drug to reactivate latent HIV-1 (disulfiram) were assessed. METHODS HIV-1-infected patients were randomized to receive three injections of MVA-B (n = 20) or placebo (n = 10). Twelve patients (eight who received vaccine and four who were given placebo) received a fourth dose of MVA-B followed by 3 months of disulfiram. Combined ART (cART) was discontinued 8 weeks after the last dose of MVA-B. Clinical Trials.gov identifier: NCT01571466. RESULTS MVA-B was safe and well tolerated. A minor, but significant, increase in the T cell responses targeting vaccine inserts of Gag was observed [a median of 290, 403 and 435 spot-forming-cells/10(6) PBMCs at baseline, after two vaccinations and after three vaccinations, respectively; P = 0.02 and P = 0.04]. After interruption of cART, a modest delay in the rebound of the plasma viral load in participants receiving vaccine but not disulfiram was observed compared with placebo recipients (P = 0.01). The dynamics of the viral load rebound did not change in patients receiving MVA-B/disulfiram. No changes in the proviral reservoir were observed after disulfiram treatment. CONCLUSIONS MVA-B vaccination was a safe strategy to increase Gag-specific T cell responses in chronically HIV-1-infected individuals, but it did not have a major impact on the latent reservoir or the rebound of plasma viral load after interruption of cART when given alone or in combination with disulfiram.
Collapse
Affiliation(s)
- Beatriz Mothe
- Irsicaixa AIDS Research Institute-HIVACAT, Hospital Germans Trias i Pujol, Badalona, Spain 'Lluita contra la Sida' Foundation, Hospital Germans Trias i Pujol, Badalona, Spain Universitat de Vic-Universitat Central de Catalunya (UVic-UCC), Vic, Spain
| | - Nuria Climent
- Hospital Clinic-HIVACAT, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Montserrat Plana
- Hospital Clinic-HIVACAT, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Miriam Rosàs
- Irsicaixa AIDS Research Institute-HIVACAT, Hospital Germans Trias i Pujol, Badalona, Spain
| | | | | | - María C Puertas
- Irsicaixa AIDS Research Institute-HIVACAT, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Jorge Carrillo
- Irsicaixa AIDS Research Institute-HIVACAT, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Nuria Gonzalez
- AIDS Immunopathogenesis Unit, Instituto de Salud Carlos III, Madrid, Spain
| | - Agathe León
- Hospital Clinic-HIVACAT, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Judit Pich
- Hospital Clinic-HIVACAT, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Joan Albert Arnaiz
- Hospital Clinic-HIVACAT, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Jose M Gatell
- Hospital Clinic-HIVACAT, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Bonaventura Clotet
- Irsicaixa AIDS Research Institute-HIVACAT, Hospital Germans Trias i Pujol, Badalona, Spain 'Lluita contra la Sida' Foundation, Hospital Germans Trias i Pujol, Badalona, Spain Universitat de Vic-Universitat Central de Catalunya (UVic-UCC), Vic, Spain
| | - Julià Blanco
- Irsicaixa AIDS Research Institute-HIVACAT, Hospital Germans Trias i Pujol, Badalona, Spain Universitat de Vic-Universitat Central de Catalunya (UVic-UCC), Vic, Spain
| | - José Alcamí
- AIDS Immunopathogenesis Unit, Instituto de Salud Carlos III, Madrid, Spain
| | - Javier Martinez-Picado
- Irsicaixa AIDS Research Institute-HIVACAT, Hospital Germans Trias i Pujol, Badalona, Spain Universitat de Vic-Universitat Central de Catalunya (UVic-UCC), Vic, Spain Universitat Autònoma de Barcelona, Barcelona, Spain Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | | | | | - Alberto C Guardo
- Hospital Clinic-HIVACAT, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - José Peña
- Hospital Reina Sofía, Córdoba, Spain
| | - José M Benito
- Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Universidad Autónoma de Barcelona, Madrid, Spain
| | - Norma Rallón
- Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Universidad Autónoma de Barcelona, Madrid, Spain
| | | | | | | | | | | | - Christian Brander
- Irsicaixa AIDS Research Institute-HIVACAT, Hospital Germans Trias i Pujol, Badalona, Spain Universitat de Vic-Universitat Central de Catalunya (UVic-UCC), Vic, Spain Universitat Autònoma de Barcelona, Barcelona, Spain Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - Felipe García
- Hospital Clinic-HIVACAT, IDIBAPS, University of Barcelona, Barcelona, Spain
| | | |
Collapse
|
8
|
Tejerina F, Bernaldo de Quirós JCL. Protease inhibitors as preferred initial regimen for antiretroviral-naive HIV patients. AIDS Rev 2011; 13:227-233. [PMID: 21975358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
At present, the majority of patients who have initiated their first antiretroviral therapy have received a combination comprising a nonnucleoside and two nucleoside analogues. The use of nonnucleosides as first-line therapy has been favored for their more convenient dosing, with less pill numbers, and the possibility of co-formulation with nucleoside analogues. Although protease inhibitors are also considered to be a preferred standard, they have been less frequently used as first regimen of choice because of their adverse effects in the short to medium term. The introduction of darunavir and atazanavir as new protease inhibitors boosted with ritonavir has resulted in a significant change in this area. These drugs show a lower incidence of adverse effects, allow once-a-day administration, and have a high barrier to resistance that prevents the selection of resistance mutations in case of virologic failure. On this basis, it is likely that over the next few years these drugs will become a standard of care, gaining acceptance and being used more frequently as preferred first-line regimen.
Collapse
Affiliation(s)
- Francisco Tejerina
- Infectious Diseases Unit/HIV, Gregorio Marañón University Hospital, Madrid, Spain
| | | |
Collapse
|
9
|
Alonso M, Rodríguez-Sánchez B, Giannella M, Catalán P, Gayoso J, de Quirós JCLB, Bouza E, de Viedma DG. Erratum to “Resistance and virulence mutations in patients with persistent infection by pandemic 2009 A/H1N1 influenza” [J. Clin. Virol. 50 (2011) 114–118]. J Clin Virol 2011. [DOI: 10.1016/j.jcv.2011.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
10
|
Alonso M, Rodríguez-Sánchez B, Giannella M, Catalán P, Gayoso J, López Bernaldo de Quirós JC, Bouza E, de Viedma DG. Resistance and virulence mutations in patients with persistent infection by pandemic 2009 A/H1N1 influenza. J Clin Virol 2011; 50:114-8. [DOI: 10.1016/j.jcv.2010.10.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Revised: 10/13/2010] [Accepted: 10/13/2010] [Indexed: 10/18/2022]
|
11
|
López Bernaldo de Quirós JC. [Tenofovir DF in rescue regimens]. Enferm Infecc Microbiol Clin 2009; 26 Suppl 8:25-30. [PMID: 19195435 DOI: 10.1157/13126269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
As with other nucleoside analogues, tenofovir (TDF) can be affected by several mutations in the reverse transcriptase gene. Most nucleoside analogue mutations (NAMs) are not induced specifically by TDF, although they can affect the activity of this drug. The impact of thymidine analogue mutations (TAMs) on tenofovir varies and, as with the remaining nucleoside analogue reverse transcriptase inhibitors, largely depends on the type and number present. Thus, the greater the number of TAMs, and the greater the number of type 1 TAMs, the more TDF activity will be affected. The 41L and 210W mutations have the greatest effect. The incidence of the 65R mutation was slight before the clinical introduction of TDF. This mutation was selected by treatments with zalcitabine monotherapy. However, after TDF came on to the market, the 65R mutation began to be more frequently reported and is currently the signature mutation of this drug. TDF has been shown to be safe and effective in patients with prior virological failure and resistance mutations in the reverse transcriptase gene. In these patients, the presence of the 41L and 210W mutations is associated with a worse response to rescue therapy containing TDF. In contrast, the presence of type 2 TAMs (67N, 70R and 219Q/E/N) has little effect on TDF activity in these patients. Importantly, in TDF therapy, the presence of the 184V mutation is associated with a more favorable virologic response than the absence of this mutation, with any of the distinct combinations of mutations present.
Collapse
|