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Overton ET, Richmond G, Rizzardini G, Jaeger H, Orrell C, Nagimova F, Bredeek F, García Deltoro M, Swindells S, Andrade-Villanueva JF, Wong A, Khuong-Josses MA, Van Solingen-Ristea R, van Eygen V, Crauwels H, Ford S, Talarico C, Benn P, Wang Y, Hudson KJ, Chounta V, Cutrell A, Patel P, Shaefer M, Margolis DA, Smith KY, Vanveggel S, Spreen W. Long-acting cabotegravir and rilpivirine dosed every 2 months in adults with HIV-1 infection (ATLAS-2M), 48-week results: a randomised, multicentre, open-label, phase 3b, non-inferiority study. Lancet 2021; 396:1994-2005. [PMID: 33308425 DOI: 10.1016/s0140-6736(20)32666-0] [Citation(s) in RCA: 141] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/28/2020] [Accepted: 10/07/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Phase 3 clinical studies showed non-inferiority of long-acting intramuscular cabotegravir and rilpivirine dosed every 4 weeks to oral antiretroviral therapy. Important phase 2 results of every 8 weeks dosing, and supportive modelling, underpin further evaluation of every 8 weeks dosing in this trial, which has the potential to offer greater convenience. Our objective was to compare the week 48 antiviral efficacy of cabotegravir plus rilpivirine long-acting dosed every 8 weeks with that of every 4 weeks dosing. METHODS ATLAS-2M is an ongoing, randomised, multicentre (13 countries; Australia, Argentina, Canada, France, Germany, Italy, Mexico, Russia, South Africa, South Korea, Spain, Sweden, and the USA), open-label, phase 3b, non-inferiority study of cabotegravir plus rilpivirine long-acting maintenance therapy administered intramuscularly every 8 weeks (cabotegravir 600 mg plus rilpivirine 900 mg) or every 4 weeks (cabotegravir 400 mg plus rilpivirine 600 mg) to treatment-experienced adults living with HIV-1. Eligible newly recruited individuals must have received an uninterrupted first or second oral standard-of-care regimen for at least 6 months without virological failure and be aged 18 years or older. Eligible participants from the ATLAS trial, from both the oral standard-of-care and long-acting groups, must have completed the 52-week comparative phase with an ATLAS-2M screening plasma HIV-1 RNA less than 50 copies per mL. Participants were randomly assigned 1:1 to receive cabotegravir plus rilpivirine long-acting every 8 weeks or every 4 weeks. The randomisation schedule was generated by means of the GlaxoSmithKline validated randomisation software RANDALL NG. The primary endpoint at week 48 was HIV-1 RNA ≥50 copies per mL (Snapshot, intention-to-treat exposed), with a non-inferiority margin of 4%. The trial is registered at ClinicalTrials.gov, NCT03299049 and is ongoing. FINDINGS Screening occurred between Oct 27, 2017, and May 31, 2018. Of 1149 individuals screened, 1045 participants were randomised to the every 8 weeks (n=522) or every 4 weeks (n=523) groups; 37% (n=391) transitioned from every 4 weeks cabotegravir plus rilpivirine long-acting in ATLAS. Median participant age was 42 years (IQR 34-50); 27% (n=280) female at birth; 73% (n=763) white race. Cabotegravir plus rilpivirine long-acting every 8 weeks was non-inferior to dosing every 4 weeks (HIV-1 RNA ≥50 copies per mL; 2% vs 1%) with an adjusted treatment difference of 0·8 (95% CI -0·6-2·2). There were eight (2%, every 8 weeks group) and two (<1%, every 4 weeks group) confirmed virological failures (two sequential measures ≥200 copies per mL). For the every 8 weeks group, five (63%) of eight had archived non-nucleoside reverse transcriptase inhibitor resistance-associated mutations to rilpivirine at baseline. The safety profile was similar between dosing groups, with 844 (81%) of 1045 participants having adverse events (excluding injection site reactions); no treatment-related deaths occurred. INTERPRETATION The efficacy and safety profiles of dosing every 8 weeks and dosing every 4 weeks were similar. These results support the use of cabotegravir plus rilpivirine long-acting administered every 2 months as a therapeutic option for people living with HIV-1. FUNDING ViiV Healthcare and Janssen.
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Affiliation(s)
| | | | - Giuliano Rizzardini
- Fatebenefratelli Sacco Hospital, Milan, Italy; School of Clinical Medicine, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Hans Jaeger
- MVZ Karlsplatz, HIV Research and Clinical Care Centre, Munich, Germany
| | - Catherine Orrell
- Desmond Tutu HIV Foundation, University of Cape Town Medical School, Cape Town, South Africa
| | - Firaya Nagimova
- Republic Center for the Prevention and Control of AIDS and Infectious Diseases, Russia
| | | | | | | | | | - Alexander Wong
- Department of Medicine, University of Saskatchewan, Regina, Saskatchewan, Canada
| | | | | | - Veerle van Eygen
- Janssen Research and Development, Janssen Pharmaceutica NV, Beerse, Belgium
| | - Herta Crauwels
- Janssen Research and Development, Janssen Pharmaceutica NV, Beerse, Belgium
| | - Susan Ford
- GlaxoSmithKline, Research Triangle Park, NC, USA
| | | | | | | | | | | | - Amy Cutrell
- ViiV Healthcare, Research Triangle Park, NC, USA
| | - Parul Patel
- ViiV Healthcare, Research Triangle Park, NC, USA
| | - Mark Shaefer
- ViiV Healthcare, Research Triangle Park, NC, USA
| | | | | | - Simon Vanveggel
- Janssen Research and Development, Janssen Pharmaceutica NV, Beerse, Belgium
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Smith GHR, Henry WK, Podzamczer D, Masiá MDM, Bettacchi CJ, Arasteh K, Jaeger H, Khuong-Josses MA, Montes-Ramírez ML, Stellbrink HJ, Yazdanpanah Y, Richmond GJ, Sutton KC, Zhang F, McCoig CC, St Clair MH, Vandermeulen K, Van Solingen-Ristea R, Smith KY, Margolis DA, Spreen WR. Efficacy, Safety, and Durability of Long-Acting Cabotegravir and Rilpivirine in Adults With Human Immunodeficiency Virus Type 1 Infection: 5-Year Results From the LATTE-2 Study. Open Forum Infect Dis 2021; 8:ofab439. [PMID: 34557563 PMCID: PMC8454521 DOI: 10.1093/ofid/ofab439] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 05/04/2021] [Accepted: 08/23/2021] [Indexed: 11/13/2022] Open
Abstract
Background In the Long-Acting Antiretroviral Treatment Enabling Trial 2 (LATTE-2) phase 2b study, long-acting (LA) injectable cabotegravir + rilpivirine dosed every 8 weeks (Q8W) or every 4 weeks (Q4W) demonstrated comparable efficacy with daily oral antiretroviral therapy (ART) through 96 weeks in ART-naive adults with human immunodeficiency virus type 1 (HIV-1). Here we report efficacy, tolerability, and safety of cabotegravir + rilpivirine LA over approximately 5 years. Methods After 20 weeks of oral cabotegravir + abacavir/lamivudine, participants were randomized to cabotegravir + rilpivirine LA Q8W or Q4W or continue oral ART through the 96-week maintenance period. In the extension period through week 256, participants continued their current LA regimen (randomized Q8W/Q4W groups) or switched from oral ART to Q8W or Q4W LA therapy (extension-switch groups). Endpoints assessed included proportion of participants with HIV-1 RNA <50 copies/mL (Snapshot algorithm) and adverse events (AEs). Results At week 256, 186 of 230 (81%) participants in randomized Q8W/Q4W groups and 41 of 44 (93%) participants in extension-switch groups had HIV-1 RNA <50 copies/mL. No protocol-defined virologic failures occurred after week 48. Injection wsite reactions infrequently resulted in discontinuation (4 [2%] and 1 [2%] participants in randomized Q8W/Q4W and extension-switch groups, respectively). Three participants in randomized Q8W/Q4W groups experienced drug-related serious AEs, including 1 fatal serious AE (Q4W group); none occurred in extension-switch groups. Of 25 participants with AEs leading to withdrawal, 20 were in the randomized Q4W group; no AE leading to withdrawal occurred in >1 participant. Conclusions Cabotegravir + rilpivirine LA exhibited long-term efficacy and tolerability, demonstrating its durability as maintenance therapy for HIV-1 infection. Clinical Trials Registration. NCT02120352.
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Affiliation(s)
| | - W Keith Henry
- Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA
| | - Daniel Podzamczer
- HIV Unit, Department of Infectious Diseases, Hospital Universitari de Bellvitge, L'Hospitalet, Barcelona, Spain
| | - Maria Del Mar Masiá
- Infectious Diseases Unit, Hospital General Universitario de Elche, Elche, Spain
| | | | | | - Hans Jaeger
- MVZ Karlsplatz, HIV Research and Clinical Care Centre, Munich, Germany
| | | | | | | | - Yazdan Yazdanpanah
- Infectious Disease Department, Hôpital Bichat Claude Bernard, Paris, France
| | | | - Kenneth C Sutton
- Clinical Development, ViiV Healthcare, Research Triangle Park, North Carolina, USA
| | - Feifan Zhang
- Dev Biostatistics, GlaxoSmithKline, Collegeville, Pennsylvania, USA
| | | | - Marty H St Clair
- Department of Translational Medical Research, ViiV Healthcare, Research Triangle Park, North Carolina, USA
| | - Kati Vandermeulen
- Medical Department of Infectious Diseases Therapeutic Area, Janssen Research and Development, Beerse, Belgium
| | - Rodica Van Solingen-Ristea
- Medical Department of Infectious Diseases Therapeutic Area, Janssen Research and Development, Beerse, Belgium
| | - Kimberly Y Smith
- Global Research and Medical Strategy, ViiV Healthcare, Research Triangle Park, North Carolina, USA
| | - David A Margolis
- Clinical Development, ViiV Healthcare, Research Triangle Park, North Carolina, USA
| | - William R Spreen
- Medicines Development, ViiV Healthcare, Research Triangle Park, North Carolina, USA
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3
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Smith G, Henry K, Podzamczer D, Masiá M, Bettacchi C, Arasteh K, Jaeger H, Khuong-Josses MA, Sutton K, Zhang F, McCoig CC, Vandermeulen K, Van Solingen-Ristea R, Spreen W, Margolis D. 638. Safety, Efficacy, and Durability of Long-Acting CAB and RPV as Maintenance Therapy for HIV-1 Infection: LATTE-2 Week 256 Results. Open Forum Infect Dis 2020. [PMCID: PMC7778165 DOI: 10.1093/ofid/ofaa439.832] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Long-acting (LA) injectable suspensions of cabotegravir (CAB) & rilpivirine (RPV) are in phase III development. LATTE-2 W160 results demonstrated high rates of virologic response & overall tolerability. This W256 analysis evaluated long-term efficacy, safety, & tolerability of every 8-week (Q8W) & 4-week (Q4W) intramuscular (IM) dosing.
Methods
LATTE-2 is a phase IIb, multicenter, parallel arm, open-label study in antiretroviral therapy–naive adults with HIV. After a 20-week Induction Period on oral CAB+abacavir/lamivudine, participants (pts) with plasma HIV-1 RNA< 50c/mL were randomized 2:2:1 to IM CAB LA+RPV LA Q8W, Q4W, or continue oral (PO) regimen in the Maintenance Period (MP). After W96, pts on IM regimens continued their current MP regimen. Pts randomized to PO in MP chose a Q8W or Q4W IM regimen in the Extension Period (EP). W256 analysis of MP & EP included virologic success with HIV-1 RNA< 50 c/mL (Food & Drug Administration Snapshot analysis), protocol-defined virologic failure (PDVF), & safety (intention-to-treat–Maintenance Exposed population).
Results
At W256, 88% (101/115; Q8W) & 74% (85/115; Q4W) of randomized IM pts had HIV-1 RNA< 50 c/mL, as did 93% (41/44) of PO to IM pts. No pt developed PDVF after W48. In the randomized IM arm (MP & EP), excluding injection-site reactions (ISRs), nasopharyngitis (45%), diarrhea (28%), & headache (24%) were the most common adverse events (AEs), with 34% (39/115; Q8W) & 33% (38/115; Q4W) of pts reporting AEs ≥grade 3, of which 12% (14/115; Q8W) & 11% (13/115; Q4W) were drug related. 3% (3/115; Q8W) & 17% (20/115; Q4W) of pts had AEs leading to withdrawal. 22% (25/115; Q8W) & 23% (27/115; Q4W) reported serious AEs (3 were drug related). In the PO to IM arm (EP only), most common AEs excluding ISRs were nasopharyngitis (25%), influenza (23%), & back pain (18%). 23% (10/44) reported AEs ≥grade 3 & 5% (2/44) had AEs leading to withdrawal. Majority of ISRs were mild/moderate pain & discomfort. < 1% of ISRs were severe, with 5 pts discontinuing due to ISRs.
Table 1
Table 2
Conclusion
CAB+RPV LA injectable therapy, administered Q8W or Q4W, demonstrated high rates of virologic response & tolerability through 5 years. W256 results add to previous results & demonstrate long-term durability of CAB+RPV LA for people living with HIV.
Disclosures
Keith Henry, MD, Gilead (Research Grant or Support, Paid to institution)GSK/ViiV (Research Grant or Support, Paid to institution)Janssen (Research Grant or Support, Paid to institution)Merck (Research Grant or Support, Paid to institution) Daniel Podzamczer, MD, PhD, Gilead (Grant/Research Support, Advisor or Review Panel member)Janssen Pharmaceutica (Grant/Research Support, Advisor or Review Panel member)Merck Sharp & Dohme (Grant/Research Support, Advisor or Review Panel member)ViiV Healthcare (Grant/Research Support, Advisor or Review Panel member) Mar Masiá, MD, PhD, Janssen Pharmaceutica (Consultant, Other Financial or Material Support, Travel/accommodations/meeting expenses)Merck Sharp & Dohme (Consultant, Other Financial or Material Support, Travel/accommodations/meeting expenses)ViiV Healthcare (Consultant, Other Financial or Material Support, Travel/accommodations/meeting expenses) Hans Jaeger, MD, Abbvie (Consultant, Speaker’s Bureau)Gilead Sciences (Consultant, Speaker’s Bureau)Janssen (Consultant, Speaker’s Bureau)MSD Sharp & Dohme (Consultant, Speaker’s Bureau)ViiV Healthcare (Consultant, Research Grant or Support, Speaker’s Bureau) Marie-Aude Khuong-Josses, MD, Viiv HC (Advisor or Review Panel member) Kenneth Sutton, MA, GlaxoSmithKline (Shareholder)ViiV Healthcare (Employee) Cynthia C. McCoig, MD, ViiV Healthcare (Employee) Kati Vandermeulen, MSC, Janssen Pharmaceutica (Employee, Shareholder) Rodica Van Solingen-Ristea, MD, Janssen R&D (Employee) William Spreen, PharmD, ViiV Healthcare (Employee, Shareholder) David Margolis, MD, MPH, GlaxoSmithKline (Shareholder)ViiV Healthcare (Employee)
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Affiliation(s)
| | - Keith Henry
- Hennepin County Medical Center, Minneapolis, Minnesota
| | | | - Mar Masiá
- Hospital General Universitario de Elche, Elche, Comunidad Valenciana, Spain
| | | | | | - Hans Jaeger
- MVZ Karlsplatz - HIV Research and Clinical Care Centre, Munich, Bayern, Germany
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Melliez H, Mary-Krause M, Bocket L, Guiguet M, Abgrall S, De Truchis P, Katlama C, Martin-Blondel G, Henn A, Revest M, Robineau O, Khuong-Josses MA, Canestri A, De Castro N, Joly V, Mokhtari S, Risso K, Gasnault J, Costagliola D. Risk of Progressive Multifocal Leukoencephalopathy in the Combination Antiretroviral Therapy Era in the French Hospital Database on Human Immunodeficiency Virus (ANRS-C4). Clin Infect Dis 2019; 67:275-282. [PMID: 29635465 DOI: 10.1093/cid/ciy074] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 01/29/2018] [Indexed: 12/31/2022] Open
Abstract
Background Risk factors for progressive multifocal leukoencephalopathy (PML) in individuals with human immunodeficiency virus (HIV) infection are poorly documented in the era of combination antiretroviral therapy (cART). Methods We studied HIV-1-infected individuals aged ≥15 years who had no history of PML and were prospectively followed up between 1997 and 2011 in the French Hospital Database on HIV (FHDH-ANRS CO4) cohort. Cox models were used to calculate adjusted hazard ratios (HRs), focusing on sub-Saharan origin, suggested to be protective, and recent cART initiation, potentially associated with an increased risk of PML. Results PML developed in 555 individuals, in 57 during the first 6 months of cART. From 1997-2000 to 2009-2011, the incidence fell from 1.15 (95% confidence interval [CI], .98-1.31) to 0.49 (.37-.61) per 1000 person-years. Sub-Saharan African origin had no clear influence (HR, 0.80; 95% CI, .58-1.11). Compared with men who have sex with men, injection drug users (IDUs) were at higher risk (HR, 1.80 [95% CI, 1.32-2.45] for male and 1.68 [1.13-2.48] for female IDUs). When IDUs were excluded, hepatitis C virus seropositivity was associated with an increased risk (HR, 1.40; 95% CI, 1.02-1.93). Compared with no cART initiation, initiation <6 months previously was associated with PML onset (HR, 4.91; 95% CI, 2.42-9.95). Conclusions Recent cART initiation is associated with an increased risk of PML, as are injection drug use and hepatitis C virus seropositivity. Sub-Saharan African origin had no protective effect.
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Affiliation(s)
- Hugues Melliez
- Sorbonne Universités, UPMC Université Paris, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique.,Service Universitaire des Maladies Infectieuses et du Voyageur, Hopital Gustave Dron, Tourcoing
| | - Murielle Mary-Krause
- Sorbonne Universités, UPMC Université Paris, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique
| | - Laurence Bocket
- Centre de Pathologies-Biologie, Centre Hospitalier Regional et Universitaire, Lille
| | - Marguerite Guiguet
- Sorbonne Universités, UPMC Université Paris, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique
| | - Sophie Abgrall
- Sorbonne Universités, UPMC Université Paris, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique.,Service de Médecine Interne et Immunologie Clinique, Hôpital Antoine Béclère, Assistance Publique-Hôpitaux de Paris (AP-HP), Clamart
| | | | - Christine Katlama
- Sorbonne Universités, UPMC Université Paris, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique.,Département des Maladies Infectieuses et Tropicales, Hôpital Pitié Salpêtrière, AP-HP, Paris
| | - Guillaume Martin-Blondel
- Service des Maladies Infectieuses et Tropicales, CHU de Toulouse.,Centre de Physiopathologie de Toulouse Purpan, INSERM UMR
| | - Aurelia Henn
- Service d'Immunologie Clinique et Maladies Infectieuses, Hôpital Henri Mondor, AP-HP, Créteil
| | - Matthieu Revest
- Service de Maladies Infectieuses et Réanimation Médicale, Hôpital Pontchaillou, Rennes
| | - Olivier Robineau
- Service Universitaire des Maladies Infectieuses et du Voyageur, Hopital Gustave Dron, Tourcoing
| | | | - Anna Canestri
- Service des Maladies infectieuses et tropicales, Hôpital Tenon
| | | | - Véronique Joly
- Hôpital Bichat, Service des Maladies Infectieuses et Tropicales, AP-HP, Paris
| | - Saadia Mokhtari
- Service des Maladies Infectieuses et Tropicales, Hôpital Nord, Marseille
| | - Karine Risso
- Service d'Infectiologie, Hôpital de l'Archet, Nice
| | - Jacques Gasnault
- Service de Médecine Interne, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France
| | - Dominique Costagliola
- Sorbonne Universités, UPMC Université Paris, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique
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5
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Aboud M, Orkin C, Podzamczer D, Bogner JR, Baker D, Khuong-Josses MA, Parks D, Angelis K, Kahl LP, Blair EA, Adkison K, Underwood M, Matthews JE, Wynne B, Vandermeulen K, Gartland M, Smith K. Efficacy and safety of dolutegravir–rilpivirine for maintenance of virological suppression in adults with HIV-1: 100-week data from the randomised, open-label, phase 3 SWORD-1 and SWORD-2 studies. The Lancet HIV 2019; 6:e576-e587. [DOI: 10.1016/s2352-3018(19)30149-3] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 04/02/2019] [Accepted: 04/18/2019] [Indexed: 11/27/2022]
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Couffignal C, Papot E, Etienne A, Legac S, Laouénan C, Beres D, Blum L, Khuong-Josses MA, Lepretre A, Papazian P, Yazdanpanah Y, Bouvet E. Treatment as prevention (TasP) and perceived sexual changes in behavior among HIV-positive persons: a French survey in infectious diseases departments in Paris. AIDS Care 2019; 32:811-817. [PMID: 31431047 DOI: 10.1080/09540121.2019.1653438] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
We evaluated awareness of treatment as prevention (TasP) among adults people living with HIV (PLHIV) in five infectious disease departments in Paris, then how they perceived its impact on their sexual well-being. This cross-sectional multicenter survey was conducted in 2014 during scheduled clinical appointments using a self-administered questionnaire. We analyzed 520 questionnaires (42% women, 54% men of whom 57% were MSM [men who have sex with men]). 75% of women were born abroad, most commonly in sub-Saharan Africa, whereas 64% of men were French-born. The mean time since HIV diagnosis was 12.8 ± 7.8 years. Eighty-seven percent [84-90%]95 % reported being aware of the impact of ART on HIV transmission, 94% MSM, 86% women, 83% heterosexual men. PLHIV reported that they gained awareness of TasP through medical doctors (86%). The fear of transmission was perceived as alleviated for 73% [69%;78%]95%, more often among MSM; the sexual life was reported to be improved for 28% [24%;33%]95%; and ART adherence to be improved for 45% [40%;50%]95%, more often among women. The awareness of TasP was relatively high, but it seems important to understand the features of male and female populations of PLHIV to adapt counseling during follow-up appointments, as women's answers differed in various regards.
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Affiliation(s)
- Camille Couffignal
- IAME-UMR 1137, Inserm and University of Paris, Paris, France.,Biostatistics Department, AP-HP, HUPNVS, Paris, France
| | - Emmanuelle Papot
- IAME-UMR 1137, Inserm and University of Paris, Paris, France.,Infectious Diseases Clinic, Bichat-Claude Bernard University Hospital, AP-HP, Paris, France
| | - Aurélie Etienne
- IAME-UMR 1137, Inserm and University of Paris, Paris, France.,Biostatistics Department, AP-HP, HUPNVS, Paris, France
| | - Sylvie Legac
- Infectious Diseases Clinic, Bichat-Claude Bernard University Hospital, AP-HP, Paris, France.,COREVIH Ile De France Nord, Paris, France
| | - Cédric Laouénan
- IAME-UMR 1137, Inserm and University of Paris, Paris, France.,Biostatistics Department, AP-HP, HUPNVS, Paris, France
| | | | - Laurent Blum
- Infectious Diseases Department, Pontoise Hospital Center, Cergy Pontoise, France
| | | | | | - Patrick Papazian
- Infectious Diseases Clinic, Bichat-Claude Bernard University Hospital, AP-HP, Paris, France.,COREVIH Ile De France Nord, Paris, France
| | - Yazdan Yazdanpanah
- IAME-UMR 1137, Inserm and University of Paris, Paris, France.,Infectious Diseases Clinic, Bichat-Claude Bernard University Hospital, AP-HP, Paris, France.,COREVIH Ile De France Nord, Paris, France
| | - Elisabeth Bouvet
- IAME-UMR 1137, Inserm and University of Paris, Paris, France.,Infectious Diseases Clinic, Bichat-Claude Bernard University Hospital, AP-HP, Paris, France.,COREVIH Ile De France Nord, Paris, France
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7
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de Monteynard LA, Dray-Spira R, de Truchis P, Grabar S, Launay O, Meynard JL, Khuong-Josses MA, Gilquin J, Rey D, Simon A, Pavie J, Mahamat A, Matheron S, Costagliola D, Abgrall S. Later cART initiation in migrant men from sub-Saharan Africa without advanced HIV disease in France. PLoS One 2015; 10:e0118492. [PMID: 25734445 PMCID: PMC4348541 DOI: 10.1371/journal.pone.0118492] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 12/12/2014] [Indexed: 11/23/2022] Open
Abstract
Objective To compare the time from entry into care for HIV infection until combination antiretroviral therapy (cART) initiation between migrants and non migrants in France, excluding late access to care. Methods Antiretroviral-naïve HIV-1-infected individuals newly enrolled in the FHDH cohort between 2002–2010, with CD4 cell counts >200/μL and no previous or current AIDS events were included. In three baseline CD4 cell count strata (200–349, 350-499, ≥500/μL), we examined the crude time until cART initiation within three years after enrolment according to geographic origin, and multivariable hazard ratios according to geographic origin, gender and HIV-transmission group, with adjustment for baseline age, enrolment period, region of care, plasma viral load, and HBV/HBC coinfection. Results Among 13338 individuals, 9605 (72.1%) were French natives (FRA), 2873 (21.4%) were migrants from sub-Saharan Africa/non-French West Indies (SSA/NFW), and 860 (6.5%) were migrants from other countries. Kaplan-Meier probabilities of cART initiation were significantly lower in SSA/NFW than in FRA individuals throughout the study period, regardless of the baseline CD4 stratum. After adjustment, the likelihood of cART initiation was respectively 15% (95%CI, 1–28) and 20% (95%CI, 2–38) lower in SSA/NFW men than in FRA men who had sex with men (MSM) in the 350-499 and ≥500 CD4 strata, while no difference was observed between other migrant groups and FRA MSM. Conclusion SSA/NFW migrant men living in France with CD4 >350/μL at entry into care are more likely to begin cART later than FRA MSM, despite free access to treatment. Administrative delays in obtaining healthcare coverage do not appear to be responsible.
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Affiliation(s)
- Laure-Amélie de Monteynard
- Sorbonne Universités, UPMC Université Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France; INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | - Rosemary Dray-Spira
- Sorbonne Universités, UPMC Université Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France; INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | - Pierre de Truchis
- AP-HP, Hôpitaux Universitaires Paris-Ile de France-Ouest, Hôpital Raymond-Poincaré, Département de Médecine Aigüe Spécialisée, Garches, France
| | - Sophie Grabar
- INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France; Université Paris Descartes, Sorbonne Paris cité, Paris, France; AP-HP, Groupe Hospitalier Cochin Broca Hôtel-Dieu, Unité de Biostatistique et Epidémiologie, Paris, France
| | - Odile Launay
- Université Paris Descartes, Sorbonne Paris cité, Paris, France; AP-HP, Hôpital Cochin, Paris, France
| | - Jean-Luc Meynard
- AP-HP, Hôpital Saint Antoine, Service des Maladies Infectieuses et Tropicales, Paris, France
| | - Marie-Aude Khuong-Josses
- Centre Hospitalier Saint-Denis, Hôpital Delafontaine, Service des Maladies Infectieuses et Tropicales, Saint-Denis, France
| | - Jacques Gilquin
- AP-HP, Hôpital Hôtel-Dieu, Unité d'immunoinfectiologie, Paris, France
| | - David Rey
- Hôpitaux Universitaire Strasbourg, Centre de Soins de l'Infection par le VIH, Strasbourg, France
| | - Anne Simon
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de médecine interne, Paris, France
| | - Juliette Pavie
- AP-HP, Hôpital Européen Georges Pompidou, Service d'immunologie clinique, Paris, France
| | - Aba Mahamat
- Centre Hospitalier Andrée Rosemon, Service des Maladies Infectieuses et Tropicales, Cayenne, France
| | - Sophie Matheron
- Université Paris Diderot, Sorbonne Paris cité, Paris, France; AP-HP, Hôpital Bichat-Claude Bernard, Service des Maladies Infectieuses et Tropicales, Paris, France
| | - Dominique Costagliola
- Sorbonne Universités, UPMC Université Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France; INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | - Sophie Abgrall
- Sorbonne Universités, UPMC Université Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France; INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France; AP-HP, Hôpital Avicenne, Service des Maladies Infectieuses et Tropicales, Bobigny, France
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Descamps D, Peytavin G, Visseaux B, Tubiana R, Damond F, Campa P, Charpentier C, Khuong-Josses MA, Duvivier C, Karmochkine M, Lukiana T, Matheron S. Dolutegravir in HIV-2-Infected Patients With Resistant Virus to First-line Integrase Inhibitors From the French Named Patient Program. Clin Infect Dis 2015; 60:1521-7. [PMID: 25690598 DOI: 10.1093/cid/civ124] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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: 12/04/2014] [Accepted: 02/09/2015] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Dolutegravir has shown in vitro activity against human immunodeficiency virus type 2 (HIV-2). We report safety and efficacy data of regimens containing dolutegravir (50 mg twice daily) in antiretroviral-experienced, HIV-2-infected patients. METHODS HIV-2-infected patients experiencing virological failure to raltegravir received dolutegravir with optimized background antiretroviral combinations within the French Named Patient Program (NPP). Plasma HIV-2 RNA (pVL) was assessed at time of dolutegravir initiation (baseline), month 3, and month 6. Antiretroviral trough plasma concentrations (C12h) were determined using liquid chromatography coupled with tandem mass spectrometry. RESULTS Thirteen HIV-2-infected-patients, with a median duration of 15 years' infection and given 16 previous antiretroviral regimens, were included in NPP. Median follow-up was 9 months (min-max, 3-15 months). Median baseline pVL and CD4 cell count were 9544 copies/mL (inter quartile range [IQR], 3096-23 120 copies/mL) and 100 cells/µL (IQR, 77-171 cells/µL), respectively. Available integrase genotypic resistance patterns were Y143C/G/H/R (n = 5), Q148R/K (n = 2), and N155H (n = 4). Optimized background antiretroviral regimens conferring a genotypic sensitivity score ≤2 in 10 patients included nucleoside reverse transcriptase inhibitors associated with darunavir/ritonavir (n = 12), saquinavir/ritonavir (n = 2), and maraviroc (n = 3). At months 3 and 6, pVL was undetectable in 6 of 13 and 4 of 12 patients, respectively, and median CD4 count was 161 (101-188) cells/µL and 167 (135-1353) cells/µL, respectively. Median dolutegravir C12h was 4086 (1756-5717 ng/mL) ng/mL in 9 patients. No serious events were notified except 1 death from progressive multifocal leukoencephalopathy at month 4. CONCLUSIONS Optimized dolutegravir-containing antiretroviral regimens supported by good plasma exposure provide a substantial initial efficacy rate for salvage therapy in heavily antiretroviral-experienced HIV-2-infected patients with virus harboring resistance to first-generation integrase inhibitors. Larger numbers of patients and longer follow-up are needed to confirm these findings.
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Affiliation(s)
- Diane Descamps
- Université Paris Diderot, Sorbonne Paris Cité INSERM, IAME, UMR 1137 Laboratoire de Virologie
| | - Gilles Peytavin
- Université Paris Diderot, Sorbonne Paris Cité INSERM, IAME, UMR 1137 Laboratoire de Pharmaco-Toxicologie, AP-HP, Hôpital Bichat-Claude Bernard
| | - Benoit Visseaux
- Université Paris Diderot, Sorbonne Paris Cité INSERM, IAME, UMR 1137 Laboratoire de Virologie
| | - Roland Tubiana
- Service des Maladies Infectieuses et Tropicales, AP-HP, Hôpital Pitié-Salpêtrière Pierre Louis Institute of Epidemiology and Public Health, Sorbonne University, UPMC, INSERM UMR-S1136
| | - Florence Damond
- Université Paris Diderot, Sorbonne Paris Cité INSERM, IAME, UMR 1137 Laboratoire de Virologie
| | - Pauline Campa
- Service des Maladies Infectieuses et Tropicales, AP-HP, Hôpital Saint-Antoine, Paris
| | - Charlotte Charpentier
- Université Paris Diderot, Sorbonne Paris Cité INSERM, IAME, UMR 1137 Laboratoire de Virologie
| | | | - Claudine Duvivier
- Service de Maladies Infectieuses et Tropicales, AP-HP, Hôpital Necker, Centre d'Infectiologie Necker-Pasteur, Université Paris Descartes, Sorbonne Paris Cité IHU Imagine
| | - Marina Karmochkine
- Service d'Immunologie Clinique, AP-HP, Hôpital Européen Georges Pompidou, Paris
| | | | - Sophie Matheron
- Université Paris Diderot, Sorbonne Paris Cité INSERM, IAME, UMR 1137 Service de Maladies Infectieuses et Tropicales, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
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9
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Clotet B, Feinberg J, van Lunzen J, Khuong-Josses MA, Antinori A, Dumitru I, Pokrovskiy V, Fehr J, Ortiz R, Saag M, Harris J, Brennan C, Fujiwara T, Min S. Once-daily dolutegravir versus darunavir plus ritonavir in antiretroviral-naive adults with HIV-1 infection (FLAMINGO): 48 week results from the randomised open-label phase 3b study. Lancet 2014; 383:2222-31. [PMID: 24698485 DOI: 10.1016/s0140-6736(14)60084-2] [Citation(s) in RCA: 367] [Impact Index Per Article: 36.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Dolutegravir has been shown to be non-inferior to an integrase inhibitor and superior to a non-nucleoside reverse transcriptase inhibitor (NNRTI). In FLAMINGO, we compared dolutegravir with darunavir plus ritonavir in individuals naive for antiretroviral therapy. METHODS In this multicentre, open-label, phase 3b, non-inferiority study, HIV-1-infected antiretroviral therapy-naive adults with HIV-1 RNA concentration of 1000 copies per mL or more and no resistance at screening were randomly assigned (1:1) to receive either dolutegravir 50 mg once daily or darunavir 800 mg plus ritonavir 100 mg once daily, with investigator-selected tenofovir-emtricitabine or abacavir-lamivudine. Randomisation was stratified by screening HIV-1 RNA (≤100,000 or >100,000 copies per mL) and nucleoside reverse transcriptase inhibitor (NRTI) selection. The primary endpoint was the proportion of patients with HIV-1 RNA concentration lower than 50 copies per mL (Food and Drug Administration [FDA] snapshot algorithm) at week 48 with a 12% non-inferiority margin. This trial is registered with ClinicalTrials.gov, NCT01449929. FINDINGS Recruitment began on Oct 31, 2011, and was completed on May 24, 2012, in 64 research centres in nine countries worldwide. Of 595 patients screened, 484 patients were included in the analysis (242 in each group). At week 48, 217 (90%) patients receiving dolutegravir and 200 (83%) patients receiving darunavir plus ritonavir had HIV-1 RNA of less than 50 copies per mL (adjusted difference 7·1%, 95% CI 0·9-13·2), non-inferiority and on pre-specified secondary analysis dolutegravir was superior (p=0·025). Confirmed virological failure occurred in two (<1%) patients in each group; we recorded no treatment-emergent resistance in either group. Discontinuation due to adverse events or stopping criteria was less frequent for dolutegravir (four [2%] patients) than for darunavir plus ritonavir (ten [4%] patients) and contributed to the difference in response rates. The most commonly reported (≥10%) adverse events were diarrhoea (dolutegravir 41 [17%] patients vs darunavir plus ritonavir 70 [29%] patients), nausea (39 [16%] vs 43 [18%]), and headache (37 [15%] vs 24 [10%]). Patients receiving dolutegravir had significantly fewer low-density lipoprotein values of grade 2 or higher (11 [2%] vs 36 [7%]; p=0·0001). INTERPRETATION Once-daily dolutegravir was superior to once-daily darunavir plus ritonavir. Once-daily dolutegravir in combination with fixed-dose NRTIs represents an effective new treatment option for HIV-1-infected, treatment-naive patients. FUNDING ViiV Healthcare and Shionogi & Co.
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Affiliation(s)
- Bonaventura Clotet
- IrsiCaixa, Hospital Universitari "Germans Trias i Pujol", Badalona, UAB, Universitat de Vic, Catalonia, Spain.
| | | | - Jan van Lunzen
- Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | | | - Andrea Antinori
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Roma, Italy
| | - Irina Dumitru
- Clinical Infectious Diseases Hospital, Constanta, Romania
| | | | - Jan Fehr
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Michael Saag
- Department of Medicine, Center for AIDS Research, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Julia Harris
- GlaxoSmithKline, Stockley Park, Uxbridge, Middlesex, UK
| | | | | | - Sherene Min
- GlaxoSmithKline, Research Triangle Park, NC, USA
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Khuong-Josses MA, Azerad D, Boussaïri A, Ekoukou D. Comparison of lopinavir level between the two formulations (soft-gel capsule and tablet) in HIV-infected pregnant women. HIV Clin Trials 2007; 8:254-5. [PMID: 17720666 DOI: 10.1310/hct0804-254] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Khuong-Josses MA, Khelil N, Guillaume AS, Ekoukou D. [Human immunodeficiency virus and pregnancy: a retrospective study of 124 women]. Pathol Biol (Paris) 2002; 50:544-6. [PMID: 12490417 DOI: 10.1016/s0369-8114(02)00343-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The objective is to describe medical and obstetrical prenatal care of 124 HIV-infected pregnant women in the Hôpital Delafontaine, Saint-Denis, France, between 1995 and 2001.Demographic, clinical and biological characteristics of study population were retrospectively collected. Three (2,4%) children were infected.
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Affiliation(s)
- M A Khuong-Josses
- Service de maladies infectieuses et tropicales, Hôpital Delafontaine, Saint-Denis, France
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