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Orkin C, Molina JM, Cahn P, Lombaard J, Supparatpinyo K, Kumar S, Campbell H, Wan H, Teal V, Jin Xu Z, Asante-Appiah E, Sklar P, Teppler H, Lahoulou R. Safety and efficacy of doravirine as first-line therapy in adults with HIV-1: week 192 results from the open-label extensions of the DRIVE-FORWARD and DRIVE-AHEAD phase 3 trials. Lancet HIV 2024; 11:e75-e85. [PMID: 38141637 DOI: 10.1016/s2352-3018(23)00258-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 08/31/2023] [Accepted: 09/27/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND In two phase 3 trials for first-line therapy in adults with HIV-1, doravirine showed non-inferior efficacy, a favourable safety profile, and a superior lipid profile to darunavir and efavirenz through to 48 and 96 weeks. Here we report 192-week results from both studies. METHODS DRIVE-FORWARD and DRIVE-AHEAD are multicentre, double-blind, randomised, active comparator-controlled, phase 3 trials of first-line antiretroviral treatment in adults with HIV-1. Eligible participants (aged ≥18 years) were naive to antiretroviral therapy, had plasma HIV-1 RNA 1000 copies per mL or more at screening, had no known resistance to any of the trial drugs, and had creatinine clearance 50 mL per min or more. DRIVE-FORWARD was conducted at 125 sites in 15 countries and compared doravirine (100 mg) with ritonavir-boosted darunavir (ritonavir [100 mg] and darunavir [800 mg]), each administered orally once daily with two nucleoside or nucleotide reverse transcriptase inhibitors (tenofovir disoproxil fumarate [300 mg] and emtricitabine [200 mg] or abacavir sulfate [600 mg] and lamivudine [300 mg]). DRIVE-AHEAD was conducted at 126 sites in 23 countries and compared doravirine (100 mg), lamivudine (300 mg), and tenofovir disoproxil fumarate (300 mg) with that of efavirenz (600 mg), emtricitabine (200 mg), and tenofovir disoproxil fumarate (300 mg), all administered orally once daily. DRIVE-FORWARD enrolment was between Dec 1, 2014, and June 1, 2020, and DRIVE-AHEAD enrolment was between June 10, 2015, and Aug 10, 2020. After the 96-week double-blind phase, eligible participants could enter an open-label extension and either continue doravirine or switch from comparator to doravirine for an additional 96 weeks. Efficacy (HIV-1 RNA <50 copies per mL) and safety assessments (adverse events and changes in laboratory parameters) were pooled. The DRIVE-FORWARD and DRIVE-AHEAD trials were registered with ClinicalTrials.gov, NCT02275780 and NCT02403674. FINDINGS Of 1494 participants treated in the double-blind phase (1261 [84%] male and 233 [16%] female), 550 continued doravirine and 502 switched to doravirine in the extension. Using the FDA snapshot approach, HIV-1 RNA less than 50 copies per mL was maintained in 457 (83%) of 550 participants who continued doravirine and 404 (80%) of 502 participants who switched to doravirine. Protocol-defined virological failure and development of resistance were low, occurring mainly before week 96. Two (<1%) of 550 participants who continued doravirine reported serious drug-related adverse events, and three (1%) who continued doravirine and one (<1%) of 502 who switched to doravirine discontinued due to drug-related adverse events. Participants continuing or switching to doravirine showed generally favourable lipid profiles, little weight gain, and small decreases in estimated glomerular filtration rates, with no discontinuations due to increased creatinine or renal adverse events. INTERPRETATION Favourable efficacy and safety profiles for doravirine at week 96 were maintained through to week 192 in participants who continued or switched to doravirine, supporting use of doravirine for long-term first-line HIV-1 treatment and for virologically suppressed adults switching therapy. FUNDING Merck Sharp & Dohme, a subsidiary of Merck & Co, Rahway, NJ, USA.
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Affiliation(s)
| | - Jean-Michel Molina
- University of Paris, Department of Infectious Diseases, St-Louis and Lariboisière Hospitals, Assistance Publique Hôpitaux de Paris, and University of Paris Cité, Paris, France
| | - Pedro Cahn
- Fundación Huesped, Buenos Aires, Argentina
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Sciannameo S, Zalazar V, Spadaccini L, Duarte M, Cahn P, Aristegui I, Sued O. Preference for long-acting injectable for ART and PrEP among people with and without HIV: a cross-sectional study in Argentina. Ther Adv Infect Dis 2024; 11:20499361241228341. [PMID: 38380160 PMCID: PMC10878205 DOI: 10.1177/20499361241228341] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 01/09/2024] [Indexed: 02/22/2024] Open
Abstract
Background Little is known about the preferences for antiretroviral therapy (ART) administration methods, such as oral daily pills or long-acting injectable (LAI) options, as well as preferences for pre-exposure prophylaxis (PrEP) administration methods among people without HIV in Latin America. Objectives This study aimed to assess the preferences for ART administration methods among people with HIV and PrEP methods among those without HIV, as well as to examine the correlations and reasons for these preferences. Design We conducted a cross-sectional web-based questionnaire between April and July 2021, using social media accounts of a HIV non-governmental organization. The questionnaire was open to all adults living in Argentina, irrespective of their sexual orientation or gender identity. Methods The questionnaire included questions on substance use, depression, chronic treatment, previous experiences with injectable medication, and HIV status. Those with HIV answered questions about ART adherence and their preferences for ART methods, while those without HIV were asked about condom use, awareness of PrEP, and their preferences for PrEP methods. Results Out of 1676 respondents, 804 had HIV, and 872 did not. Among those with HIV, 91.5% expressed a high preference for LAI-ART, with significantly higher preferences among participants with higher educational levels, cisgender gay, bisexual, and queer men, younger individuals, and those with prior injectable medication experience. Among those without HIV, 68% preferred LAI-PrEP, and this preference was positively associated with previous positive experiences with injectable medication. Conclusion The strong preference for LAI-ART suggests the potential for improved adherence and well-being among people with HIV. Additionally, the preference for LAI-PrEP among those without HIV emphasizes the importance of considering this option for HIV prevention strategies. This study highlights the need to offer diverse methods for ART and prevention to accommodate different preferences and improve health care outcomes in Latin America.
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Affiliation(s)
| | - Virginia Zalazar
- Fundación Huésped, Pasaje Carlos Gianantonio 3932, Buenos Aires C1202AB, Argentina
| | | | - Mariana Duarte
- Research Department, Fundación Huésped, Buenos Aires, Argentina
| | - Pedro Cahn
- Research Department, Fundación Huésped, Buenos Aires, Argentina
| | - Ines Aristegui
- Research Department, Fundación Huésped, Buenos Aires, Argentina
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Lacunza E, Fink V, Salas ME, Canzoneri R, Naipauer J, Williams S, Coso O, Sued O, Cahn P, Mesri EA, Abba MC. Oral and anal microbiome from HIV-exposed individuals: role of host-associated factors in taxa composition and metabolic pathways. NPJ Biofilms Microbiomes 2023; 9:48. [PMID: 37438354 DOI: 10.1038/s41522-023-00413-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 06/20/2023] [Indexed: 07/14/2023] Open
Abstract
Evidence indicates that the microbiome plays a significant role in HIV immunopathogenesis and associated complications. This study aimed to characterize the oral and anal microbiome of Men who have Sex with Men (MSM) and Transgender Women (TGW), with and without HIV. One hundred and thirty oral and anal DNA-derived samples were obtained from 78 participants and subjected to shotgun metagenomics sequencing for further microbiome analysis. Significant differences in the microbiome composition were found among subjects associated with HIV infection, gender, sex behavior, CD4+ T-cell counts, antiretroviral therapy (ART), and the presence of HPV-associated precancerous anal lesions. Results confirm the occurrence of oncogenic viromes in this high HIV-risk population. The oral microbiome in HIV-associated cases exhibited an enrichment of bacteria associated with periodontal disease pathogenesis. Conversely, anal bacteria showed a significant decrease in HIV-infected subjects (Coprococcus comes, Finegoldia magna, Blautia obeum, Catenibacterium mitsuokai). TGW showed enrichment in species related to sexual transmission, which concurs that most recruited TGW are or have been sex workers. Prevotella bivia and Fusobacterium gonidiaformans were positively associated with anal precancerous lesions among HIV-infected subjects. The enrichment of Holdemanella biformis and C. comes was associated with detectable viral load and ART-untreated patients. Metabolic pathways were distinctly affected by predominant factors linked to sexual behavior or HIV pathogenesis. Gene family analysis identified bacterial gene signatures as potential prognostic and predictive biomarkers for HIV/AIDS-associated malignancies. Conclusions: Identified microbial features at accessible sites are potential biomarkers for predicting precancerous anal lesions and therapeutic targets for HIV immunopathogenesis.
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Affiliation(s)
- Ezequiel Lacunza
- Centro de Investigaciones Inmunológicas Básicas y Aplicadas (CINIBA), Facultad de Ciencias Médicas, Universidad Nacional de La Plata, La Plata, Argentina.
| | - Valeria Fink
- Dirección de Investigaciones, Fundación Huésped, Buenos Aires, Argentina
| | - María E Salas
- Centro de Investigaciones Inmunológicas Básicas y Aplicadas (CINIBA), Facultad de Ciencias Médicas, Universidad Nacional de La Plata, La Plata, Argentina
| | - Romina Canzoneri
- Centro de Investigaciones Inmunológicas Básicas y Aplicadas (CINIBA), Facultad de Ciencias Médicas, Universidad Nacional de La Plata, La Plata, Argentina
| | - Julián Naipauer
- Instituto de Fisiología, Biología Molecular y Neurociencias (IFIBYNE), CONICET - Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Sion Williams
- University of Miami - Center for AIDS Research (UM-CFAR) / Sylvester Comprehensive Cancer Center (CCC), University of Miami Miller School of Medicine, Miami, FL, USA
| | - Omar Coso
- Instituto de Fisiología, Biología Molecular y Neurociencias (IFIBYNE), CONICET - Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Omar Sued
- Pan American Health Organization, Washington, USA
| | - Pedro Cahn
- Dirección de Investigaciones, Fundación Huésped, Buenos Aires, Argentina
| | - Enrique A Mesri
- University of Miami - Center for AIDS Research (UM-CFAR) / Sylvester Comprehensive Cancer Center (CCC), University of Miami Miller School of Medicine, Miami, FL, USA
| | - Martín C Abba
- Centro de Investigaciones Inmunológicas Básicas y Aplicadas (CINIBA), Facultad de Ciencias Médicas, Universidad Nacional de La Plata, La Plata, Argentina.
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Grosso TM, Hernández-Sánchez D, Dragovic G, Vasylyev M, Saumoy M, Blanco JR, García D, Koval T, Loste C, Westerhof T, Clotet B, Sued O, Cahn P, Negredo E. Identifying the needs of older people living with HIV (≥ 50 years old) from multiple centres over the world: a descriptive analysis. AIDS Res Ther 2023; 20:10. [PMID: 36782210 PMCID: PMC9924192 DOI: 10.1186/s12981-022-00488-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 12/01/2022] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Older People Living with HIV (OPWH) combine both aging and HIV-infection features, resulting in ageism, stigma, social isolation, and low quality of life. This context brings up new challenges for healthcare professionals, who now must aid patients with a significant comorbidity burden and polypharmacy treatments. OPWH opinion on their health management is hardly ever considered as a variable to study, though it would help to understand their needs on dissimilar settings. METHODS We performed a cross-sectional, comparative study including patients living with HIV aged ≥50 years old from multiple centers worldwide and gave them a survey addressing their perception on overall health issues, psychological problems, social activities, geriatric conditions, and opinions on healthcare. Data was analyzed through Chisquared tests sorting by geographical regions, age groups, or both. RESULTS We organized 680 participants data by location (Center and South America [CSA], Western Europe [WE], Africa, Eastern Europe and Israel [EEI]) and by age groups (50- 55, 56-65, 66-75, >75). In EEI, HIV serostatus socializing and reaching undetectable viral load were the main problems. CSA participants are the least satisfied regarding their healthcare, and a great part of them are not retired. Africans show the best health perception, have financial problems, and fancy their HIV doctors. WE is the most developed region studied and their participants report the best scores. Moreover, older age groups tend to live alone, have a lower perception of psychological problems, and reduced social life. CONCLUSIONS Patients' opinions outline region- and age-specific unmet needs. In EEI, socializing HIV and reaching undetectable viral load were the main concerns. CSA low satisfaction outcomes might reflect high expectations or profound inequities in the region. African participants results mirror a system where general health is hard to achieve, but HIV clinics are much more appealing to them. WE is the most satisfied region about their healthcare. In this context, age-specific information, education and counseling programs (i.e. Patient Reported Outcomes, Patient Centered Care, multidisciplinary teams) are needed to promote physical and mental health among older adults living with HIV/AIDS. This is crucial for improving health-related quality of life and patient's satisfaction.
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Affiliation(s)
- Tomás Martín Grosso
- grid.491017.a0000 0004 7664 5892Unidad de Ensayos Clínicos, Fundación Huésped, Buenos Aires, Argentina ,grid.26089.350000 0001 2228 6538Laboratorio de Inmunología, Universidad Nacional de Luján, Buenos Aires, Argentina
| | - Diana Hernández-Sánchez
- grid.411438.b0000 0004 1767 6330Lluita contra les Infeccions, Hospital Universitari Germans Trias i Pujol, Badalona, Spain ,grid.7080.f0000 0001 2296 0625Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Gordana Dragovic
- grid.7149.b0000 0001 2166 9385Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - María Saumoy
- grid.411129.e0000 0000 8836 0780HIV and STD Unit, Hospital de Bellvitge, Barcelona, Spain
| | - José Ramón Blanco
- grid.428104.bInfectious Disease Department, Hospital Universitario San Pedro - CIBIR, Logroño, Spain
| | - Diego García
- Adhara HIV/AIDS Association, Sevilla Checkpoint, Seville, Spain
| | - Tetiana Koval
- grid.513024.1Department of Infectious Diseases, Poltava State Medical University, Poltava, Ukraine
| | - Cora Loste
- grid.411438.b0000 0004 1767 6330Lluita contra les Infeccions, Hospital Universitari Germans Trias i Pujol, Badalona, Spain ,grid.7080.f0000 0001 2296 0625Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Tendayi Westerhof
- grid.411438.b0000 0004 1767 6330AIDS Research Institute-IRSICAIXA, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Bonaventura Clotet
- grid.7080.f0000 0001 2296 0625Universitat Autònoma de Barcelona, Barcelona, Spain ,grid.7080.f0000 0001 2296 0625AIDS Research Institute-IRSICAIXA, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain ,grid.440820.aUniversitat de Vic - Universidad Central de Catalunya (UVIC-UCC), Vic, Spain
| | - Omar Sued
- grid.491017.a0000 0004 7664 5892Unidad de Ensayos Clínicos, Fundación Huésped, Buenos Aires, Argentina
| | - Pedro Cahn
- grid.491017.a0000 0004 7664 5892Unidad de Ensayos Clínicos, Fundación Huésped, Buenos Aires, Argentina
| | - Eugènia Negredo
- Lluita contra les Infeccions, Hospital Universitari Germans Trias i Pujol, Badalona, Spain. .,Universitat Autònoma de Barcelona, Barcelona, Spain. .,Universitat de Vic - Universidad Central de Catalunya (UVIC-UCC), Vic, Spain.
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Frola CE, Aristegui I, Figueroa MI, Radusky PD, Cardozo N, Zalazar V, Cesar C, Patterson P, Fink V, Gun A, Cahn P, Sued O. Retention among transgender women treated with dolutegravir associated with tenofovir/lamivudine or emtricitabine in Argentina: TransViiV study. PLoS One 2023; 18:e0279996. [PMID: 36662723 PMCID: PMC9858466 DOI: 10.1371/journal.pone.0279996] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 12/17/2022] [Indexed: 01/21/2023] Open
Abstract
In Argentina, transgender women (TGW) have a high HIV prevalence (34%). However, this population shows lower levels of adherence, retention in HIV care and viral suppression than cisgender patients. The World Health Organization (WHO) recommends the transition to dolutegravir (DTG)-based regimens to reduce adverse events and improve adherence and retention. The purpose of this study was to determine retention, adherence and viral suppression in naïve TGW starting a DTG-based first-line antiretroviral treatment (ART) and to identify clinical and psychosocial factors associated with retention. We designed a prospective, open-label, single-arm trial among ART-naïve HIV positive TGW (Clinical Trial Number: NCT03033836). Participants were followed at weeks 4, 8, 12, 24, 36 and 48, in a trans-affirmative HIV care service that included peer navigators, between December, 2015 and May, 2019. Retention was defined as the proportion of TGW retained at week 48 and adherence was self-reported. Viral suppression at <50 copies/mL was evaluated using snapshot algorithm and as per protocol analysis. Of 75 TGW screened, 61 were enrolled. At baseline, median age was 28 y/o., HIV-1-RNA (pVL) 46,908 copies/mL and CD4+ T-cell count 383 cells/mm3. At week 48, 77% were retained and 72% had viral suppression (97% per protocol). The regimen was well tolerated and participants reported high adherence (about 95%). Eleven of the fourteen TGW who discontinued or were lost to follow-up had undetectable pVL at their last visit. Older age was associated with better retention. DTG-based treatment delivered by a trans-competent team in a trans-affirmative service was safe and well tolerated by TGW and associated with high retention, high adherence and high viral suppression at 48 weeks among those being retained.
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Affiliation(s)
- Claudia E. Frola
- Research Department, Fundación Huésped, Buenos Aires, Argentina
- Division of Infectious Diseases, Juan A. Fernández Hospital, Buenos Aires, Argentina
| | - Inés Aristegui
- Research Department, Fundación Huésped, Buenos Aires, Argentina
- Department of Research in Psychology, Universidad de Palermo, Buenos Aires, Argentina
| | | | - Pablo D. Radusky
- Research Department, Fundación Huésped, Buenos Aires, Argentina
- Faculty of Psychology, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Nadir Cardozo
- Research Department, Fundación Huésped, Buenos Aires, Argentina
- Association of Transvestites, Transsexuals, and Transgenders of Argentina (A.T.T.T.A.), Buenos Aires, Argentina
| | | | - Carina Cesar
- Research Department, Fundación Huésped, Buenos Aires, Argentina
| | | | - Valeria Fink
- Research Department, Fundación Huésped, Buenos Aires, Argentina
| | - Ana Gun
- Research Department, Fundación Huésped, Buenos Aires, Argentina
| | - Pedro Cahn
- Research Department, Fundación Huésped, Buenos Aires, Argentina
| | - Omar Sued
- Research Department, Fundación Huésped, Buenos Aires, Argentina
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De Luca A, Zalazar V, Salusso D, Frontini E, Fabian S, Cardozo NF, Cesar C, Cahn P, Sued O, Aristegui I. "If I'm at home, I do it at home": Qualitative study on HIV self-testing among transgender women in Argentina. Int J STD AIDS 2023; 34:25-30. [PMID: 36287178 DOI: 10.1177/09564624221132624] [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: 01/04/2023]
Abstract
BACKGROUND Evidence among key populations supports acceptability of HIV self-testing (HIVST) due to its privacy and convenience. However, insufficient research has been done among transgender women (TGW), especially in Latin America. Consequently, the aim of this study was to explore the acceptability, perceptions and recommendations for HIVST implementation among TGW in Buenos Aires. METHODS A focus group was conducted in July 2019. Particpants were invited to touch and learn about a displayed HIVST kit. The following main topics were explored: acceptability, reasons for seeking self-testing, preferences for training, distribution, periodicity and recommendations for HIVST implementation. RESULTS The sample consisted of 12 TGWs; mean age of 26 years (IQR = 22-28); 66% had history of sex-work. The main motivations for seeking HIVST were convenience, privacy, and usage to reduce stigma and discrimination by health-care providers. Recommendations for HIVST were: distribution from primary health centers and trans-sensitive centers; affordable price; assistance by peer health promoters; and the provision of clear written and video instructions. CONCLUSIONS Tailored implementation of HIVST can increase HIV testing rates, early detection, and linkage to HIV-care in this high-prevalence group. This study provided community-driven suggestions to inform and adapt an HIVST feasibility pilot study and future implementation in Argentina.
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Affiliation(s)
- Amalia De Luca
- 541285Fundación Huésped, Research Department, Buenos Aires, Argentina
| | - Virginia Zalazar
- 541285Fundación Huésped, Research Department, Buenos Aires, Argentina
| | - Diego Salusso
- 541285Fundación Huésped, Research Department, Buenos Aires, Argentina
| | - Emilia Frontini
- 541285Fundación Huésped, Research Department, Buenos Aires, Argentina
| | - Solange Fabian
- 541285Fundación Huésped, Research Department, Buenos Aires, Argentina.,Asociación Civil Gondolin, Buenos Aires, Argentina
| | - Nadir Fernana Cardozo
- 541285Fundación Huésped, Research Department, Buenos Aires, Argentina.,Asociación de Travestis, Transexuales y Transgéneros de Argentina (A.T.T.T.A.), Buenos Aires, Argentina.,RedLacTrans, Red Latinoamericana y del Caribe de Personas Trans.,Casa Trans, Buenos Aires, Argentina
| | - Carina Cesar
- 541285Fundación Huésped, Research Department, Buenos Aires, Argentina
| | - Pedro Cahn
- 541285Fundación Huésped, Research Department, Buenos Aires, Argentina.,Asociación Civil Gondolin, Buenos Aires, Argentina
| | - Omar Sued
- 541285Fundación Huésped, Research Department, Buenos Aires, Argentina
| | - Inés Aristegui
- 541285Fundación Huésped, Research Department, Buenos Aires, Argentina.,Department of Research in Psychology, Universidad de Palermo, Buenos Aires, Argentina
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Gibas KM, Kelly SG, Arribas JR, Cahn P, Orkin C, Daar ES, Sax PE, Taiwo BO. Two-drug regimens for HIV treatment. Lancet HIV 2022; 9:e868-e883. [PMID: 36309038 PMCID: PMC10015554 DOI: 10.1016/s2352-3018(22)00249-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 08/16/2022] [Accepted: 08/22/2022] [Indexed: 12/05/2022]
Abstract
Combination therapy with three antiretroviral agents has been integral to successful HIV-1 treatment since 1996. Although the efficacy, adverse effects, and toxicities of contemporary three-drug regimens have improved, even the newest therapies have potential adverse effects. The use of two-drug regimens is one way to reduce lifetime exposure to antiretroviral drugs while maintaining the benefits of viral suppression. Multiple large, randomised trials have shown the virological non-inferiority of certain two-drug regimens versus three-drug comparators, including adverse effect differences that reflect known profiles of the antiretroviral drugs in the respective regimens. Two-drug combinations are now recommended in treatment guidelines and include the first long-acting antiretroviral regimen for the treatment of HIV-1. Recommended two-drug regimens differ in their risks for, and factors associated with, virological failure and emergent resistance. The tolerability, safety, metabolic profiles, and drug interactions of two-drug regimens also vary by the constituent drugs. No current two-drug regimen is recommended for people with chronic hepatitis B virus as none include tenofovir. Two-drug regimens have increased options for individualised care.
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Affiliation(s)
- Kevin M Gibas
- Division of Infectious Diseases, Vanderbilt University Medical Center, Vanderbilt University, Nashville, TN, USA
| | - Sean G Kelly
- Division of Infectious Diseases, Vanderbilt University Medical Center, Vanderbilt University, Nashville, TN, USA
| | - Jose R Arribas
- Infectious Diseases Unit, La Paz University Hospital, Hospital La Paz Institute for Health Research, Madrid, Spain; School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
| | - Pedro Cahn
- Fundación Huésped, Buenos Aires, Argentina
| | - Chloe Orkin
- Department of Immunobiology, Queen Mary University of London, London, UK
| | - Eric S Daar
- The Lundquist Institute, Harbor University of California, Los Angeles, Torrence, CA, USA
| | - Paul E Sax
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA
| | - Babafemi O Taiwo
- Division of Infectious Diseases, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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Orkin C, Cahn P, Castagna A, Emu B, Harrigan P, Kuritzkes DR, Nelson M, Schapiro J. Opening the door on entry inhibitors in HIV: Redefining the use of entry inhibitors in heavily treatment experienced and treatment-limited individuals living with HIV. HIV Med 2022; 23:936-946. [PMID: 35293094 PMCID: PMC9546304 DOI: 10.1111/hiv.13288] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 01/21/2022] [Accepted: 02/16/2022] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Entry inhibitors are a relatively new class of antiretroviral therapy and are typically indicated in heavily treatment experienced individuals living with HIV. Despite this, there is no formal definition of 'heavily treatment experienced'. Interpretation of this term generally includes acknowledgement of multidrug resistance and reflects the fact that patients in need of further treatment options may have experienced multiple lines of therapy. However, it fails to recognize treatment limiting factors including contraindications, age-associated comorbidities, and difficulty adhering to regimens. METHODS This manuscript follows a roundtable discussion and aims to identify the unmet needs of those living with HIV who are in need of further treatment options, to broaden the definition of heavily treatment experienced and to clarify the use of newer agents, with an emphasis on the potential role of entry inhibitors, in this population. RESULTS/CONCLUSIONS Within the entry inhibitor class, mechanisms of action differ between agents; resistance to one subclass does not confer resistance to others. Combinations of entry inhibitors should be considered in the same regimen, and if lack of response is seen to one entry inhibitor another can be tried. When selecting an entry inhibitor, physicians should account for patient preferences and needs as well as agent-specific clinical characteristics. Absence of documented multidrug resistance should not exclude an individual from treatment with an entry inhibitor; entry inhibitors are a valuable treatment option for all individuals who are treatment limited or treatment exhausted. We should advocate for additional clinical trials that help define the role of entry inhibitors in people with exhausted/limited ART options other than drug resistance.
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Affiliation(s)
| | - Pedro Cahn
- Fundacion HuespedBuenos AiresArgentina
- Buenos Aires University Medical SchoolBuenos AiresArgentina
| | - Antonella Castagna
- Vita‐Salute San Raffaele UniversitySan Raffaele Scientific InstituteMilanItaly
| | - Brinda Emu
- Yale School of MedicineNew HavenConnecticutUSA
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Núñez I, Crabtree-Ramirez B, Shepherd BE, Sterling TR, Cahn P, Veloso VG, Cortes CP, Padgett D, Gotuzzo E, Sierra-Madero J, McGowan CC, Person AK, Caro-Vega Y. Late-onset opportunistic infections while receiving anti-retroviral therapy in Latin America: burden and risk factors. Int J Infect Dis 2022; 122:469-475. [PMID: 35768025 PMCID: PMC9851270 DOI: 10.1016/j.ijid.2022.06.041] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 04/28/2022] [Accepted: 06/23/2022] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES The aim of this study was to describe the incidence, clinical characteristics, and risk factors of late-onset opportunistic infections (LOI) in people who live with HIV (PWLHA) within the Caribbean, Central and South America network for HIV epidemiology. METHODS We performed a retrospective cohort study including treatment-naive PWLHA enrolled at seven sites (Argentina, Brazil, Chile, Peru, Mexico, and two sites in Honduras). Follow-up began at 6 months after treatment started. Outcomes were LOI, loss to follow-up, and death. We used a Cox proportional hazards model and a competing risks model to evaluate risk factors. RESULTS A total of 10,583 patients were included. Median follow up was at 5.4 years. LOI occurred in 895 (8.4%) patients. Median time to opportunistic infection was 2.1 years. The most common infections were tuberculosis (39%), esophageal candidiasis (10%), and Pneumocystis jirovecii (P. jirovecii) pneumonia (10%). Death occurred in 576 (5.4%) patients, and 3021 (28.5%) patients were lost to follow-up. A protease inhibitor-based regimen (hazard ratio 1.25), AIDS-defining events during the first 6 months of antiretroviral-treatment (hazard ratio 2.12), starting antiretroviral-treatment in earlier years (hazard ratio 1.52 for 2005 vs 2010), and treatment switch (hazard ratio 1.31) were associated with a higher risk of LOI. CONCLUSION LOI occurred in nearly one in 10 patients. People with risk factors could benefit from closer follow-up.
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Affiliation(s)
- Isaac Núñez
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Departamento de Infectología, Ciudad de México, México
| | - Brenda Crabtree-Ramirez
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Departamento de Infectología, Ciudad de México, México
| | | | | | - Pedro Cahn
- Fundación Huésped, Buenos Aires, Argentina
| | - Valdiléa G Veloso
- Instituto Nacional de Infectología Evandro Chagas, Rio de Janeiro, Brazil
| | | | - Denis Padgett
- Hospital Escuela Universitario, Tegucigalpa, Honduras
| | - Eduardo Gotuzzo
- Instituto de Medicina Tropical "Alexander von Humboldt," Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Juan Sierra-Madero
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Departamento de Infectología, Ciudad de México, México
| | | | - Anna K Person
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Yanink Caro-Vega
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Departamento de Infectología, Ciudad de México, México.
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10
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Sued O, Cecchini D, Rolón MJ, Calanni L, David D, Lupo S, Cahn P, Cassetti I, Weiss SM, Alcaide ML, Rodriguez VJ, Mantero A, Jones DL. A small cluster randomised clinical trial to improve health outcomes among Argentine patients disengaged from HIV care. Lancet Reg Health Am 2022; 13:100307. [PMID: 36210799 PMCID: PMC9536254 DOI: 10.1016/j.lana.2022.100307] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Patients disengaged from HIV care, e.g., missed medication pick-ups, not attending physician visits, account for ≥70% of new HIV infections. Re-engaging and sustaining engagement is essential to controlling the HIV pandemic. This study tested a physician-delivered evidence-based intervention, Motivational Interviewing (MI), to improve health outcomes, adherence to antiretroviral therapy (ART), HIV virologic suppression, CD4+ count, retention in HIV care, and self-efficacy among patients disengaged from care in Argentina. Methods Regional clinics (n = 6) were randomised to condition, MI Intervention or Enhanced Standard of Care (ESOC), and recruited N = 360 patients disengaged from HIV care. ART adherence, HIV RNA viral load, CD4+ count retention, and self-efficacy were assessed at baseline, 6, 12, 18, and 24-months. Indirect effects from condition to main outcomes were examined using patient-provider relationship as a mediator. The study was a cluster-randomised clinical trial entitled Conexiones y Opciones Positivas en la Argentina 2 (COPA2) and was registered at clinicaltrials.gov, NCT02846350. Findings Participants were an average age of 39·15 (SD = 10·96), 51% were women; intervention participants were older (p = ·019), and more ESOC participants were women (60% vs. 42%, p = 0·001). Using mixed models, the intervention had no effect on ART adherence over time by condition on HIV RNA viral load, CD4+ count retention, or self-efficacy. However, analysing mediated paths, there was an indirect effect of condition on ART adherence (B = 0·188, p = 0·009), HIV viral load (B = -0·095, P = 0·027), and self-efficacy (B = 0·063, P = 0·001), suggesting the intervention was associated with improved patient-provider relationships, which was in turn associated with increased ART adherence, lower HIV viral load, and higher self-efficacy. Interpretation These findings suggest that physician-delivered MI may enhance the patient-provider relationship, self-efficacy, and ART adherence, and reduced HIV viral load in patients disengaged from HIV care. However, these findings are preliminary due to the small number of clusters randomised, and replication is warranted. Funding National Institutes of Health.
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Affiliation(s)
- Omar Sued
- Fundación Huésped, Buenos Aires, Argentina
| | - Diego Cecchini
- Hospital General de Agudos Dr. Cosme Argerich, Buenos Aires, Argentina
- Helios Salud, Buenos Aires, Argentina
| | - María José Rolón
- Hospital General de Agudos Dr. Juan A. Fernández, Buenos Aires, Argentina
| | | | | | - Sergio Lupo
- Instituto Centralizado de Asistencia e Investigación Clínica Integral (CAICI), Rosario, Argentina
| | - Pedro Cahn
- Fundación Huésped, Buenos Aires, Argentina
| | | | - Stephen M Weiss
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Maria Luisa Alcaide
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Violeta J Rodriguez
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Alejandro Mantero
- Department of Public Health Sciences, Division of Biostatistics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Deborah L Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
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11
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Grosso TM, Alcamí J, Arribas JR, Martín M, Sereti I, Tarr P, Cahn P, Clotet B, Sued O, Negredo E. HIV and aging, biological mechanisms, and therapies: What do we know? AIDS Rev 2022; 25:79-86. [DOI: 10.24875/aidsrev.21000085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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12
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Gartland M, Cahn P, DeJesus E, Diaz RS, Grossberg R, Kozal M, Kumar P, Molina JM, Mendo Urbina F, Wang M, Du F, Chabria S, Clark A, Garside L, Krystal M, Mannino F, Pierce A, Ackerman P, Lataillade M. Week 96 Genotypic and Phenotypic Results of the Fostemsavir Phase 3 BRIGHTE Study in Heavily Treatment-Experienced Adults Living with Multidrug-Resistant HIV-1. Antimicrob Agents Chemother 2022; 66:e0175121. [PMID: 35502922 PMCID: PMC9211436 DOI: 10.1128/aac.01751-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
In the phase 3 BRIGHTE study in heavily treatment-experienced adults with multidrug-resistant HIV-1, fostemsavir plus optimized background therapy (OBT) resulted in sustained rates of virologic suppression through 96 weeks. HIV-1 RNA <40 copies/mL was achieved in 163/272 (60%) Randomized Cohort (RC) participants (with 1 or 2 remaining approved fully active antiretrovirals) and 37/99 (37%) Non-randomized Cohort (NRC) participants (with 0 fully active antiretrovirals). Here we report genotypic and phenotypic analyses of HIV-1 samples from 63/272 (23%) RC participants and 49/99 (49%) NRC participants who met protocol-defined virologic failure (PDVF) criteria through Week 96. The incidence of PDVF was as expected in this difficult-to-treat patient population and, among RC participants, was comparable regardless of the presence of predefined gp120 amino acid substitutions that potentially influence phenotypic susceptibility to temsavir (S375H/I/M/N/T, M426L, M434I, M475I) or baseline temsavir 50% inhibitory concentration fold change (IC50 FC). The incidence of PDVF was lower among participants with higher overall susceptibility score to newly used antiretrovirals (OSS-new), indicating that OSS-new may be a preferred predictor of virologic outcome in heavily treatment-experienced individuals. Predefined gp120 substitutions, most commonly M426L or S375N, were emergent on treatment in 24/50 (48%) RC and 33/44 (75%) NRC participants with PDVF, with related increases in temsavir IC50 FC. In BRIGHTE, PDVF was not consistently associated with treatment-emergent genotypic or phenotypic changes in susceptibility to temsavir or to antiretrovirals in the initial OBT. Further research will be needed to identify which factors are most likely to contribute to virologic failure in this heavily treatment-experienced population (ClinicalTrials.gov, NCT02362503).
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Affiliation(s)
| | - Pedro Cahn
- Fundación Huesped, Buenos Aires, Argentina
| | | | - Ricardo Sobhie Diaz
- Infectious Diseases Division, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | | | - Michael Kozal
- Department of Internal Medicine, Infectious Diseases Section, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Princy Kumar
- Department of Medicine and Microbiology, Georgetown University Medical Center, Washington, DC, USA
| | - Jean-Michel Molina
- University of Paris, Saint-Louis and Lariboisière Hospitals, Assistance Publique Hôpitaux de Paris, Paris, France
| | | | - Marcia Wang
- GlaxoSmithKline, Collegeville, Pennsylvania, USA
| | - Fangfang Du
- GlaxoSmithKline, Collegeville, Pennsylvania, USA
| | | | | | | | | | | | - Amy Pierce
- ViiV Healthcare, Research Triangle Park, North Carolina, USA
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13
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Salido J, Czernikier A, Trifone C, Polo ML, Figueroa MI, Urioste A, Cahn P, Sued O, Salomon H, Laufer N, Ghiglione Y, Turk G. Pre-cART Immune Parameters in People Living With HIV Might Help Predict CD8+ T-Cell Characteristics, Inflammation Levels, and Reservoir Composition After Effective cART. Pathog Immun 2022; 6:60-89. [PMID: 34988339 PMCID: PMC8714178 DOI: 10.20411/pai.v6i2.447] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 05/27/2021] [Accepted: 08/22/2021] [Indexed: 01/09/2023] Open
Abstract
Background Combined antiretroviral treatment (cART) for HIV infection is highly effective in controlling viral replication. However, it cannot achieve a sterilizing cure. Several strategies have been proposed to achieve a functional cure, some of them based on immune-mediated clearing of persistently infected cells. Here, we aimed at identifying factors related to CD8TC and CD4TC quality before cART initiation that associate with the persistence of CD8TC antiviral response after cART, inflammation levels, and the size of the viral reservoir. Methods Samples from 25 persons living with HIV were obtained before and after (15 months) cART initiation. Phenotype and functionality of bulk and HIV-specific T cells were assayed by flow cytometry ex vivo or after expansion in pre-cART or post-cART samples, respectively. Cell-Associated (CA) HIV DNA (total and integrated) and RNA (unspliced [US] and multiple spliced [MS]) were quantitated by real-time PCR on post-cART samples. Post-cART plasma levels of CXCL10 (IP-10), soluble CD14 (sCD14) and soluble CD163 (sCD163) were measured by ELISA. Results Pre-cART phenotype of CD8TCs and magnitude and phenotype of HIV-specific response correlated with the phenotype and functionality of CD8TCs post-cART. Moreover, the phenotype of the CD8TCs pre-cART correlated with markers of HIV persistence and inflammation post-cART. Finally, exhaustion and differentiation of CD4TCs pre-cART were associated with the composition of the HIV reservoir post-cART and the level of inflammation. Conclusions Overall, this work provides data to help understand and identify parameters that could be used as markers in the development of immune-based functional HIV cure strategies.
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Affiliation(s)
- Jimena Salido
- Universidad de Buenos Aires, Facultad de Medicina, Departamento de Microbiología, Parasitología e Inmunología, Buenos Aires, Argentina.,CONICET - Universidad de Buenos Aires, Instituto de Investigaciones Biomédicas en Retrovirus y SIDA (INBIRS), Buenos Aires, Argentina
| | - Alejandro Czernikier
- CONICET - Universidad de Buenos Aires, Instituto de Investigaciones Biomédicas en Retrovirus y SIDA (INBIRS), Buenos Aires, Argentina.,Universidad de Buenos Aires, Facultad de Medicina, Buenos Aires, Argentina
| | - César Trifone
- CONICET - Universidad de Buenos Aires, Instituto de Investigaciones Biomédicas en Retrovirus y SIDA (INBIRS), Buenos Aires, Argentina.,Universidad de Buenos Aires, Facultad de Medicina, Buenos Aires, Argentina
| | - María Laura Polo
- CONICET - Universidad de Buenos Aires, Instituto de Investigaciones Biomédicas en Retrovirus y SIDA (INBIRS), Buenos Aires, Argentina.,Universidad de Buenos Aires, Facultad de Medicina, Buenos Aires, Argentina
| | | | - Alejandra Urioste
- CONICET - Universidad de Buenos Aires, Instituto de Investigaciones Biomédicas en Retrovirus y SIDA (INBIRS), Buenos Aires, Argentina.,Universidad de Buenos Aires, Facultad de Medicina, Buenos Aires, Argentina
| | - Pedro Cahn
- Fundación Huésped, Buenos Aires, Argentina
| | - Omar Sued
- Fundación Huésped, Buenos Aires, Argentina
| | - Horacio Salomon
- Universidad de Buenos Aires, Facultad de Medicina, Departamento de Microbiología, Parasitología e Inmunología, Buenos Aires, Argentina.,CONICET - Universidad de Buenos Aires, Instituto de Investigaciones Biomédicas en Retrovirus y SIDA (INBIRS), Buenos Aires, Argentina
| | - Natalia Laufer
- Universidad de Buenos Aires, Facultad de Medicina, Departamento de Microbiología, Parasitología e Inmunología, Buenos Aires, Argentina.,CONICET - Universidad de Buenos Aires, Instituto de Investigaciones Biomédicas en Retrovirus y SIDA (INBIRS), Buenos Aires, Argentina.,Hospital General de Agudos "Dr. JA Fernández" Buenos Aires, Argentina
| | - Yanina Ghiglione
- CONICET - Universidad de Buenos Aires, Instituto de Investigaciones Biomédicas en Retrovirus y SIDA (INBIRS), Buenos Aires, Argentina.,Universidad de Buenos Aires, Facultad de Medicina, Buenos Aires, Argentina
| | - Gabriela Turk
- Universidad de Buenos Aires, Facultad de Medicina, Departamento de Microbiología, Parasitología e Inmunología, Buenos Aires, Argentina.,CONICET - Universidad de Buenos Aires, Instituto de Investigaciones Biomédicas en Retrovirus y SIDA (INBIRS), Buenos Aires, Argentina
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14
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Cahn P, Sierra Madero J, Arribas JR, Antinori A, Ortiz R, Clarke AE, Hung CC, Rockstroh JK, Girard PM, Sievers J, Man CY, Urbaityte R, Brandon DJ, Underwood M, Pappa KA, Curtis L, Smith KY, Gartland M, Aboud M, van Wyk J, Wynne B. Three-year durable efficacy of dolutegravir plus lamivudine in antiretroviral therapy - naive adults with HIV-1 infection. AIDS 2022; 36:39-48. [PMID: 34534138 PMCID: PMC8654248 DOI: 10.1097/qad.0000000000003070] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/13/2021] [Accepted: 08/23/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess efficacy and safety of dolutegravir (DTG) + lamivudine (3TC) vs. DTG + tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) in treatment-naive adults with HIV-1 in the prespecified 144-week secondary analyses of GEMINI-1 and GEMINI-2. DESIGN Identical, multicenter, phase III, randomized, non-inferiority studies (double-blind through 96 weeks). METHODS Participants with HIV-1 RNA ≤500 000 copies/ml and no major viral resistance mutations to nucleoside reverse transcriptase inhibitors, nonnucleoside reverse transcriptase inhibitors, or protease inhibitors were randomized 1:1 to once-daily DTG + 3TC or DTG + TDF/FTC. RESULTS At week 144, DTG + 3TC (N = 716) was noninferior to DTG + TDF/FTC (N = 717) in proportion of participants achieving HIV-1 RNA <50 copies/ml (Snapshot algorithm) in the pooled analysis (82% vs. 84%, respectively; adjusted treatment difference [95% confidence interval (CI)], -1.8% [-5.8, 2.1]), GEMINI-1 (-3.6% [-9.4, 2.1]), and GEMINI-2 (0.0% [-5.3, 5.3]). Twelve DTG + 3TC participants and nine DTG + TDF/FTC participants met protocol-defined confirmed virologic withdrawal (CVW) criteria; none developed treatment-emergent resistance. One DTG + 3TC participant who did not meet CVW criteria developed M184V at week 132 and R263R/K at week 144, conferring a 1.8-fold change in susceptibility to DTG; non-adherence to therapy was reported. Significantly fewer drug-related adverse events occurred with DTG + 3TC vs. DTG + TDF/FTC (20% vs. 27%; relative risk [95% CI], 0.76 [0.63-0.92]). Renal and bone biomarker changes favored DTG + 3TC. CONCLUSIONS Three-year durable efficacy, long-term tolerability, and high barrier to resistance support first-line use of DTG + 3TC for HIV-1 treatment (see Supplemental Digital Content 1, http://links.lww.com/QAD/C297; video abstract).
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Affiliation(s)
- Pedro Cahn
- Fundación Huésped, Buenos Aires, Argentina
| | - Juan Sierra Madero
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Andrea Antinori
- Istituto Nazionale per le Malattie Infettive Lazzaro Spallanzani IRCCS, Rome, Italy
| | | | - Amanda E. Clarke
- Royal Sussex County Hospital, and Brighton & Sussex Medical School, Brighton, UK
| | | | | | | | | | - Choy Y. Man
- ViiV Healthcare, Research Triangle Park, North Carolina, USA
| | | | | | - Mark Underwood
- ViiV Healthcare, Research Triangle Park, North Carolina, USA
| | - Keith A. Pappa
- ViiV Healthcare, Research Triangle Park, North Carolina, USA
| | | | | | - Martin Gartland
- ViiV Healthcare, Research Triangle Park, North Carolina, USA
| | | | | | - Brian Wynne
- ViiV Healthcare, Research Triangle Park, North Carolina, USA
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15
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Cahn P, Molina JM, Lombaard J, Squires K, Kumar S, Wan H, Teal V, Asante-Appiah E, Sklar P, Martin EA, Lahoulou R. 626. The Efficacy and Safety of Maintenance with Doravirine Plus Two NRTIs after Initial Suppression in Adults with HIV-1 in the DRIVE-FORWARD Clinical Trial: Results from the Study Extension through 192 Weeks. Open Forum Infect Dis 2021. [PMCID: PMC8644615 DOI: 10.1093/ofid/ofab466.824] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
DRIVE-FORWARD is a phase 3 trial with a completed double-blind period comparing doravirine (DOR) 100 mg with ritonavir-boosted darunavir (DRV/r) 800/100 mg, both administered with two nucleos(t)ide reverse transcriptase inhibitors (NRTIs; tenofovir and emtricitabine, or abacavir and lamivudine), and an ongoing open-label extension. At Week (W) 48, DOR demonstrated non-inferior efficacy to DRV/r, with a superior lipid profile. Those results were sustained at W96. Here we present efficacy and safety results through W192.
Methods
Participants who completed the 96-week double-blind phase and met inclusion criteria were eligible to receive open-label DOR plus two NRTIs in a 96-week extension. Efficacy and safety at W192 were assessed in two groups: participants initially randomized to DOR and maintained on DOR (n=259) and those who switched from DRV/r to DOR at W96 (n=233).
Results
HIV-1 RNA < 50 copies/mL were maintained through W192 in 81.1% of participants who continued DOR and 80.7% of those who switched from DRV/r to DOR. The mean increase in CD4 T-cell counts from W96 to W192 was similar for participants maintained on DOR (47 cells/mm3) and those switched from DRV/r (53 cells/mm3). Protocol-defined virologic failure occurred in 3.1% and 5.6% of participants maintained on DOR and switched from DRV/r, respectively, and development of genotypic resistance was low in both groups (Table 1). Discontinuation due to adverse events was also low (Table 1). Fasting LDL-cholesterol, non-HDL-cholesterol, and triglycerides showed minimal increase in participants maintained on DOR and were reduced in those switched from DRV/r to DOR (Table 1). Participants maintained on DOR had minimal weight gain after W96 (median 1 kg), and a small increase overall (median 1.9 kg, Day 1 through W192); participants who switched to DOR had a small increase after W96 (median 1.5 kg), similar to the median weight gain in the base study (DOR 1.8 kg; DRV/r 0.7 kg).
Conclusion
Among participants who continued DOR in the DRIVE-FORWARD open-label extension, virologic suppression and favorable safety were maintained for an additional 96 weeks. Participants who switched from DRV/r to DOR maintained virologic suppression and demonstrated favorable safety for 96 weeks.
Disclosures
Pedro Cahn, MD, PHD, Merck (Advisor or Review Panel member)ViiV Healthcare (Grant/Research Support, Advisor or Review Panel member) Kathleen Squires, MD, Merck (Employee) Sushma Kumar, PhD, Merck (Employee) Hong Wan, PhD, Merck (Employee) Valerie Teal, MS, Merck (Employee) Ernest Asante-Appiah, PhD, Merck (Employee) Peter Sklar, MD, Merck (Employee) Elizabeth A. Martin, DO, MPH, MBA, Merck (Employee) Rima Lahoulou, n/a, Merck (Employee)
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Affiliation(s)
- Pedro Cahn
- Fundación Huésped, Buenos Aires, Buenos Aires, Argentina
| | | | | | | | | | - Hong Wan
- Merck & Co,. Inc, Kenilworth, New Jersey
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Molina JM, Ene L, Cahn P, Fätkenheuer G, Van Wijngaerden E, Lombaard J, Zakharova N, Van Eygen V, Vanveggel S, Van Solingen-Ristea R. Long-term safety and efficacy of rilpivirine in combination with nucleoside/nucleotide reverse transcriptase inhibitors in HIV-1 infected patients: 336-week rollover study of phase 2b and 3 clinical studies. Antivir Ther 2021; 26:95-105. [DOI: 10.1177/13596535211062388] [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: 11/16/2022]
Abstract
Background To evaluate the long-term safety and efficacy of rilpivirine (RPV), a non-nucleoside reverse transcriptase inhibitor (NNRTI), in combination with nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs) in human immunodeficiency virus (HIV)–infected patients. Methods RPV-treated HIV-infected patients from phase 2b or 3 studies rolled-over into this phase 3, open-label study and received RPV 25 mg once daily (QD) with choice of two NRTIs. Adverse events (AEs), plasma viral load, CD4+ cell count, and antiviral resistance were evaluated. Results Of the 482 patients treated, 437 (>90%) patients discontinued study treatment; 371 (77%) had switched to commercially available RPV, 14 (2.9%) discontinued due to AEs, and 6 (1.2%) had virologic failure. In this rollover study, patients were followed up to week 336, although data was limited beyond 288 weeks. Forty-five (9.3%) patients were still undergoing treatment at the time of data cut-off for the current analysis (8 February 2018). The most frequently reported AEs were pregnancy in 7 (1.5%) patients and syphilis in 5 (1.0%) patients. Grade 3–4 AEs were reported in 17 (3.5%) patients, and AEs possibly related to RPV in 23 (4.8%) patients. Over 288 weeks of treatment, 80.1% (95% CI: 74.9%; 84.3%) of patients maintained virologic suppression (HIV-1 RNA <50 copies/mL). The absolute CD4+ cell count increased over time until week 192 and remained constant thereafter. Conclusions RPV 25 mg QD in combination with an investigator-selected background regimen of two NRTIs demonstrated sustained long-term virologic suppression. The treatment was well-tolerated with no new safety findings.
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Affiliation(s)
- Jean Michel Molina
- University of Paris, Department of Infectious Diseases, St-Louis and Lariboisière hospitals, APHP, Paris, France
| | - Luminita Ene
- Spitalul de Boli Infectioase si Tropicale "Dr. Victor Babes" Bucuresti, Sos, Bucuresti, Romania
| | - Pedro Cahn
- Fundacion Huesped, Buenos Aires, Argentina
| | - Gerd Fätkenheuer
- Department of Internal Medicine, University of Cologne, KerpenerStraße, Cologne, Germany
| | - Eric Van Wijngaerden
- Department of General Internal Medicine, University Hospitals Leuven, Leuven, Belgium
| | | | - Natalia Zakharova
- Centre for Prophylaxis and Control of AIDS and Infectious Diseases, St. Petersburg, Russia
| | | | - Simon Vanveggel
- Janssen Research & Development, Turnhoutseweg, Beerse, Belgium
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Sued O, Cahn P. Latin America Priorities after 40 years of the beginning of the HIV pandemic. Lancet Reg Health Am 2021; 1:100024. [PMID: 36776757 PMCID: PMC9904065 DOI: 10.1016/j.lana.2021.100024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 06/30/2021] [Accepted: 07/04/2021] [Indexed: 06/18/2023]
Affiliation(s)
| | - Pedro Cahn
- Corresponding author: Pedro Cahn; MD, PhD., Fundación Huésped, Buenos Aires, Argentina
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18
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Kumar P, Johnson M, Molina JM, Rizzardini G, Cahn P, Bickel M, Wan H, Xu ZJ, Morais C, Sklar P, Greaves W. Brief Report: Switching to DOR/3TC/TDF Maintains HIV-1 Virologic Suppression Through Week 144 in the DRIVE-SHIFT Trial. J Acquir Immune Defic Syndr 2021; 87:801-805. [PMID: 33633036 PMCID: PMC8126485 DOI: 10.1097/qai.0000000000002642] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 12/30/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND In the primary analysis of the DRIVE-SHIFT trial, switching to doravirine/lamivudine/tenofovir disoproxil fumarate (DOR/3TC/TDF) maintained suppression of HIV-1 through week 48. Here, we present long-term efficacy and safety outcomes through week 144 of the DRIVE-SHIFT trial. METHODS This phase 3, randomized, open-label trial evaluated switching from a stable antiretroviral regimen to once-daily DOR/3TC/TDF in adults with HIV-1 suppressed for ≥6 months and no previous virologic failure. Participants switched at day 1 [immediate switch group (ISG); n = 447] or week 24 [delayed switch group (DSG); n = 209]. Nine ISG participants who completed week 48 but did not enter extension-1 were excluded from week 144 efficacy analyses. RESULTS At week 144, HIV-1 RNA <50 copies/mL was maintained in 80.1% of the ISG (351/438) and 83.7% of the DSG (175/209), while 2.7% (12/438) and 4.8% (10/209), respectively, had HIV-1 RNA ≥50 copies/mL (Food and Drug Administration Snapshot approach). Protocol-defined virologic failure after switch occurred in 2.1% of ISG (9/438) and 3.3% of DSG (7/209); no viral resistance to doravirine was detected in 4 participants with samples available. Reductions in fasting lipids were observed at 24 weeks after switch and maintained through week 144. The mean weight change from switch to week 144 was +1.4 kg for ISG and +1.2 kg for DSG. The most common adverse events were nasopharyngitis (16.2%), headache (12.3%), and diarrhea (9.1%). Overall, 4.1% discontinued because of adverse events, and no deaths occurred. CONCLUSIONS These results confirm that switching to once-daily DOR/3TC/TDF is a generally well-tolerated option for maintaining viral suppression in adults considering a change in therapy. REGISTRATION ClinicalTrials.gov NCT02397096.
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Affiliation(s)
- Princy Kumar
- Division of Infectious Diseases and Travel Medicine, Georgetown University Medical Center, Washington, DC
| | - Margaret Johnson
- Department of HIV Medicine, Royal Free Hospital, London, United Kingdom
| | - Jean-Michel Molina
- Saint-Louis and Lariboisière Hospitals, APHP, University of Paris, INSERM U944, Paris, France
| | - Giuliano Rizzardini
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco Hospital, Milan, Italy
| | - Pedro Cahn
- Fundación Huésped and Buenos Aires University, Buenos Aires, Argentina
| | - Markus Bickel
- Infektiologikum, Centre for Infectious Diseases, Frankfurt, Germany; and
| | - Hong Wan
- Merck & Co., Inc., Kenilworth, NJ
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Aristegui I, Radusky PD, Zalazar V, Cardozo N, Fabian S, Duarte M, Frola C, Cahn P, Sued O. Correlates of depressive symptoms in transgender women initiating HIV treatment in Argentina. Journal of Gay & Lesbian Mental Health 2021. [DOI: 10.1080/19359705.2020.1868370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Ines Aristegui
- Research Department, Fundación Huésped, Buenos Aires, Argentina
- Research in Psychology Department, Universidad de Palermo, Buenos Aires, Argentina
| | - Pablo D. Radusky
- Research Department, Fundación Huésped, Buenos Aires, Argentina
- Faculty of Psychology, Universidad de Buenos Aires, Buenos Aires, Argentina
| | | | - Nadir Cardozo
- Research Department, Fundación Huésped, Buenos Aires, Argentina
- Association of Transvestites, Transsexuals, and Transgenders of Argentina (A.T.T.T.A.), Buenos Aires, Argentina
| | - Solange Fabian
- Research Department, Fundación Huésped, Buenos Aires, Argentina
- Asociación Civil Hotel Gondolin, Buenos Aires, Argentina
| | - Mariana Duarte
- Research Department, Fundación Huésped, Buenos Aires, Argentina
- Association of Transvestites, Transsexuals, and Transgenders of Argentina (A.T.T.T.A.), Buenos Aires, Argentina
| | - Claudia Frola
- Research Department, Fundación Huésped, Buenos Aires, Argentina
- Infectious Diseases Unit, Juan A. Fernández Hospital, Buenos Aires, Argentina
| | - Pedro Cahn
- Research Department, Fundación Huésped, Buenos Aires, Argentina
| | - Omar Sued
- Research Department, Fundación Huésped, Buenos Aires, Argentina
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20
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Lopardo G, Belloso WH, Nannini E, Colonna M, Sanguineti S, Zylberman V, Muñoz L, Dobarro M, Lebersztein G, Farina J, Vidiella G, Bertetti A, Crudo F, Alzogaray MF, Barcelona L, Teijeiro R, Lambert S, Scublinsky D, Iacono M, Stanek V, Solari R, Cruz P, Casas MM, Abusamra L, Luciardi HL, Cremona A, Caruso D, de Miguel B, Lloret SP, Millán S, Kilstein Y, Pereiro A, Sued O, Cahn P, Spatz L, Goldbaum F. RBD-specific polyclonal F(ab´) 2 fragments of equine antibodies in patients with moderate to severe COVID-19 disease: A randomized, multicenter, double-blind, placebo-controlled, adaptive phase 2/3 clinical trial. EClinicalMedicine 2021; 34:100843. [PMID: 33870149 PMCID: PMC8037439 DOI: 10.1016/j.eclinm.2021.100843] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/10/2021] [Accepted: 03/17/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND passive immunotherapy is a therapeutic alternative for patients with COVID-19. Equine polyclonal antibodies (EpAbs) could represent a source of scalable neutralizing antibodies against SARS-CoV-2. METHODS we conducted a double-blind, randomized, placebo-controlled trial to assess efficacy and safety of EpAbs (INM005) in hospitalized adult patients with moderate and severe COVID-19 pneumonia in 19 hospitals of Argentina. Primary endpoint was improvement in at least two categories in WHO ordinal clinical scale at day 28 or hospital discharge (ClinicalTrials.gov number NCT04494984). FINDINGS between August 1st and October 26th, 2020, a total of 245 patients were enrolled. Enrolled patients were assigned to receive two blinded doses of INM005 (n = 118) or placebo (n = 123). Median age was 54 years old, 65•1% were male and 61% had moderate disease at baseline. Median time from symptoms onset to study treatment was 6 days (interquartile range 5 to 8). No statistically significant difference was noted between study groups on primary endpoint (risk difference [95% IC]: 5•28% [-3•95; 14•50]; p = 0•15). Rate of improvement in at least two categories was statistically significantly higher for INM005 at days 14 and 21 of follow-up. Time to improvement in two ordinal categories or hospital discharge was 14•2 (± 0•7) days in the INM005 group and 16•3 (± 0•7) days in the placebo group, hazard ratio 1•31 (95% CI 1•0 to 1•74). Subgroup analyses showed a beneficial effect of INM005 over severe patients and in those with negative baseline antibodies. Overall mortality was 6•9% the INM005 group and 11•4% in the placebo group (risk difference [95% IC]: 0•57 [0•24 to 1•37]). Adverse events of special interest were mild or moderate; no anaphylaxis was reported. INTERPRETATION Albeit not having reached the primary endpoint, we found clinical improvement of hospitalized patients with SARS-CoV-2 pneumonia, particularly those with severe disease.
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Affiliation(s)
- Gustavo Lopardo
- Hospital Municipal Dr. Bernardo Houssay, Pte Hipólito Yrigoyen 1757, Florida, Provincia de Buenos Aires, Argentina
- Fundación del Centro de Estudios Infectológicos (FUNCEI), French 3085, Ciudad Autónoma de Buenos Aires, Buenos Aires C1425, Argentina
| | - Waldo H. Belloso
- Department of Research, Hospital Italiano de Buenos Aires. Pres. Tte. Gral. Juan Domingo Perón 4190, Ciudad Autónoma de Buenos Aires, Buenos Aires C1199, Argentina
| | - Esteban Nannini
- Departamento de Enfermedades Infecciosas, Sanatorio Británico, Paraguay 40, Rosario, Santa Fé S2000 CVB, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina
| | - Mariana Colonna
- Inmunova S.A., 25 de mayo 1021, Villa Lynch, Gral. San Martín, Buenos Aires CP B1650HMP, Argentina
| | - Santiago Sanguineti
- Inmunova S.A., 25 de mayo 1021, Villa Lynch, Gral. San Martín, Buenos Aires CP B1650HMP, Argentina
| | - Vanesa Zylberman
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina
- Inmunova S.A., 25 de mayo 1021, Villa Lynch, Gral. San Martín, Buenos Aires CP B1650HMP, Argentina
| | - Luciana Muñoz
- Inmunova S.A., 25 de mayo 1021, Villa Lynch, Gral. San Martín, Buenos Aires CP B1650HMP, Argentina
| | - Martín Dobarro
- Sanatorio Sagrado Corazón (OSECAC), Bartolomé Mitre 1955, Ciudad Autónoma de Buenos Aires, Buenos Aires CP1039, Argentina
| | - Gabriel Lebersztein
- Sanatorio Sagrado Corazón (OSECAC), Bartolomé Mitre 1955, Ciudad Autónoma de Buenos Aires, Buenos Aires CP1039, Argentina
| | - Javier Farina
- Hospital de Alta Complejidad Cuenca Alta S.A.M.I.C. Dr. Néstor Carlos Kirchner, RP6, Cañuelas, Provincia de Buenos Aires, Argentina
| | - Gabriela Vidiella
- Sanatorio Agote. Dr. Luis Agote 2477, Ciudad Autónoma de Buenos Aires, Buenos Aires C1425 EOE, Argentina
| | - Anselmo Bertetti
- Sanatorio Güemes, Francisco Acuña de Figueroa 1240, Ciudad Autónoma de Buenos Aires, Buenos Aires C1180, Argentina
| | - Favio Crudo
- Hospital Municipal Emilio Zerboni, Moreno 90, San Antonio de Areco, Provincia de Buenos Aires B2760, Argentina
- Universidad Nacional de San Antonio de Areco, Av. Güiraldes 689, San Antonio de Areco, Provincia de Buenos Aires, Argentina
| | | | - Laura Barcelona
- Hospital Municipal Dr. Bernardo Houssay, Pte Hipólito Yrigoyen 1757, Florida, Provincia de Buenos Aires, Argentina
| | - Ricardo Teijeiro
- Hospital General de Agudos Dr. Ignacio Pirovano, Av. Monroe 3555, Ciudad Autónoma de Buenos Aires, Buenos Aires C1428, Argentina
| | - Sandra Lambert
- Hospital de Alta Complejidad El Cruce Néstor Kirchner, Av. Calchaquí 5401, Florencio Varela, Provincia de Buenos Aires, Argentina
| | - Darío Scublinsky
- Clínica Zabala. Av. Cabildo 1295, Ciudad Autónoma de Buenos Aires, Buenos Aires C1426 AAM, Argentina
| | - Marisa Iacono
- Hospital Provincial Neuquén Dr. Castro Rendón, Buenos Aires 450, Neuquén Q8300, Argentina
| | - Vanina Stanek
- Sección de Infectología, Servicio de Medicina Interna, Hospital Italiano de Buenos Aires. Pres. Tte. Gral. Juan Domingo Perón 4190, Ciudad Autónoma de Buenos Aires, Buenos Aires C1199, Argentina
| | - Rubén Solari
- Hospital de Infecciosas Francisco Javier Muñiz, Uspallata 2272, Ciudad Autónoma de Buenos Aires, Buenos Aires C1282, Argentina
| | - Pablo Cruz
- Centro Gallego de Buenos Aires, Av. Belgrano 2199, Ciudad Autónoma de Buenos Aires, Buenos Aires C1096, Argentina
| | - Marcelo Martín Casas
- Clínica Adventista Belgrano. Estomba 1710, Ciudad Autónoma de Buenos Aires, Buenos Aires C1430 EGF, Argentina
| | - Lorena Abusamra
- Hospital Municipal Dr. Diego Thompson, Avellaneda 33, Villa Lynch, Gral. San Martín, Buenos Aires B1650, Argentina
| | - Héctor Lucas Luciardi
- Hospital Centro de Salud Zenón J. Santillán, Av. Avellaneda 750, San Miguel de Tucumán, Tucumán T4000, Argentina
| | - Alberto Cremona
- Hospital Italiano La Plata, Av. 51, La Plata, Provincia de Buenos Aires B1900, Argentina
| | - Diego Caruso
- Hospital Español, Av. Belgrano 2975, Ciudad Autónoma de Buenos Aires, Buenos Aires C1209, Argentina
| | | | - Santiago Perez Lloret
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina
- Departamento de Docencia e Investigación, Facultad de Ciencias Médicas, Universidad Católica Argentina, Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
- Universidad Abierta Interamericana, Centro de Altos Estudios en Ciencias Humanas y de la Salud (UAI-CAECIHS), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Av. San Juan 951, Ciudad Autónoma de Buenos Aires, Buenos Aires C1147 AAH, Argentina
| | - Susana Millán
- mAbxience, Manuel Pombo Angulo 28, 3rd floor, Madrid 28050, Spain
| | - Yael Kilstein
- PHV LATAM, AES, Amenábar 3851, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - Ana Pereiro
- Fundación Mundo Sano, Paraguay 1535, Ciudad Autónoma de Buenos Aires, Buenos Aires C1061ABC, Argentina
| | - Omar Sued
- Fundación Huésped, Pasaje Ángel Peluffo 3932PB, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - Pedro Cahn
- Fundación Huésped, Pasaje Ángel Peluffo 3932PB, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - Linus Spatz
- Inmunova S.A., 25 de mayo 1021, Villa Lynch, Gral. San Martín, Buenos Aires CP B1650HMP, Argentina
| | - Fernando Goldbaum
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina
- Inmunova S.A., 25 de mayo 1021, Villa Lynch, Gral. San Martín, Buenos Aires CP B1650HMP, Argentina
- Fundación Instituto Leloir, IIBBA-CONICET. Av. Patricias Argentinas 435, Buenos Aires C1405BWE, Argentina
- CRIP - Centro de Rediseño e Ingeniería de Proteínas UNSAM Campus Miguelete. 25 de Mayo y Francia Villa Lynch, Gral. San Martín, Buenos Aires B1650HMK, Argentina
- Corresponding author at: Inmunova S.A., 25 de mayo 1021, Villa Lynch, Gral. San Martín, Buenos Aires CP B1650HMP, Argentina.
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21
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Zalazar V, Frola CE, Gun A, Radusky PD, Panis NK, Cardozo NF, Fabian S, Duarte MI, Aristegui I, Cahn P, Sued O. Acceptability of dual HIV/syphilis rapid test in community- and home-based testing strategy among transgender women in Buenos Aires, Argentina. Int J STD AIDS 2021; 32:501-509. [PMID: 33533303 DOI: 10.1177/0956462420979852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/16/2022]
Abstract
BACKGROUND Little is known of acceptability and feasibility of dual HIV and syphilis rapid tests in community- and home-based provider-initiated strategies among transgender women (TGW), in Latin America. Objectives were (1) to assess the acceptability of this strategy and, (2) to determine the percentage of positive results of HIV and syphilis, analyze the correlates of HIV or syphilis positive results, and measure the rates of effective referral and treatment completion among TGW. METHODS A multidisciplinary team tested 89 TGW in Buenos Aires. An acceptability survey was administered after the HIV/syphilis Duo test was used. All confirmed cases were referred for treatment initiation. RESULTS We found high levels of acceptability (98.8%) of this strategy among TGW. However, only 60.7% preferred simultaneous HIV and syphilis diagnosis test. Moreover, we found 9% of positive results of HIV, 51.7% of syphilis, and 3.4% of positive results for both infections. Only not being tested before was associated with an HIV positive result, and only low level of education was associated with a positive syphilis result. Among 8 TGW who tested positive for HIV, 37.5% (n = 3) started antiretroviral therapy. Of 46 who tested positive for syphilis, only 73.9% (n = 34) were effectively referred and from 23 who started treatment, only 39.1% completed it. CONCLUSIONS Community- and home-based dual HIV and syphilis rapid test is a feasible and highly acceptable approach for this hard-to-reach population. Implementing similar strategies could improve screening uptake and accessibility. However, these results highlight the need to improve strategies for treatment uptake, in order to reduce morbidity and risk of onward transmission.
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Affiliation(s)
- Virginia Zalazar
- Research Department, 541285Fundación Huésped, Buenos Aires, Argentina
| | - Claudia E Frola
- Research Department, 541285Fundación Huésped, Buenos Aires, Argentina.,Infectious Diseases Unit, 62916Hospital Juan A. Fernández, Buenos Aires, Argentina
| | - Ana Gun
- Research Department, 541285Fundación Huésped, Buenos Aires, Argentina
| | - Pablo D Radusky
- Research Department, 541285Fundación Huésped, Buenos Aires, Argentina.,Facultad de Psicologia, 28196Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Natalia K Panis
- Research Department, 541285Fundación Huésped, Buenos Aires, Argentina
| | - Nadir F Cardozo
- Research Department, 541285Fundación Huésped, Buenos Aires, Argentina.,Asociación de Travestis, Transexuales y Transgéneros de Argentina (A.T.T.T.A.), Buenos Aires, Argentina.,Red Latinoamericana y del Caribe de Personas Trans, RedLacTrans, Argentina.,Casa Trans, Buenos Aires, Argentina
| | - Solange Fabian
- Research Department, 541285Fundación Huésped, Buenos Aires, Argentina.,Asociación Civil Gondolin, Buenos Aires, Argentina
| | - Mariana I Duarte
- Research Department, 541285Fundación Huésped, Buenos Aires, Argentina.,Asociación de Travestis, Transexuales y Transgéneros de Argentina (A.T.T.T.A.), Buenos Aires, Argentina.,Red Latinoamericana y del Caribe de Personas Trans, RedLacTrans, Argentina.,Casa Trans, Buenos Aires, Argentina
| | - Inés Aristegui
- Research Department, 541285Fundación Huésped, Buenos Aires, Argentina.,Centro de Investigaciones en Psicología, 28206Universidad de Palermo, Buenos Aires, Argentina
| | - Pedro Cahn
- Research Department, 541285Fundación Huésped, Buenos Aires, Argentina
| | - Omar Sued
- Research Department, 541285Fundación Huésped, Buenos Aires, Argentina
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22
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Sued O, Cecchini D, Abbamonte JM, Rodriguez VJ, Mandell LN, Cristofari NV, Figueroa MI, Cassetti I, Cahn P, Weiss SM, Alcaide ML, Cahn F, Calanni L, Crinejo A, David D, Lupo S, Pérez C, Pérez R, Rodriguez C, Rolón MJ, Sisto A, Trapé L, Jones DL. Correction to: Cumulative Burden of Mental Health Factors and Engagement in HIV Care in Argentina. Int J Behav Med 2021; 28:402. [PMID: 33501555 DOI: 10.1007/s12529-021-09955-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Omar Sued
- Fundación Huésped, Buenos Aires, Argentina.
| | - Diego Cecchini
- Hospital General de Agudos Dr. Cosme Argerich, Buenos Aires, Argentina.,Helios Salud, Buenos Aires, Argentina
| | - John M Abbamonte
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Violeta J Rodriguez
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.,Department of Psychology, University of Georgia, Athens, GA, USA
| | - Lissa N Mandell
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Nicholas V Cristofari
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | | | - Pedro Cahn
- Fundación Huésped, Buenos Aires, Argentina
| | - Stephen M Weiss
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Florencia Cahn
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Ana Crinejo
- CEIN Unidad Infectologica, Neuquén, Argentina
| | | | - Sergio Lupo
- Hospital Guillermo Rawson, Córdoba, Argentina
| | - Carolina Pérez
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Claudia Rodriguez
- Hospital General de Agudos Dr. Cosme Argerich, Buenos Aires, Argentina
| | - María José Rolón
- Instituto Centralizado de Asistencia e Investigación Clínica Integral (CAICI), Rosario, Argentina
| | - Alicia Sisto
- Instituto Centralizado de Asistencia e Investigación Clínica Integral (CAICI), Rosario, Argentina
| | | | - Deborah L Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
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Thompson M, Orkin C, Molina JM, Sax P, Cahn P, Squires K, Xu X, Rodgers A, Kumar S, Teppler H, Martin E, Hanna G, Hwang C. Once-daily Doravirine for Initial Treatment of Adults Living With Human Immunodeficiency Virus-1: An Integrated Safety Analysis. Clin Infect Dis 2021; 70:1336-1343. [PMID: 31121013 DOI: 10.1093/cid/ciz423] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 01/31/2019] [Accepted: 05/22/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND A prespecified integrated safety analysis was conducted for 3 doravirine (DOR) double-blind trials (Phase IIb: P007 [NCT01632345]; Phase III: DRIVE-FORWARD [NCT02275780] and DRIVE-AHEAD [NCT02403674]). METHODS DOR (100 mg) arms from these trials were compared with darunavir plus ritonavir (DRV+r) in DRIVE-FORWARD and efavirenz (EFV) in P007 and DRIVE-AHEAD. Background therapies were emtricitabine/tenofovir disoproxil fumarate (FTC/TDF) in P007; abacavir/lamivudine (ABC/3TC) or FTC/TDF in DRIVE-FORWARD; and 3TC/TDF for DOR and FTC/TDF for EFV in DRIVE-AHEAD. The primary endpoint was the proportion of participants discontinuing due to adverse events (AEs) through Week 48. RESULTS Discontinuation rates due to AEs were similar for participants on DOR and DRV+r (2.5% vs 3.1%, respectively) and lower for those on DOR than for those on EFV (2.5% vs 6.6%, respectively). Rates of drug-related AEs for DOR, DRV+r, and EFV were 30.9%, 32.1%, and 61.4%, respectively. In an analysis of DOR versus EFV, the treatment difference for discontinuations due to AEs was -3.4%, favoring DOR (95% confidence interval -6.2 to -0.8; P = .012). Fewer participants experienced neuropsychiatric AEs on DOR than on EFV (25.0% vs 55.9%, respectively), and fewer experienced diarrhea on DOR than on DRV+r (12.4% vs 22.5%, respectively). Changes from baseline in most lipid parameters also favored DOR. CONCLUSIONS At Week 48, DOR at 100 mg had a favorable safety profile compared with EFV or DRV+r and a favorable tolerability profile compared with EFV. CLINICAL TRIALS REGISTRATION NCT01632345; NCT02275780 and NCT02403674.
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Affiliation(s)
| | - Chloe Orkin
- Queen Mary University, London, United Kingdom
| | | | - Paul Sax
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Pedro Cahn
- Fundación Huesped, Buenos Aires, Argentina
| | - Kathleen Squires
- Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Xia Xu
- Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, New Jersey
| | - Anthony Rodgers
- Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, New Jersey
| | - Sushma Kumar
- Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, New Jersey
| | - Hedy Teppler
- Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, New Jersey
| | - Elizabeth Martin
- Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, New Jersey
| | - George Hanna
- Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, New Jersey
| | - Carey Hwang
- Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, New Jersey
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Figueroa MI, Camiro-Zuñiga A, Belaunzaran-Zamudio PF, Sierra Madero J, Andrade Villanueva J, Arribas JR, Lama JR, Cecchini DM, Lopardo G, Crabtree-Ramírez B, Gun A, Patterson P, Fink VI, Sued OG, Cahn P. The effect of protease inhibitor-based dual antiretroviral regimens on CD4/CD8 ratio during the first year of therapy in ART-naïve patients with HIV-infection. HIV Med 2020; 22:254-261. [PMID: 33336523 DOI: 10.1111/hiv.13008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 08/11/2020] [Revised: 09/03/2020] [Accepted: 10/09/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To assess the effect of protease inhibitor (PI)-based dual therapy on CD4/CD8 ratio during the first year of therapy in antiretroviral therapy (ART)-naïve patients using data from randomized controlled clinical trials. METHODS We pooled data from the GARDEL and ANDES studies, both randomized controlled clinical trials that recruited ART-naïve people living with HIV and randomly assigned them to receive PI-based dual therapy (DT) or triple therapy (TT) aiming to compare viral efficacy. We compared median CD4/CD8 ratios and the proportion of patients with CD4/CD8 ratio > 1 at 48 weeks after ART initiation in both treatment arms using the Mann-Whitney U-test and the χ2 test. We performed subgroup analysis for patients > 50 years old, with baseline CD4 counts ≤ 200 cells/μL, viral load > 100 000 HIV RNA copies/mL, and ritonavir-boosted lopinavir-based therapy. RESULTS We analysed data from 571 patients: 292 on DT and 279 on TT. No differences were observed in CD4/CD8 ratio (0.632 vs. 0.617, P = 0.729) or in the proportion of patients with CD4/CD8 ratio > 1 (17.9% vs. 19.3%, P = 0.678) 48 weeks after ART initiation. Subgroup analysis showed no further differences. CONCLUSION The impact of PI-based DT regimens on the CD4/CD8 ratio during the first year of treatment for ART-naïve patients is similar to that of TT.
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Affiliation(s)
| | | | - P F Belaunzaran-Zamudio
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - J Sierra Madero
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | | | - J R Lama
- Asociación Civil Impacta Salud y Educación, Lima, Perú
| | | | - G Lopardo
- Centro de Estudios Infectológicos, Buenos Aires, Argentina
| | - B Crabtree-Ramírez
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - A Gun
- Fundación Huésped, Buenos Aires, Argentina
| | | | - V I Fink
- Fundación Huésped, Buenos Aires, Argentina
| | - O G Sued
- Fundación Huésped, Buenos Aires, Argentina
| | - P Cahn
- Fundación Huésped, Buenos Aires, Argentina
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25
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Radusky PD, Zalazar V, Cardozo N, Fabian S, Duarte M, Frola C, Cahn P, Sued O, Aristegui I. Reduction of Gender Identity Stigma and Improvements in Mental Health Among Transgender Women Initiating HIV Treatment in a Trans-Sensitive Clinic in Argentina. Transgend Health 2020; 5:216-224. [PMID: 33644313 DOI: 10.1089/trgh.2020.0005] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Stigma toward transgender women (TGW) increases psychosocial vulnerability, leading to poor mental health and affecting access and retention in HIV care. Trans-sensitive health care (TSHC) has the potential to mitigate this adverse impact. This study aimed to describe baseline characteristics in gender identity stigma (GIS), mental health, and substance use among TGW living with HIV initiating antiretroviral treatment and to analyze changes after 6 months in HIV care in a TSHC clinic in Argentina. Methods: Sixty-one TGW living with HIV responded to the following questionnaires at baseline and after 6 months in TSHC: sociodemographic, experiences of GIS (in health care, police, etc.), Center for Epidemiologic Studies Depression Scale (CES-D) (depression), State Trait Anxiety Inventory (STAI) (anxiety), Drug Abuse Screening Test (DAST-10) (drug use), Alcohol Use Disorders Identification Test (AUDIT) (alcohol use), 8-item Personal Wellbeing Index-Adults (PWI-A) (quality of life [QOL]), Personality Inventory for DSM-5-Brief Form (PID-5-BF) (maladaptive personality traits), and Duke Index (social support). Analyses included Pearson correlations to analyze associations between variables; and paired sample t-tests, to explore changes between baseline and 6 months. Results: A significant proportion experienced episodes of GIS the last year in any context. At baseline, 50.8% showed significant depressive symptoms and 65.6% reported any drug use in the last year. At 6 months, participants experienced a significant reduction of GIS, both enacted and internalized, anxiety, drug, and alcohol use, and improvement in QOL. The remaining mental health indicators were not significantly modified. Conclusion: A TSHC service may have a gender-affirmative impact on TGW initiating HIV care that contributes to reduce GIS and substance use and improve mental health. This highlights the importance that HIV care programs for TGW comply with trans-sensitive essential components to enhance retention.
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Affiliation(s)
- Pablo D Radusky
- Research Department, Fundación Huésped, Buenos Aires, Argentina
- Faculty of Psychology, Universidad de Buenos Aires, Buenos Aires, Argentina
| | | | - Nadir Cardozo
- Research Department, Fundación Huésped, Buenos Aires, Argentina
- Association of Transvestites, Transsexuals, and Transgenders of Argentina (A.T.T.T.A.), Buenos Aires, Argentina
| | - Solange Fabian
- Research Department, Fundación Huésped, Buenos Aires, Argentina
- Asociación Civil Hotel Gondolin, Buenos Aires, Argentina
| | - Mariana Duarte
- Research Department, Fundación Huésped, Buenos Aires, Argentina
- Association of Transvestites, Transsexuals, and Transgenders of Argentina (A.T.T.T.A.), Buenos Aires, Argentina
| | - Claudia Frola
- Research Department, Fundación Huésped, Buenos Aires, Argentina
- Infectious Diseases Unit, Juan A. Fernández Hospital, Buenos Aires, Argentina
| | - Pedro Cahn
- Research Department, Fundación Huésped, Buenos Aires, Argentina
| | - Omar Sued
- Research Department, Fundación Huésped, Buenos Aires, Argentina
| | - Inés Aristegui
- Research Department, Fundación Huésped, Buenos Aires, Argentina
- Infectious Diseases Unit, Universidad de Palermo, Buenos Aires, Argentina
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26
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Lataillade M, Lalezari JP, Kozal M, Aberg JA, Pialoux G, Cahn P, Thompson M, Molina JM, Moreno S, Grinsztejn B, Diaz RS, Castagna A, Kumar PN, Latiff GH, De Jesus E, Wang M, Chabria S, Gartland M, Pierce A, Ackerman P, Llamoso C. Safety and efficacy of the HIV-1 attachment inhibitor prodrug fostemsavir in heavily treatment-experienced individuals: week 96 results of the phase 3 BRIGHTE study. The Lancet HIV 2020; 7:e740-e751. [DOI: 10.1016/s2352-3018(20)30240-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/20/2020] [Accepted: 07/28/2020] [Indexed: 10/23/2022]
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27
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Sued O, Cecchini D, Abbamonte JM, Rodriguez VJ, Mandell LN, Cristofari NV, Figueroa MI, Cassetti I, Cahn P, Weiss SM, Alcaide ML, Cahn F, Calanni L, Crinejo A, David D, Lupo S, Pérez C, Pérez R, Rodriguez C, Rolón MJ, Sisto A, Trapé L, Jones DL. Cumulative Burden of Mental Health Factors and Engagement in HIV Care in Argentina. Int J Behav Med 2020; 28:318-327. [PMID: 32725586 DOI: 10.1007/s12529-020-09921-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Cumulative burden of multiple mental health conditions may worsen physical health outcomes in vulnerable populations. Accordingly, identifying cumulative burdens of mental health conditions that may affect HIV treatment and care can guide public health strategies to reduce their impact on HIV-related health outcomes. This study examined the relationship between the cumulative burden of mental health conditions and factors associated with engagement in HIV care in Argentina. METHOD Data for this study was obtained at baseline from Conexiones y Opciones Positivas en la Argentina 2 (COPA2). Participants (N = 360) were cisgender patients living with HIV who were lost to care, recruited from seven clinics serving people living with HIV in four Argentine urban centers. Cumulative burden of mental health conditions (i.e., depressive symptoms, problematic substance use, unhealthy alcohol use, and psychotic symptoms) was assessed. RESULTS Every one-point increase in the number of mental health conditions present was associated with a decrement in patient-provider communication (b = - 0.22, p < .001), self-efficacy (b = - 0.13, p = .012), and motivation for adherence (b = - 0.11, p = .039). CONCLUSION This study found cumulative burden of depression, problematic substance use, unhealthy alcohol use, and psychotic symptoms to be negatively associated with factors related to engagement in HIV care. Results highlight the importance of identification and treatment of challenges to mental health, in order to ameliorate their influence on engagement in HIV care.
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Affiliation(s)
- Omar Sued
- Fundacion Huesped, Buenos Aires, Argentina.
| | - Diego Cecchini
- Hospital General de Agudos Dr. Cosme Argerich, Buenos Aires, Argentina.,Helios Salud, Buenos Aires, Argentina
| | - John M Abbamonte
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Violeta J Rodriguez
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.,Department of Psychology, University of Georgia, Athens, GA, USA
| | - Lissa N Mandell
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Nicholas V Cristofari
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | | | - Pedro Cahn
- Fundacion Huesped, Buenos Aires, Argentina
| | - Stephen M Weiss
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Maria L Alcaide
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | | | - Ana Crinejo
- Hospital Guillermo Rawson, Córdoba, Argentina
| | | | - Sergio Lupo
- Instituto Centralizado de Asistencia e Investigación Clínica Integral (CAICI), Rosario, Argentina
| | | | | | - Claudia Rodriguez
- Hospital General de Agudos Dr. Cosme Argerich, Buenos Aires, Argentina
| | - María José Rolón
- Hospital General de Agudos Dr. Juan A. Fernández, Buenos Aires, Argentina
| | - Alicia Sisto
- Hospital General de Agudos Dr. Juan A. Fernández, Buenos Aires, Argentina
| | - Liliana Trapé
- Instituto Centralizado de Asistencia e Investigación Clínica Integral (CAICI), Rosario, Argentina
| | - Deborah L Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
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28
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Cecchini D, Alcaide ML, Rodriguez VDJ, Mandell LN, Abbamonte JM, Cassetti I, Cahn P, Sued O, Weiss SM, Jones DL. Women of Reproductive Age Living with HIV in Argentina: Unique Challenges for Reengagement in Care. J Int Assoc Provid AIDS Care 2020; 18:2325958219883250. [PMID: 31623511 PMCID: PMC6900676 DOI: 10.1177/2325958219883250] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study evaluated the reasons for not taking antiretroviral treatment (ART) among
women of reproductive age who are disengaged from HIV care (have missed pharmacy pickups
and physician visits), with the goal of identifying strategies for reengagement in HIV
care. Participants were cisgender women (n = 162), 18 to 49 years of age, and who
completed sociodemographic, medical history, reasons why they were not taking ART, mental
health, motivation, and self-efficacy assessments. Latent class analysis was used for
analysis. Women who reported avoidance-based coping (avoid thinking about HIV) had higher
depression (U = 608.5, z = −2.7, P =
.007), lower motivation (U = 601, z = −2.8,
P = .006), and lower self-efficacy (U = 644.5,
z = −2.4, P = .017) than those not using this
maladaptive strategy. As women living with HIV experience a disproportionate burden of
poor health outcomes, interventions focused on the management of depression may improve
HIV outcomes and prevent HIV transmission.
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Affiliation(s)
| | - Maria Luisa Alcaide
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Violeta de Jesus Rodriguez
- Department of Psychology, University of Georgia, Athens, GA, USA.,Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Lissa Nicole Mandell
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - John Michael Abbamonte
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Pedro Cahn
- Fundacion Huesped, Buenos Aires, Argentina
| | - Omar Sued
- Fundacion Huesped, Buenos Aires, Argentina
| | - Stephen Marshall Weiss
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Deborah Lynne Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
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29
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Tan DHS, Raboud JM, Szadkowski L, Grinsztejn B, Madruga JV, Figueroa MI, Cahn P, Barton SE, Clarke A, Fox J, Zubyk W, Walmsley SL. Effect of valaciclovir on CD4 count decline in untreated HIV: an international randomized controlled trial. J Antimicrob Chemother 2020; 74:480-488. [PMID: 30376108 PMCID: PMC6337901 DOI: 10.1093/jac/dky433] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 09/26/2018] [Indexed: 11/14/2022] Open
Abstract
Objectives To determine the impact of valaciclovir on HIV disease progression in treatment-naive HIV-positive adults. Methods In this fully blind, multicentre, 1:1 randomized placebo-controlled trial, treatment-naive HIV-1-positive adults with CD4 counts 400–900 cells/mm3 and not meeting contemporaneous recommendations for combination ART (cART) were randomized to valaciclovir 500 mg or placebo twice daily, and followed quarterly until having two consecutive CD4 counts ≤350 cells/mm3 or initiating cART for any reason. The primary analysis compared the rate of CD4 count decline by study arm after adjusting for baseline CD4 count and viral load (VL). Secondary analyses compared the rate of CD4 percentage decline, HIV VL, herpes simplex virus (HSV) recurrences and drug-related adverse events. The trial closed after release of the START trial results in August 2015. Results We enrolled 198 participants in Canada, Brazil, Argentina and the UK. Median (IQR) age was 35 (30–43) years. Baseline CD4 count was 592 (491–694) cells/mm3 and VL was 4.04 (3.5–4.5) log10 copies/mL. Over 276 person-years of follow-up, CD4 counts declined by 49 cells/mm3/year in the valaciclovir arm versus 58 cells/mm3/year in the placebo arm (P = 0.65). No differences were seen in the rate of change in CD4 percentage (−1.2%/year versus −1.7%/year, P = 0.34). VL was 0.27 log10 copies/mL lower in valaciclovir participants overall (P<0.001). Placebo participants had more HSV recurrences (62 versus 21/100 person-years, P < 0.0001) but similar rates of grade ≥2 drug-related adverse events. Conclusions Unlike prior trials using aciclovir, we found that valaciclovir did not slow CD4 count decline in cART-untreated adults, although power was limited due to premature study discontinuation. Valaciclovir modestly lowered HIV VL.
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Affiliation(s)
- Darrell H S Tan
- Division of Infectious Diseases, St. Michael's Hospital, Toronto, Canada.,Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada.,Division of Infectious Diseases, University Health Network, Toronto, Canada
| | - Janet M Raboud
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Toronto General Research Institute, Toronto, Canada
| | - Leah Szadkowski
- Biostatistics Research Unit, University Health Network, Toronto, Canada
| | - Beatriz Grinsztejn
- Instituto de Pesquisa Clínica Evandro Chagas (IPEC), Fundaçao Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | | | - Pedro Cahn
- Fundación Huesped, Buenos Aires, Argentina
| | | | - Amanda Clarke
- Brighton & Sussex University Hospital NHS Trust, Brighton, UK
| | - Julie Fox
- Guy's & St. Thomas' NHS Foundation Trust, London, UK
| | - Wendy Zubyk
- CIHR Canadian HIV Trials Network, Vancouver, Canada
| | - Sharon L Walmsley
- Department of Medicine, University of Toronto, Toronto, Canada.,Division of Infectious Diseases, University Health Network, Toronto, Canada.,Toronto General Research Institute, Toronto, Canada.,CIHR Canadian HIV Trials Network, Vancouver, Canada
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30
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Kozal M, Aberg J, Pialoux G, Cahn P, Thompson M, Molina JM, Grinsztejn B, Diaz R, Castagna A, Kumar P, Latiff G, DeJesus E, Gummel M, Gartland M, Pierce A, Ackerman P, Llamoso C, Lataillade M. Fostemsavir in Adults with Multidrug-Resistant HIV-1 Infection. N Engl J Med 2020; 382:1232-1243. [PMID: 32212519 DOI: 10.1056/nejmoa1902493] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [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] [Indexed: 11/19/2022]
Abstract
BACKGROUND Among some patients with human immunodeficiency virus type 1 (HIV-1) infection who have undergone multiple antiretroviral therapies and have limited options for treatment, new classes of antiretroviral drugs with novel mechanisms of action are needed. Fostemsavir is the prodrug of temsavir, a first-in-class investigational HIV-1 attachment inhibitor. METHODS In this ongoing phase 3 trial in 23 countries, we enrolled patients with multidrug-resistant HIV-1 infection in two cohorts, according to their remaining treatment options. In the first cohort, we assigned (in a 3:1 ratio) patients who had the option of using at least one fully active, approved antiretroviral drug in at least one but no more than two antiretroviral classes to add either fostemsavir (at a dose of 600 mg twice daily) or placebo to their failing regimen for 8 days, followed by open-label fostemsavir plus optimized background therapy (randomized cohort). In the second cohort, patients who had no remaining antiretroviral options were started on open-label fostemsavir plus optimized background therapy on day 1 (nonrandomized cohort). The primary end point was the mean change in the HIV-1 RNA level from day 1 through day 8 in the randomized cohort. RESULTS A total of 371 patients were treated, including 272 in the randomized cohort and 99 in the nonrandomized cohort. At day 8, the mean decrease in the HIV-1 RNA level was 0.79 log10 copies per milliliter in the fostemsavir group and 0.17 log10 copies in the placebo group (P<0.001). At week 48, a virologic response (HIV-1 RNA level, <40 copies per milliliter) had occurred in 54% of the patients in the randomized cohort and in 38% of those in the nonrandomized cohort; the mean increase in the CD4+ T-cell count was 139 cells per cubic millimeter and 64 cells per cubic millimeter, respectively. Adverse events led to the discontinuation of fostemsavir in 7% of the patients. In the randomized cohort, glycoprotein 120 (gp120) substitutions were found in 20 of 47 patients (43%) with virologic failure. CONCLUSIONS In patients with multidrug-resistant HIV-1 infection with limited therapy options, those who received fostemsavir had a significantly greater decrease in the HIV-1 RNA level than those who received placebo during the first 8 days. Efficacy was sustained through 48 weeks. (Funded by Bristol-Myers Squibb and GSK/ViiV Healthcare; BRIGHTE ClinicalTrials.gov number, NCT02362503.).
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Affiliation(s)
- Michael Kozal
- From Yale University School of Medicine and the Veterans Affairs Connecticut Healthcare System, New Haven (M.K.), and ViiV Healthcare, Branford (P.A., C.L., M.L.) - all in Connecticut; Icahn School of Medicine at Mount Sinai, New York (J.A.); Hôpital Tenon, Assistance Publique-Hôpitaux de Paris (AP-HP) (G.P.), and Hôpital Saint Louis, AP-HP, and University of Paris Diderot Paris 7 (J.-M.M.), Paris; Fundación Huesped, Buenos Aires (P.C.); AIDS Research Consortium of Atlanta, Atlanta (M.T.); Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro (B.G.), and Federal University of São Paulo, São Paulo (R.D.); San Raffaele Scientific Institute, Milan (A.C.); Georgetown University Hospital, Washington, DC (P.K.); Maxwell Center, Durban, South Africa (G.L.); Orlando Immunology Center, Orlando, FL (E.D.); GlaxoSmithKline, Upper Providence, PA (M. Gummel); and ViiV Healthcare, Research Triangle Park, NC (M. Gartland, A.P.)
| | - Judith Aberg
- From Yale University School of Medicine and the Veterans Affairs Connecticut Healthcare System, New Haven (M.K.), and ViiV Healthcare, Branford (P.A., C.L., M.L.) - all in Connecticut; Icahn School of Medicine at Mount Sinai, New York (J.A.); Hôpital Tenon, Assistance Publique-Hôpitaux de Paris (AP-HP) (G.P.), and Hôpital Saint Louis, AP-HP, and University of Paris Diderot Paris 7 (J.-M.M.), Paris; Fundación Huesped, Buenos Aires (P.C.); AIDS Research Consortium of Atlanta, Atlanta (M.T.); Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro (B.G.), and Federal University of São Paulo, São Paulo (R.D.); San Raffaele Scientific Institute, Milan (A.C.); Georgetown University Hospital, Washington, DC (P.K.); Maxwell Center, Durban, South Africa (G.L.); Orlando Immunology Center, Orlando, FL (E.D.); GlaxoSmithKline, Upper Providence, PA (M. Gummel); and ViiV Healthcare, Research Triangle Park, NC (M. Gartland, A.P.)
| | - Gilles Pialoux
- From Yale University School of Medicine and the Veterans Affairs Connecticut Healthcare System, New Haven (M.K.), and ViiV Healthcare, Branford (P.A., C.L., M.L.) - all in Connecticut; Icahn School of Medicine at Mount Sinai, New York (J.A.); Hôpital Tenon, Assistance Publique-Hôpitaux de Paris (AP-HP) (G.P.), and Hôpital Saint Louis, AP-HP, and University of Paris Diderot Paris 7 (J.-M.M.), Paris; Fundación Huesped, Buenos Aires (P.C.); AIDS Research Consortium of Atlanta, Atlanta (M.T.); Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro (B.G.), and Federal University of São Paulo, São Paulo (R.D.); San Raffaele Scientific Institute, Milan (A.C.); Georgetown University Hospital, Washington, DC (P.K.); Maxwell Center, Durban, South Africa (G.L.); Orlando Immunology Center, Orlando, FL (E.D.); GlaxoSmithKline, Upper Providence, PA (M. Gummel); and ViiV Healthcare, Research Triangle Park, NC (M. Gartland, A.P.)
| | - Pedro Cahn
- From Yale University School of Medicine and the Veterans Affairs Connecticut Healthcare System, New Haven (M.K.), and ViiV Healthcare, Branford (P.A., C.L., M.L.) - all in Connecticut; Icahn School of Medicine at Mount Sinai, New York (J.A.); Hôpital Tenon, Assistance Publique-Hôpitaux de Paris (AP-HP) (G.P.), and Hôpital Saint Louis, AP-HP, and University of Paris Diderot Paris 7 (J.-M.M.), Paris; Fundación Huesped, Buenos Aires (P.C.); AIDS Research Consortium of Atlanta, Atlanta (M.T.); Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro (B.G.), and Federal University of São Paulo, São Paulo (R.D.); San Raffaele Scientific Institute, Milan (A.C.); Georgetown University Hospital, Washington, DC (P.K.); Maxwell Center, Durban, South Africa (G.L.); Orlando Immunology Center, Orlando, FL (E.D.); GlaxoSmithKline, Upper Providence, PA (M. Gummel); and ViiV Healthcare, Research Triangle Park, NC (M. Gartland, A.P.)
| | - Melanie Thompson
- From Yale University School of Medicine and the Veterans Affairs Connecticut Healthcare System, New Haven (M.K.), and ViiV Healthcare, Branford (P.A., C.L., M.L.) - all in Connecticut; Icahn School of Medicine at Mount Sinai, New York (J.A.); Hôpital Tenon, Assistance Publique-Hôpitaux de Paris (AP-HP) (G.P.), and Hôpital Saint Louis, AP-HP, and University of Paris Diderot Paris 7 (J.-M.M.), Paris; Fundación Huesped, Buenos Aires (P.C.); AIDS Research Consortium of Atlanta, Atlanta (M.T.); Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro (B.G.), and Federal University of São Paulo, São Paulo (R.D.); San Raffaele Scientific Institute, Milan (A.C.); Georgetown University Hospital, Washington, DC (P.K.); Maxwell Center, Durban, South Africa (G.L.); Orlando Immunology Center, Orlando, FL (E.D.); GlaxoSmithKline, Upper Providence, PA (M. Gummel); and ViiV Healthcare, Research Triangle Park, NC (M. Gartland, A.P.)
| | - Jean-Michel Molina
- From Yale University School of Medicine and the Veterans Affairs Connecticut Healthcare System, New Haven (M.K.), and ViiV Healthcare, Branford (P.A., C.L., M.L.) - all in Connecticut; Icahn School of Medicine at Mount Sinai, New York (J.A.); Hôpital Tenon, Assistance Publique-Hôpitaux de Paris (AP-HP) (G.P.), and Hôpital Saint Louis, AP-HP, and University of Paris Diderot Paris 7 (J.-M.M.), Paris; Fundación Huesped, Buenos Aires (P.C.); AIDS Research Consortium of Atlanta, Atlanta (M.T.); Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro (B.G.), and Federal University of São Paulo, São Paulo (R.D.); San Raffaele Scientific Institute, Milan (A.C.); Georgetown University Hospital, Washington, DC (P.K.); Maxwell Center, Durban, South Africa (G.L.); Orlando Immunology Center, Orlando, FL (E.D.); GlaxoSmithKline, Upper Providence, PA (M. Gummel); and ViiV Healthcare, Research Triangle Park, NC (M. Gartland, A.P.)
| | - Beatriz Grinsztejn
- From Yale University School of Medicine and the Veterans Affairs Connecticut Healthcare System, New Haven (M.K.), and ViiV Healthcare, Branford (P.A., C.L., M.L.) - all in Connecticut; Icahn School of Medicine at Mount Sinai, New York (J.A.); Hôpital Tenon, Assistance Publique-Hôpitaux de Paris (AP-HP) (G.P.), and Hôpital Saint Louis, AP-HP, and University of Paris Diderot Paris 7 (J.-M.M.), Paris; Fundación Huesped, Buenos Aires (P.C.); AIDS Research Consortium of Atlanta, Atlanta (M.T.); Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro (B.G.), and Federal University of São Paulo, São Paulo (R.D.); San Raffaele Scientific Institute, Milan (A.C.); Georgetown University Hospital, Washington, DC (P.K.); Maxwell Center, Durban, South Africa (G.L.); Orlando Immunology Center, Orlando, FL (E.D.); GlaxoSmithKline, Upper Providence, PA (M. Gummel); and ViiV Healthcare, Research Triangle Park, NC (M. Gartland, A.P.)
| | - Ricardo Diaz
- From Yale University School of Medicine and the Veterans Affairs Connecticut Healthcare System, New Haven (M.K.), and ViiV Healthcare, Branford (P.A., C.L., M.L.) - all in Connecticut; Icahn School of Medicine at Mount Sinai, New York (J.A.); Hôpital Tenon, Assistance Publique-Hôpitaux de Paris (AP-HP) (G.P.), and Hôpital Saint Louis, AP-HP, and University of Paris Diderot Paris 7 (J.-M.M.), Paris; Fundación Huesped, Buenos Aires (P.C.); AIDS Research Consortium of Atlanta, Atlanta (M.T.); Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro (B.G.), and Federal University of São Paulo, São Paulo (R.D.); San Raffaele Scientific Institute, Milan (A.C.); Georgetown University Hospital, Washington, DC (P.K.); Maxwell Center, Durban, South Africa (G.L.); Orlando Immunology Center, Orlando, FL (E.D.); GlaxoSmithKline, Upper Providence, PA (M. Gummel); and ViiV Healthcare, Research Triangle Park, NC (M. Gartland, A.P.)
| | - Antonella Castagna
- From Yale University School of Medicine and the Veterans Affairs Connecticut Healthcare System, New Haven (M.K.), and ViiV Healthcare, Branford (P.A., C.L., M.L.) - all in Connecticut; Icahn School of Medicine at Mount Sinai, New York (J.A.); Hôpital Tenon, Assistance Publique-Hôpitaux de Paris (AP-HP) (G.P.), and Hôpital Saint Louis, AP-HP, and University of Paris Diderot Paris 7 (J.-M.M.), Paris; Fundación Huesped, Buenos Aires (P.C.); AIDS Research Consortium of Atlanta, Atlanta (M.T.); Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro (B.G.), and Federal University of São Paulo, São Paulo (R.D.); San Raffaele Scientific Institute, Milan (A.C.); Georgetown University Hospital, Washington, DC (P.K.); Maxwell Center, Durban, South Africa (G.L.); Orlando Immunology Center, Orlando, FL (E.D.); GlaxoSmithKline, Upper Providence, PA (M. Gummel); and ViiV Healthcare, Research Triangle Park, NC (M. Gartland, A.P.)
| | - Princy Kumar
- From Yale University School of Medicine and the Veterans Affairs Connecticut Healthcare System, New Haven (M.K.), and ViiV Healthcare, Branford (P.A., C.L., M.L.) - all in Connecticut; Icahn School of Medicine at Mount Sinai, New York (J.A.); Hôpital Tenon, Assistance Publique-Hôpitaux de Paris (AP-HP) (G.P.), and Hôpital Saint Louis, AP-HP, and University of Paris Diderot Paris 7 (J.-M.M.), Paris; Fundación Huesped, Buenos Aires (P.C.); AIDS Research Consortium of Atlanta, Atlanta (M.T.); Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro (B.G.), and Federal University of São Paulo, São Paulo (R.D.); San Raffaele Scientific Institute, Milan (A.C.); Georgetown University Hospital, Washington, DC (P.K.); Maxwell Center, Durban, South Africa (G.L.); Orlando Immunology Center, Orlando, FL (E.D.); GlaxoSmithKline, Upper Providence, PA (M. Gummel); and ViiV Healthcare, Research Triangle Park, NC (M. Gartland, A.P.)
| | - Gulam Latiff
- From Yale University School of Medicine and the Veterans Affairs Connecticut Healthcare System, New Haven (M.K.), and ViiV Healthcare, Branford (P.A., C.L., M.L.) - all in Connecticut; Icahn School of Medicine at Mount Sinai, New York (J.A.); Hôpital Tenon, Assistance Publique-Hôpitaux de Paris (AP-HP) (G.P.), and Hôpital Saint Louis, AP-HP, and University of Paris Diderot Paris 7 (J.-M.M.), Paris; Fundación Huesped, Buenos Aires (P.C.); AIDS Research Consortium of Atlanta, Atlanta (M.T.); Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro (B.G.), and Federal University of São Paulo, São Paulo (R.D.); San Raffaele Scientific Institute, Milan (A.C.); Georgetown University Hospital, Washington, DC (P.K.); Maxwell Center, Durban, South Africa (G.L.); Orlando Immunology Center, Orlando, FL (E.D.); GlaxoSmithKline, Upper Providence, PA (M. Gummel); and ViiV Healthcare, Research Triangle Park, NC (M. Gartland, A.P.)
| | - Edwin DeJesus
- From Yale University School of Medicine and the Veterans Affairs Connecticut Healthcare System, New Haven (M.K.), and ViiV Healthcare, Branford (P.A., C.L., M.L.) - all in Connecticut; Icahn School of Medicine at Mount Sinai, New York (J.A.); Hôpital Tenon, Assistance Publique-Hôpitaux de Paris (AP-HP) (G.P.), and Hôpital Saint Louis, AP-HP, and University of Paris Diderot Paris 7 (J.-M.M.), Paris; Fundación Huesped, Buenos Aires (P.C.); AIDS Research Consortium of Atlanta, Atlanta (M.T.); Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro (B.G.), and Federal University of São Paulo, São Paulo (R.D.); San Raffaele Scientific Institute, Milan (A.C.); Georgetown University Hospital, Washington, DC (P.K.); Maxwell Center, Durban, South Africa (G.L.); Orlando Immunology Center, Orlando, FL (E.D.); GlaxoSmithKline, Upper Providence, PA (M. Gummel); and ViiV Healthcare, Research Triangle Park, NC (M. Gartland, A.P.)
| | - Mark Gummel
- From Yale University School of Medicine and the Veterans Affairs Connecticut Healthcare System, New Haven (M.K.), and ViiV Healthcare, Branford (P.A., C.L., M.L.) - all in Connecticut; Icahn School of Medicine at Mount Sinai, New York (J.A.); Hôpital Tenon, Assistance Publique-Hôpitaux de Paris (AP-HP) (G.P.), and Hôpital Saint Louis, AP-HP, and University of Paris Diderot Paris 7 (J.-M.M.), Paris; Fundación Huesped, Buenos Aires (P.C.); AIDS Research Consortium of Atlanta, Atlanta (M.T.); Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro (B.G.), and Federal University of São Paulo, São Paulo (R.D.); San Raffaele Scientific Institute, Milan (A.C.); Georgetown University Hospital, Washington, DC (P.K.); Maxwell Center, Durban, South Africa (G.L.); Orlando Immunology Center, Orlando, FL (E.D.); GlaxoSmithKline, Upper Providence, PA (M. Gummel); and ViiV Healthcare, Research Triangle Park, NC (M. Gartland, A.P.)
| | - Margaret Gartland
- From Yale University School of Medicine and the Veterans Affairs Connecticut Healthcare System, New Haven (M.K.), and ViiV Healthcare, Branford (P.A., C.L., M.L.) - all in Connecticut; Icahn School of Medicine at Mount Sinai, New York (J.A.); Hôpital Tenon, Assistance Publique-Hôpitaux de Paris (AP-HP) (G.P.), and Hôpital Saint Louis, AP-HP, and University of Paris Diderot Paris 7 (J.-M.M.), Paris; Fundación Huesped, Buenos Aires (P.C.); AIDS Research Consortium of Atlanta, Atlanta (M.T.); Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro (B.G.), and Federal University of São Paulo, São Paulo (R.D.); San Raffaele Scientific Institute, Milan (A.C.); Georgetown University Hospital, Washington, DC (P.K.); Maxwell Center, Durban, South Africa (G.L.); Orlando Immunology Center, Orlando, FL (E.D.); GlaxoSmithKline, Upper Providence, PA (M. Gummel); and ViiV Healthcare, Research Triangle Park, NC (M. Gartland, A.P.)
| | - Amy Pierce
- From Yale University School of Medicine and the Veterans Affairs Connecticut Healthcare System, New Haven (M.K.), and ViiV Healthcare, Branford (P.A., C.L., M.L.) - all in Connecticut; Icahn School of Medicine at Mount Sinai, New York (J.A.); Hôpital Tenon, Assistance Publique-Hôpitaux de Paris (AP-HP) (G.P.), and Hôpital Saint Louis, AP-HP, and University of Paris Diderot Paris 7 (J.-M.M.), Paris; Fundación Huesped, Buenos Aires (P.C.); AIDS Research Consortium of Atlanta, Atlanta (M.T.); Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro (B.G.), and Federal University of São Paulo, São Paulo (R.D.); San Raffaele Scientific Institute, Milan (A.C.); Georgetown University Hospital, Washington, DC (P.K.); Maxwell Center, Durban, South Africa (G.L.); Orlando Immunology Center, Orlando, FL (E.D.); GlaxoSmithKline, Upper Providence, PA (M. Gummel); and ViiV Healthcare, Research Triangle Park, NC (M. Gartland, A.P.)
| | - Peter Ackerman
- From Yale University School of Medicine and the Veterans Affairs Connecticut Healthcare System, New Haven (M.K.), and ViiV Healthcare, Branford (P.A., C.L., M.L.) - all in Connecticut; Icahn School of Medicine at Mount Sinai, New York (J.A.); Hôpital Tenon, Assistance Publique-Hôpitaux de Paris (AP-HP) (G.P.), and Hôpital Saint Louis, AP-HP, and University of Paris Diderot Paris 7 (J.-M.M.), Paris; Fundación Huesped, Buenos Aires (P.C.); AIDS Research Consortium of Atlanta, Atlanta (M.T.); Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro (B.G.), and Federal University of São Paulo, São Paulo (R.D.); San Raffaele Scientific Institute, Milan (A.C.); Georgetown University Hospital, Washington, DC (P.K.); Maxwell Center, Durban, South Africa (G.L.); Orlando Immunology Center, Orlando, FL (E.D.); GlaxoSmithKline, Upper Providence, PA (M. Gummel); and ViiV Healthcare, Research Triangle Park, NC (M. Gartland, A.P.)
| | - Cyril Llamoso
- From Yale University School of Medicine and the Veterans Affairs Connecticut Healthcare System, New Haven (M.K.), and ViiV Healthcare, Branford (P.A., C.L., M.L.) - all in Connecticut; Icahn School of Medicine at Mount Sinai, New York (J.A.); Hôpital Tenon, Assistance Publique-Hôpitaux de Paris (AP-HP) (G.P.), and Hôpital Saint Louis, AP-HP, and University of Paris Diderot Paris 7 (J.-M.M.), Paris; Fundación Huesped, Buenos Aires (P.C.); AIDS Research Consortium of Atlanta, Atlanta (M.T.); Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro (B.G.), and Federal University of São Paulo, São Paulo (R.D.); San Raffaele Scientific Institute, Milan (A.C.); Georgetown University Hospital, Washington, DC (P.K.); Maxwell Center, Durban, South Africa (G.L.); Orlando Immunology Center, Orlando, FL (E.D.); GlaxoSmithKline, Upper Providence, PA (M. Gummel); and ViiV Healthcare, Research Triangle Park, NC (M. Gartland, A.P.)
| | - Max Lataillade
- From Yale University School of Medicine and the Veterans Affairs Connecticut Healthcare System, New Haven (M.K.), and ViiV Healthcare, Branford (P.A., C.L., M.L.) - all in Connecticut; Icahn School of Medicine at Mount Sinai, New York (J.A.); Hôpital Tenon, Assistance Publique-Hôpitaux de Paris (AP-HP) (G.P.), and Hôpital Saint Louis, AP-HP, and University of Paris Diderot Paris 7 (J.-M.M.), Paris; Fundación Huesped, Buenos Aires (P.C.); AIDS Research Consortium of Atlanta, Atlanta (M.T.); Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro (B.G.), and Federal University of São Paulo, São Paulo (R.D.); San Raffaele Scientific Institute, Milan (A.C.); Georgetown University Hospital, Washington, DC (P.K.); Maxwell Center, Durban, South Africa (G.L.); Orlando Immunology Center, Orlando, FL (E.D.); GlaxoSmithKline, Upper Providence, PA (M. Gummel); and ViiV Healthcare, Research Triangle Park, NC (M. Gartland, A.P.)
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Swindells S, Andrade-Villanueva JF, Richmond GJ, Rizzardini G, Baumgarten A, Masiá M, Latiff G, Pokrovsky V, Bredeek F, Smith G, Cahn P, Kim YS, Ford SL, Talarico CL, Patel P, Chounta V, Crauwels H, Parys W, Vanveggel S, Mrus J, Huang J, Harrington CM, Hudson KJ, Margolis DA, Smith KY, Williams PE, Spreen WR. Long-Acting Cabotegravir and Rilpivirine for Maintenance of HIV-1 Suppression. N Engl J Med 2020; 382:1112-1123. [PMID: 32130809 DOI: 10.1056/nejmoa1904398] [Citation(s) in RCA: 236] [Impact Index Per Article: 59.0] [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] [Indexed: 11/19/2022]
Abstract
BACKGROUND Simplified regimens for the treatment of human immunodeficiency virus type 1 (HIV-1) infection may increase patient satisfaction and facilitate adherence. METHODS In this phase 3, open-label, multicenter, noninferiority trial involving patients who had had plasma HIV-1 RNA levels of less than 50 copies per milliliter for at least 6 months while taking standard oral antiretroviral therapy, we randomly assigned participants (1:1) to either continue their oral therapy or switch to monthly intramuscular injections of long-acting cabotegravir, an HIV-1 integrase strand-transfer inhibitor, and long-acting rilpivirine, a nonnucleoside reverse-transcriptase inhibitor. The primary end point was the percentage of participants with an HIV-1 RNA level of 50 copies per milliliter or higher at week 48, determined with the use of the Food and Drug Administration snapshot algorithm. RESULTS Treatment was initiated in 308 participants per group. At week 48, HIV-1 RNA levels of 50 copies per milliliter or higher were found in 5 participants (1.6%) receiving long-acting therapy and in 3 (1.0%) receiving oral therapy (adjusted difference, 0.6 percentage points; 95% confidence interval [CI], -1.2 to 2.5), a result that met the criterion for noninferiority for the primary end point (noninferiority margin, 6 percentage points). An HIV-1 RNA level of less than 50 copies per milliliter at week 48 was found in 92.5% of participants receiving long-acting therapy and in 95.5% of those receiving oral therapy (adjusted difference, -3.0 percentage points; 95% CI, -6.7 to 0.7), a result that met the criterion for noninferiority for this end point (noninferiority margin, -10 percentage points). Virologic failure was confirmed in 3 participants who received long-acting therapy and 4 participants who received oral therapy. Adverse events were more common in the long-acting-therapy group and included injection-site pain, which occurred in 231 recipients (75%) of long-acting therapy and was mild or moderate in most cases; 1% withdrew because of this event. Serious adverse events were reported in no more than 5% of participants in each group. CONCLUSIONS Monthly injections of long-acting cabotegravir and rilpivirine were noninferior to standard oral therapy for maintaining HIV-1 suppression. Injection-related adverse events were common but only infrequently led to medication withdrawal. (Funded by ViiV Healthcare and Janssen; ATLAS ClinicalTrials.gov number, NCT02951052.).
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Affiliation(s)
- Susan Swindells
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Jaime-Federico Andrade-Villanueva
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Gary J Richmond
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Giuliano Rizzardini
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Axel Baumgarten
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Mar Masiá
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Gulam Latiff
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Vadim Pokrovsky
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Fritz Bredeek
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Graham Smith
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Pedro Cahn
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Yeon-Sook Kim
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Susan L Ford
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Christine L Talarico
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Parul Patel
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Vasiliki Chounta
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Herta Crauwels
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Wim Parys
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Simon Vanveggel
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Joseph Mrus
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Jenny Huang
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Conn M Harrington
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Krischan J Hudson
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - David A Margolis
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Kimberly Y Smith
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - Peter E Williams
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
| | - William R Spreen
- From the University of Nebraska Medical Center, Omaha (S.S.); Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico (J.-F.A.-V.); Broward Health Medical Center, Broward Health Imperial Point, Fort Lauderdale, FL (G.J.R.); Fatebenefratelli Sacco Hospital, Milan (G.R.); the Center for Infectious Diseases, Berlin (A.B.); Hospital de Elche, Elche, Spain (M.M.); Maxwell Centre, Durban, South Africa (G.L.); the Central Research Institute of Epidemiology, Moscow (V.P.); Metropolis Medical Group, San Francisco (F.B.); Maple Leaf Research, Toronto (G.S.), and GlaxoSmithKline, Mississauga (J.H.) - both in Ontario, Canada; Fundación Huésped, Buenos Aires (P.C.); Chungnam National University School of Medicine, Daejeon, South Korea (Y.-S.K.); GlaxoSmithKline (S.L.F.) and ViiV Healthcare (C.L.T., P.P., J.M., C.M.H., K.J.H., D.A.M., K.Y.S., W.R.S.) - both in Research Triangle Park, NC; ViiV Healthcare, Brentford, United Kingdom (V.C.); and Janssen Research and Development, Beerse, Belgium (H.C., W.P., S.V., P.E.W.)
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Crabtree‐Ramírez B, Belaunzarán‐Zamudio PF, Cortes CP, Morales M, Sued O, Sierra‐Madero J, Cahn P, Pozniak A, Grinsztejn B. The HIV epidemic in Latin America: a time to reflect on the history of success and the challenges ahead. J Int AIDS Soc 2020; 23:e25468. [PMID: 32115884 PMCID: PMC7049674 DOI: 10.1002/jia2.25468] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 02/02/2020] [Indexed: 11/21/2022] Open
Affiliation(s)
- Brenda Crabtree‐Ramírez
- Departamento de InfectologíaInstituto Nacional de Ciencias Médicas y Nutrición, Salvador ZubiránTlalpanMexico
| | - Pablo F Belaunzarán‐Zamudio
- Departamento de InfectologíaInstituto Nacional de Ciencias Médicas y Nutrición, Salvador ZubiránTlalpanMexico
| | | | | | - Omar Sued
- Fundación HuéspedInvestigaciones ClínicasBuenos AiresArgentina
| | - Juan Sierra‐Madero
- Departamento de InfectologíaInstituto Nacional de Ciencias Médicas y Nutrición, Salvador ZubiránTlalpanMexico
| | - Pedro Cahn
- Fundación HuéspedInvestigaciones ClínicasBuenos AiresArgentina
| | - Anton Pozniak
- Chelsea and Westminster Hospital NHS Foundation Trust and Imperial College LondonLondonUK
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro ChagasFundacao Oswaldo CruzRio de JaneiroBrazil
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Cahn P, Madero JS, Arribas J, Antinori A, Ortiz R, Clarke A, Hung C, Rockstroh J, Girard P, Sievers J, Man C, Urbaityte R, Underwood M, Tenorio A, Pappa K, Wynne B, Gartland M, Aboud M, van Wyk J, Smith K, El-Bahy Y. Durable Efficacy of Dolutegravir (DTG) Plus Lamivudine (3TC) in Antiretroviral Treatment-Naive Adults With HIV-1 Infection: 96-Week Results From the GEMINI Studies. J Infect Public Health 2020. [DOI: 10.1016/j.jiph.2020.01.118] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Damilano G, Sued O, Satorres S, Ruiz MJ, Ghiglione Y, Guzman F, Turk G, Quiroga F, Cahn P, Salomón H, Dilernia D. Bioinformatic analysis of post-transmission viral readaptation in Argentine patients with acute HIV-1 infection. Infect Genet Evol 2020; 81:104207. [PMID: 31991176 DOI: 10.1016/j.meegid.2020.104207] [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] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 01/18/2020] [Accepted: 01/22/2020] [Indexed: 11/24/2022]
Abstract
During the acute phase of HIV-1 infection, a strong readaptation occurs in the viral population. Our objective was to analyze the post-transmission mutations associated with escape to the cytotoxic immune response and its relationship with the progression of the infection. In this study, a total of 17 patients were enrolled during acute/early primary HIV infection and 8 subjects that were the HIV positive partner resulting in 8 transmission pairs. Genotyping of the genetic polymorphisms of HLA class I A and B was performed using PCR-SSOP. Viral RNA extraction was from plasma. 570 single Gag-gene amplifications were obtained by limiting-dilution RT-PCR. Epitope prediction was performed with NetMHC CBS prediction server for the 19 HLA-A and B alleles. Cytotoxic response prediction was performed by using the IEDB Analysis Resource. From our results, we deduce that the transmitted CTL / gag escape frequency in the founder virus was at least double compared to the post-transmission events. Additionally, by means of an algorithm that combines these frequencies, we observed that the founder viruses better adapted to the HLA A / B alleles of the recipient could contribute to a greater progression of the infection. Our results suggest that there is a large adaptation of HIV-1 to the HLA A / B alleles prevalent in our population. However, despite this adaptive advantage, the virus needs to make "readjustments" through new escape and compensatory mutations. Interestingly, according to our results, this readaptation could have a role in the progression of the infection.
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Affiliation(s)
- G Damilano
- CONICET-Universidad de Buenos Aires, Instituto de Investigaciones Biomédicas en Retrovirus y Sida (INBIRS), Buenos Aires, Argentina.
| | - O Sued
- Fundación Huésped-Buenos Aires, Argentina
| | - S Satorres
- Facultad de Química, Bioquímica y Farmacia, Universidad Nacional de San luis (UNSL), Argentina
| | - M J Ruiz
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Quebec, Canada
| | - Y Ghiglione
- CONICET-Universidad de Buenos Aires, Instituto de Investigaciones Biomédicas en Retrovirus y Sida (INBIRS), Buenos Aires, Argentina
| | - F Guzman
- Núcleo de Biotecnología Curauma, Pontificia Universidad Católica de Valparaíso, Chile
| | - G Turk
- CONICET-Universidad de Buenos Aires, Instituto de Investigaciones Biomédicas en Retrovirus y Sida (INBIRS), Buenos Aires, Argentina
| | - F Quiroga
- CONICET-Universidad de Buenos Aires, Instituto de Investigaciones Biomédicas en Retrovirus y Sida (INBIRS), Buenos Aires, Argentina
| | - P Cahn
- Hospital General de Agudos "Dr. JA Fernández", Buenos Aires, Argentina
| | - H Salomón
- CONICET-Universidad de Buenos Aires, Instituto de Investigaciones Biomédicas en Retrovirus y Sida (INBIRS), Buenos Aires, Argentina
| | - D Dilernia
- Emory Vaccine Center, Emory University, Atlanta, GA, United States of America
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Boffito M, Waters L, Cahn P, Paredes R, Koteff J, Van Wyk J, Vincent T, Demarest J, Adkison K, Quercia R. Perspectives on the Barrier to Resistance for Dolutegravir + Lamivudine, a Two-Drug Antiretroviral Therapy for HIV-1 Infection. AIDS Res Hum Retroviruses 2020; 36:13-18. [PMID: 31507204 PMCID: PMC6944139 DOI: 10.1089/aid.2019.0171] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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] [Indexed: 11/29/2022] Open
Abstract
In HIV-1-infected patients, virological failure can occur as a consequence of the mutations that accumulate in the viral genome that allow replication to continue in the presence of antiretrovirals (ARVs). The development of treatment-emergent resistance to an ARV can limit a patient's options for future therapy, prompting the need for ARV regimens that are resilient to the emergence of resistance. The genetic barrier to resistance refers to the number of mutations in an ARV's therapeutic target that are required to confer a clinically meaningful loss of susceptibility to the drug. The emergence of resistance can be affected by pharmacological aspects of the ARV, including its structure, inhibitory quotient, therapeutic index, and pharmacokinetic characteristics. Dolutegravir (DTG) has demonstrated a high barrier to resistance, including when used in a two-drug regimen (2DR) with lamivudine (3TC). In the GEMINI-1 and GEMINI-2 studies, DTG +3TC was noninferior to DTG + emtricitabine/tenofovir disoproxil fumarate in treatment-naive participants, with similar proportions achieving HIV-1 RNA <50 copies/mL through 96 weeks. Furthermore, in the TANGO study, virological suppression was maintained at 48 weeks after switching to DTG +3TC from a tenofovir alafenamide (TAF)-based regimen compared with continuing a TAF-based regimen. Most other 2DRs with successful outcomes compared with three-drug regimens have been based on protease inhibitors (PIs); however, this class is associated with adverse metabolic effects and drug–drug interactions. In this review, we discuss the barrier to resistance in the context of a 2DR in which a boosted PI is replaced with DTG +3TC.
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Affiliation(s)
- Marta Boffito
- Chelsea and Westminister Hospital, London, United Kingdom
| | | | - Pedro Cahn
- Fundación Huésped, Buenos Aires, Argentina
| | | | - Justin Koteff
- ViiV Healthcare, Research Triangle Park, North Carolina
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Mandell LN, Rodriguez VJ, De La Rosa A, Abbamonte JM, Sued O, Cecchini D, Cassetti I, Cahn P, Weiss SM, Jones DL. Suicidal Ideation Among Adults Re-engaging in HIV Care in Argentina. AIDS Behav 2019; 23:3427-3434. [PMID: 31049810 DOI: 10.1007/s10461-019-02526-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Argentina has one of the highest suicide rates in Latin America and the Caribbean. Though people living with HIV are at increased risk for suicidal behavior, little research on suicide risk has been conducted among HIV-positive people in this region. This study examined risk factors for suicidal ideation among HIV-infected adults (N = 360) re-engaging in care in Argentina. Overall, 21% of participants reported suicidal ideation in the past week. In adjusted logistic regression models, younger age, increased depressive symptomatology, and drug abuse were associated with suicidal ideation (p < 0.05); decreased motivation for adherence and fewer months since initiating antiretroviral therapy approached significance (p = 0.07). Suicidal ideation was common in this sample of HIV-positive patients in Argentina. Findings highlight the need for routine risk assessment and interventions integrated into the HIV care continuum, addressing depression, substance use, and suicidal behavior.
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Affiliation(s)
- Lissa N Mandell
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Violeta J Rodriguez
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Aileen De La Rosa
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - John M Abbamonte
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Omar Sued
- Fundación Huésped, Buenos Aires, Argentina
| | | | | | - Pedro Cahn
- Fundación Huésped, Buenos Aires, Argentina
| | - Stephen M Weiss
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Deborah L Jones
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.
- University of Miami Miller School of Medicine, 1400 NW 10th Ave., Suite 404A, Miami, FL, 33136, USA.
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Tan DHS, Rolon MJ, Figueroa MI, Sued O, Gun A, Kaul R, Raboud JM, Szadkowski L, Hull MW, Walmsley SL, Cahn P. Inflammatory biomarker levels over 48 weeks with dual vs triple lopinavir/ritonavir-based therapy: Substudy of a randomized trial. PLoS One 2019; 14:e0221653. [PMID: 31490959 PMCID: PMC6730918 DOI: 10.1371/journal.pone.0221653] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 08/09/2019] [Indexed: 11/18/2022] Open
Abstract
Background Inflammation has been associated with increased morbidity and mortality in HIV-positive patients. We compared inflammatory biomarkers with dual therapy using lopinavir/ritonavir plus lamivudine (LPV/r+3TC) versus triple therapy using LPV/r plus two nucleoside reverse transcriptase inhibitors (LPV/r+2NRTIs) in treatment-naïve HIV-positive adults. Methods This was a substudy among Argentinian participants in the randomized trial GARDEL. We measured hsCRP, IL-6, MCP-1, TNF, D-dimer and sCD14 from plasma collected at baseline, week 24 and week 48. Generalized estimating equations with an identity/logit link were used to model the average impact of dual versus triple therapy on each biomarker over time, controlling for baseline levels. Additional models estimated the average effect of virologic suppression on biomarker levels over time, adjusting for age, sex, and baseline CD4 count. Results Of 191 trial participants enrolled in Argentina, 172 had baseline and follow-up measurements and were included. Median (IQR) age was 35.5 (28.5, 45) years and CD4 cell count was 310 (219, 414) cells/mm3. Dual therapy was not associated with significantly different biomarker levels over 48 weeks relative to triple therapy. Virologic suppression was associated with statistically significant decreases in MCP-1, TNF and D-dimer levels and an unexpected increase in sCD14 levels. No change was observed in hsCRP or the proportion of participants with undetectable IL-6 levels. Conclusions In addition to having virologic non-inferiority, LPV/r+3TC dual therapy is generally associated with similar inflammatory biomarker levels over 48 weeks compared to LPV/r+2NRTIs triple therapy in treatment-naïve adults. Further study of dual treatment regimens is warranted.
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Affiliation(s)
- Darrell H. S. Tan
- St. Michael’s Hospital Division of Infectious Diseases, Toronto, ON, Canada
- University Health Network Division of Infectious Diseases, Toronto, ON, Canada
- University of Toronto Department of Medicine, Toronto, ON, Canada
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
- * E-mail:
| | - Maria Jose Rolon
- Fundación Huésped, Pasaje Angel Peluffo 3932 (C1202ABB), Ciudad Autónoma de Buenos Aires, Argentina
| | - Maria Ines Figueroa
- Fundación Huésped, Pasaje Angel Peluffo 3932 (C1202ABB), Ciudad Autónoma de Buenos Aires, Argentina
| | - Omar Sued
- Fundación Huésped, Pasaje Angel Peluffo 3932 (C1202ABB), Ciudad Autónoma de Buenos Aires, Argentina
| | - Ana Gun
- Fundación Huésped, Pasaje Angel Peluffo 3932 (C1202ABB), Ciudad Autónoma de Buenos Aires, Argentina
| | - Rupert Kaul
- University Health Network Division of Infectious Diseases, Toronto, ON, Canada
- University of Toronto Department of Medicine, Toronto, ON, Canada
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
- University of Toronto Department of Immunology, Toronto, ON, Canada
| | - Janet M. Raboud
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Leah Szadkowski
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | | | - Sharon L. Walmsley
- University Health Network Division of Infectious Diseases, Toronto, ON, Canada
- University of Toronto Department of Medicine, Toronto, ON, Canada
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Pedro Cahn
- Fundación Huésped, Pasaje Angel Peluffo 3932 (C1202ABB), Ciudad Autónoma de Buenos Aires, Argentina
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Salido J, Czernikier A, Trifone C, Figueroa M, Salomón H, Cahn P, Sued O, Laufer N, Ghiglione Y, Turk G. Early skewed differentiation and PD-1 expression in CD4+ cells relate to immune dysfunction and viral persistence in individuals living with HIV 1 year post-cART initiation. J Virus Erad 2019. [DOI: 10.1016/s2055-6640(20)31026-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Cahn P, Madero JS, Arribas JR, Antinori A, Ortiz R, Clarke AE, Hung CC, Rockstroh JK, Girard PM, Sievers J, Man C, Currie A, Underwood M, Tenorio AR, Pappa K, Wynne B, Fettiplace A, Gartland M, Aboud M, Smith K. Dolutegravir plus lamivudine versus dolutegravir plus tenofovir disoproxil fumarate and emtricitabine in antiretroviral-naive adults with HIV-1 infection (GEMINI-1 and GEMINI-2): week 48 results from two multicentre, double-blind, randomised, non-inferiority, phase 3 trials. Lancet 2019; 393:143-155. [PMID: 30420123 DOI: 10.1016/s0140-6736(18)32462-0] [Citation(s) in RCA: 225] [Impact Index Per Article: 45.0] [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: 09/07/2018] [Revised: 09/22/2018] [Accepted: 09/28/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Effective two-drug regimens could decrease long-term drug exposure and toxicity with HIV-1 antiretroviral therapy (ART). We therefore aimed to evaluate the efficacy and safety of a two-drug regimen compared with a three-drug regimen for the treatment of HIV-1 infection in ART-naive adults. METHODS We conducted two identically designed, multicentre, double-blind, randomised, non-inferiority, phase 3 trials: GEMINI-1 and GEMINI-2. Both studies were done at 192 centres in 21 countries. We included participants (≥18 years) with HIV-1 infection and a screening HIV-1 RNA of 500 000 copies per mL or less, and who were naive to ART. We randomly assigned participants (1:1) to receive a once-daily two-drug regimen of dolutegravir (50 mg) plus lamivudine (300 mg) or a once-daily three-drug regimen of dolutegravir (50 mg) plus tenofovir disoproxil fumarate (300 mg) and emtricitabine (200 mg). Both drug regimens were administered orally. We masked participants and investigators to treatment assignment: dolutegravir was administered as single-entity tablets (similar to its commercial formulation, except with a different film colour), and lamivudine tablets and tenofovir disoproxil fumarate and emtricitabine tablets were over-encapsulated to visually match each other. Primary endpoint was the proportion of participants with HIV-1 RNA of less than 50 copies per mL at week 48 in the intention-to-treat-exposed population, using the Snapshot algorithm and a non-inferiority margin of -10%. Safety analyses were done on the safety population. GEMINI-1 and GEMINI-2 are registered with ClinicalTrials.gov, numbers NCT02831673 and NCT02831764, respectively. FINDINGS Between July 18, 2016, and March 31, 2017, 1441 participants across both studies were randomly assigned to receive either the two-drug regimen (n=719) or three-drug regimen (n=722). At week 48 in the GEMINI-1 intention-to-treat-exposed population, 320 (90%) of 356 participants receiving the two-drug regimen and 332 (93%) of 358 receiving the three-drug regimen achieved plasma HIV-1 RNA of less than 50 copies per mL (adjusted treatment difference -2·6%, 95% CI -6·7 to 1·5); in GEMINI-2, 335 (93%) of 360 in the two-drug regimen and 337 (94%) of 359 in the three-drug regimen achieved HIV-1 RNA of less than 50 copies per mL (adjusted treatment difference -0·7%, 95% CI -4·3 to 2·9), showing non-inferiority at a -10% margin in both studies (pooled analysis: 655 [91%] of 716 in the two-drug regimen vs 669 [93%] of 717 in the three-drug regimen; adjusted treatment difference -1·7%, 95% CI -4·4 to 1·1). Numerically, more drug-related adverse events occurred with the three-drug regimen than with the two-drug regimen (169 [24%] of 717 vs 126 [18%] of 716); few participants discontinued because of adverse events (16 [2%] in the three-drug regimen and 15 [2%] in the two-drug regimen). Two deaths were reported in the two-drug regimen group of GEMINI-2, but neither was considered to be related to the study medication. INTERPRETATION The non-inferior efficacy and similar tolerability profile of dolutegravir plus lamivudine to a guideline-recommended three-drug regimen at 48 weeks in ART-naive adults supports its use as initial therapy for patients with HIV-1 infection. FUNDING ViiV Healthcare.
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Affiliation(s)
- Pedro Cahn
- Department of Infectious Diseases, Buenos Aires University, Buenos Aires, Argentina; Fundación Huésped, Buenos Aires, Argentina
| | - Juan Sierra Madero
- Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - José Ramón Arribas
- Hospital Universitario La Paz, Instituto de Investigación Hospital La Paz, Madrid, Spain
| | - Andrea Antinori
- UOC Immunodeficienze virali, Instituto Nazionale per le Malattie Infettive Lazzaro Spallanzani-IRCCS, Rome, Italy
| | | | - Amanda E Clarke
- Sexual Health and Clinical Trials, Royal Sussex County Hospital, Brighton, UK
| | - Chien-Ching Hung
- Division of Infectious Diseases, National Taiwan University Hospital, Taipei, Taiwan
| | | | - Pierre-Marie Girard
- Service des Maladies Infectieuses et Tropicales, Hôpital Saint Antoine, Paris, France
| | - Jörg Sievers
- Clinical Development, ViiV Healthcare, Brentford, UK.
| | - Choy Man
- Clinical Development, ViiV Healthcare, Research Triangle Park, NC, USA
| | | | - Mark Underwood
- Clinical Virology, ViiV Healthcare, Research Triangle Park, NC, USA
| | - Allan R Tenorio
- Clinical Development, ViiV Healthcare, Research Triangle Park, NC, USA
| | - Keith Pappa
- Clinical Development, ViiV Healthcare, Research Triangle Park, NC, USA
| | - Brian Wynne
- Clinical Development, ViiV Healthcare, Research Triangle Park, NC, USA
| | - Anna Fettiplace
- Global Clinical Safety and Pharmacovigilance, GlaxoSmithKline, Stockley Park, UK
| | - Martin Gartland
- Medicine Development, ViiV Healthcare, Research Triangle Park, NC, USA
| | - Michael Aboud
- Global Medical Affairs, ViiV Healthcare, Brentford, UK
| | - Kimberly Smith
- Global Research and Medical Strategy, ViiV Healthcare, Research Triangle Park, NC, USA
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Jaworski JP, Frola C, Cahn P. Novel preventive and therapeutic strategies against HIV infection. Medicina (B Aires) 2019; 79:534-539. [PMID: 31864222] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Abstract
Since its first isolation in 1983, over 77 million people became infected with the human immunodeficiency virus (HIV), and only one case has been reported in which the virus was completely removed from the body. A recent second case was reported that remains to be confirmed. Antiretroviral therapy (ART) manages to control blood viral replication and, consequently, to restore -at least partially- the functions of the immune system, with a notable positive impact on the morbidity and mortality associated with the virus. However, given the difficulty in eliminating the virus from the body, treatment should be given for life. This long-term exposure to antiretroviral drugs implies the risk of generating intolerance, toxic effects, gaps in adherence and the potential selection of resistance mutations. Another limitation is the high cost of treating 37 million persons living with HIV, most of whom are living in resource-limited countries and relying on international aid initiatives. Having these challenges in mind, there is general agreement that new approaches for preventing and treating HIV infection are needed to control the epidemic, while vaccine development efforts continue. In this regard, new generation broadly neutralising monoclonal antibodies (bnMAbs) against the HIV viral envelope protein can prevent virus acquisition, reduce viremia, enhance immunity, and induce the killing of infected cells in animal models of HIV infection. Most importantly, some clinical trials have shown that bnMAbs could effectively d ecrease viremia and delay viral rebound in people chronically infected with HIV.
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Affiliation(s)
- Juan Pablo Jaworski
- Instituto Nacional de Tecnología Agropecuaria, Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina. E-mail:
| | - Claudia Frola
- Fundación Huésped, Buenos Aires, Argentina
- Hospital General de Agudos Dr. Juan A. Fernández, Buenos Aires, Argentina
| | - Pedro Cahn
- Fundación Huésped, Buenos Aires, Argentina
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Cahn P, Sierra‐Madero J, Arribas J, Antinori A, Ortiz R, Clarke A, Hung C, Rockstroh J, Girard P, Man C, Sievers J, Currie A, Underwood M, Tenorio A, Pappa K, Wynne B, Gartland M, Aboud M, Smith K, Zajdenverg R. NÃO INFERIORIDADE DE EFICÁCIA DE DOLUTEGRAVIR (DTG) MAIS LAMIVUDIDINA (3 TC) VERSUS DTG MAIS DOSE FIXA COMBINADA DE TENOFOVIR/EMTRICITABINA (TDF/FTC) EM ADULTOS VIRGENS DE TRATAMENTO ANTIRRETROVIRAL QUE VIVEM COM HIV‐1: RESULTADOS DE 48 SEMANAS DOS ESTU. Braz J Infect Dis 2018. [DOI: 10.1016/j.bjid.2018.10.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Blugerman GA, Valiente JA, Cesar C, Yamamoto C, Sued O, Cahn P. [Retention in care and distance between home and hospital in HIV patients of Buenos Aires City]. Actual SIDA Infectol 2018; 26:54-60. [PMID: 36727083 PMCID: PMC9886959 DOI: 10.52226/revista.v26i98.21] [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] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background Distance from patient's home to the hospital has been proposed as one of the limiting factors for patient's retention in care. Methods Retrospective cohort study of HIV+ patients 18 years or older who had their first clinical visit between 2011 and 2013 at a reference center in Buenos Aires, Argentina. Patients were considered to be retained in care if they had>=1 clinical visit, laboratory markers (VL and/or CD4 count) and/or ARVs pick-up during the year after their first clinical visit. Each patient address's latitude-longitude was obtained using Google Maps® web service. Home-hospital distance and travel time were obtained with Google Maps Distance Matrix API® service. Results Of 1020 patients who started follow-up, 15 died and 158 were transferred to another site. Of the remaining, 816 (96.3%) had identifiable address in their electronic medical record. Median age at the time of the first visit was 33 (IQR 27-41) years, 654 (77.9%) patients were male. Median home-hospital distance was 10.3 (IQR 4.4-34.7) km and median travel time was 58.5 (IQR 35-102.5) minutes. 730 patients (89.5%; CI 87.1-91.5%) remained in follow-up after 1 year of their first visit. We didńt find association between travel time and home-hospital distance with retention in this population. Conclusions In our study, distance between home and the care center was not associated with lower retention one year after first visit in adult HIV patients attending a public hospital.
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Affiliation(s)
| | - José Antonio Valiente
- División Infectología, Hospital General de Agudos Juan A. Fernández, Buenos Aires, Argentina
| | | | | | - Omar Sued
- Fundación Huésped, Buenos Aires, Argentina
| | - Pedro Cahn
- Fundación Huésped, Buenos Aires, Argentina
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Kumar P, Johnson M, Molina JM, Rizzardini G, Cahn P, Bickel M, Mallolas J, Zhou Y, Morais C, Kumar S, Sklar P, Hanna GJ, Hwang C, Greaves W. LB2. Switch to Doravirine/Lamivudine/Tenofovir Disoproxil Fumarate (DOR/3TC/TDF) Maintains Virologic Suppression Through 48 Weeks: Results of the DRIVE-SHIFT Trial. Open Forum Infect Dis 2018. [PMCID: PMC6254879 DOI: 10.1093/ofid/ofy229.2176] [Citation(s) in RCA: 3] [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: 11/18/2022] Open
Abstract
Background Doravirine is a novel, non-nucleoside reverse-transcriptase inhibitor (NNRTI) that has demonstrated efficacy in two Phase 3 trials in treatment-naïve adults with HIV-1. Methods This open-label, active-controlled, noninferiority (NI) trial evaluated a once-daily single-tablet regimen of doravirine 100 mg, lamivudine 300 mg, and tenofovir disoproxil fumarate 300 mg (DOR/3TC/TDF) vs. continuation of current therapy in adults with HIV-1 virologically suppressed for ≥6 months on a stable regimen of two NRTIs plus a boosted protease inhibitor (PI), boosted elvitegravir, or NNRTI. Participants with screening HIV-1 RNA <40 copies/mL, no history of virologic failure on any regimen, and no resistance to DOR/3TC/TDF were randomized (2:1) to start DOR/3TC/TDF on Day 1 (immediate switch group, ISG) or after 24 weeks (delayed switch group, DSG). The primary endpoint was the proportion (%) of participants with HIV-1 RNA <50 copies/mL (FDA snapshot approach), with the primary comparison between ISG at Week 48 and DSG at Week 24 and a secondary comparison between the groups at Week 24; the NI margin was -8%. The % of participants with HIV-1 RNA ≥50 copies/mL was also analyzed (FDA snapshot approach; NI margin 4%). Results A total of 670 participants (447 ISG, 223 DSG) were treated and included in the analyses; 84.5% were male, 76.4% were white, and mean age was 43.3 years. At Week 24, 93.7% (419/447) of ISG vs. 94.6% (211/223) of DSG had HIV-1 RNA <50 copies/mL (difference −0.9% [−4.7, 3.0]), and 1.8% of each group had HIV-1 RNA ≥50 copies/mL. At Week 48, 90.8% (406/447) of ISG maintained HIV-1 RNA <50 copies/mL (vs. 94.6% of DSG at Week 24; difference −3.8%, 95% CI [−7.9%, 0.3%]), and 1.6% of ISG had HIV-1 RNA ≥50 copies/mL. In the ritonavir-boosted PI stratum, mean changes in fasting LDL-C and non-HDL-C at Week 24 were significantly lower (P < 0.0001) in ISG vs. DSG (table). Rates of any AE and of drug-related AEs at Week 24 were higher in ISG vs. DSG. AEs were mild in most ISG participants (64% of those with any AE; 80% of those with drug-related AEs). Conclusion A once-daily single-tablet regimen of DOR/3TC/TDF demonstrated non-inferior efficacy and acceptable safety compared with continuing therapy, and is an option for maintaining viral suppression in patients considering a change in therapy. Disclosures P. Kumar, Merck, Pfizer, Janssen,: Grant Investigator and Shareholder, Research grant. GSK, Gilead, Teratechnologies, TaiMed,: Grant Investigator, Scientific Advisor and Shareholder, Consulting fee and Research grant. J. M. Molina, Merck GIlead ViiV Janssen Teva: Ad Board and Speaker’s Bureau, Consulting fee. Gilead Sciences: Grant Investigator, Research support. G. Rizzardini, ViiV, Gilead Science, MSD, Angelini, and Abbvie: Board Member and Speaker’s Bureau, Speaker honorarium. Gliead, ViiV, and MSD: Research Contractor, Research grant. P. Cahn, Abbvie: Grant, Research grant. Merck: Grant, Advisory Board. ViiV Healthcare: Grant, Advisory Board. M. Bickel, Merck & Co., Inc.: Research Contractor, Research grant. Y. Zhou, Merck & Co., Inc.: Employee, Salary. C. Morais, Merck Sharp & Dohme, a subsidiary of Merck & Co., Inc.: Employee and Shareholder, May hold stock/stock options in the company and Salary. S. Kumar, Merck & Co., Inc.: Employee and Shareholder, Salary. P. Sklar, Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc.: Employee and Shareholder, Salary. G. J. Hanna, Merck Sharp & Dohme, a subsidiary of Merck & Co., inc.: Employee and Shareholder, May hold stock/stock options in the company. and Salary. C. Hwang, Merck Sharp & Dohme, a subsidiary of Merck & Co., Inc.: Employee and Shareholder, Salary. W. Greaves, Merck Sharp & Dohme, a subsidiary of Merck & Co., Inc.: Employee, May hold stock/stock options within the company. ![]()
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Affiliation(s)
- Princy Kumar
- Division of Infectious Diseases and Travel Medicine, Medstar Georgetown University Hospital, Washington, DC
| | | | | | | | - Pedro Cahn
- Fundación Huésped, Buenos Aires, Argentina
| | | | | | - Yan Zhou
- Merck & Co., Inc., Kenilworth, New Jersey
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Thompson M, Orkin C, Molina JM, Gatell J, Sax P, Cahn P, Squires K, Zhou Y, Xu X, Rodgers A, Kumar S, Teppler H, Martin E, Hanna G, Hwang C. 543. An Integrated Safety Analysis Comparing Once-Daily Doravirine (DOR) to Darunavir+Ritonavir (DRV+r) and Efavirenz (EFV) in HIV-1-Infected, Antiretroviral Therapy (ART)-Naïve Adults. Open Forum Infect Dis 2018. [PMCID: PMC6255676 DOI: 10.1093/ofid/ofy210.551] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background DOR is a novel NNRTI that has shown noninferior efficacy to DRV+r- and EFV-based regimens in phase 3 trials (DRIVE-FORWARD [NCT02275780] and DRIVE-AHEAD [NCT02403674]). A prespecified integrated analysis of those trials plus a completed phase 2 trial (P007; NCT01632345) was performed to evaluate the overall safety and tolerability of DOR. Methods In this integrated analysis, DOR (100 mg QD) arms from P007, DRIVE-FORWARD, and DRIVE-AHEAD were compared with DRV+r in DRIVE-FORWARD and EFV in P007 and DRIVE-AHEAD for treatment of HIV-1 in ART-naïve adults. The NRTI background included FTC/TDF in P007, ABC/3TC or FTC/TDF in DRIVE-FORWARD, and 3TC/TDF for DOR and FTC/TDF for EFV in DRIVE-AHEAD. The primary safety endpoint was the proportion of participants discontinuing due to adverse events (AEs) through Week 48. Results A total of 1,710 treated participants were included in the analysis (table). Similar proportions of DOR− and DRV+r-treated participants, and fewer of those treated with DOR than with EFV discontinued due to AEs (2.5% vs. 3.1%, DOR vs. DRV+r; 2.5% vs. 6.6%, DOR vs. EFV). Drug-related AEs (DRAEs) were similar for DOR (30.9%) and DRV+r (32.1%), and higher for EFV (61.4%). The most common DRAEs (≥10% any group, any grade) were dizziness (4.9%, 1.8%, and 30.7%) diarrhea (4.0%, 12.8%, and 5.7%), and abnormal dreams (3.2%, 0.3%, and 10.6%) for DOR, DRV+r, and EFV, respectively. Higher rates of central nervous system (CNS) AEs were reported for DOR when EFV was the comparator, while similar low rates of CNS AEs were reported for DOR when DRV+r was the comparator. In two prespecified analyses combining the DOR 100-mg arms and EFV arms from P007 and DRIVE-AHEAD, 2.8% vs. 6.1% discontinued due to AEs on the DOR- and EFV-treated arms, respectively, for a treatment difference of −3.4% (95% CI: −6.2, −0.8; P = 0.012); 25.0% vs. 55.9% of participants experienced ≥1 neuropsychiatric AE in DOR and EFV arms, respectively. Conclusion At Week 48, DOR was generally safe and well tolerated in ART-naïve adults with HIV-1. Statistically significantly lower proportions of DOR- than EFV-treated participants discontinued due to AEs supported by a lower proportion that discontinued due to DRAEs. Those on DOR had fewer CNS AEs compared with those on EFV, and less diarrhea than those on DRV+r. ![]()
Disclosures M. Thompson, Merck & Co., Inc.: Research funding to AIDS Research Consortium of Atlanta; no funds to me personally, Research funding to AIDS Research Consortium of Atlanta; no funds to me personally. Bristol Myers Squibb: Research funding to AIDS Research Consortium of Atlanta; no funds to me personally, Research funding to AIDS Research Consortium of Atlanta; no funds to me personally. CytoDyn, Inc.: Research funding to AIDS Research Consortium of Atlanta; no funds to me personally, Research funding to AIDS Research Consortium of Atlanta; no funds to me personally. Gilead Sciences, Inc.: Research funding to AIDS Research Consortium of Atlanta; no funds to me personally, Research funding to AIDS Research Consortium of Atlanta; no funds to me personally. GlaxoSmithKline: Research funding to AIDS Research Consortium of Atlanta; no funds to me personally, Research funding to AIDS Research Consortium of Atlanta; no funds to me personally. Roche Laboratories: Research Funding, Research funding to AIDS Research Consortium of Atlanta; no funds to me personally and Research grant. TaiMed, Inc.: Research Funding, Research funding to AIDS Research Consortium of Atlanta; no funds to me personally and Research grant. ViiV Healthcare: Research Funding, Research funding to AIDS Research Consortium of Atlanta; no funds to me personally. C. Orkin, AbbVie, Abbott, Boehringer Ingelheim, BMS, Gilead, GSK, Janssen, ViiV: Ad Board, Grant Investigator and Research Contractor, Research grant and Research support. J. M. Molina, Merck GIlead ViiV Janssen Teva: Ad Board and Speaker’s Bureau, Consulting fee. Gilead Sciences: Grant Investigator, Research support. J. Gatell, Gilead Sciences: Grant and Independent Contractor, Consulting fee and Educational grant. Janssen: Grant and Independent Contractor, Consulting fee. ViiV Healthcare: Grant and Independent Contractor, Consulting fee. MSD: Grant and Independent Contractor, Consulting fee. P. Sax, Gilead: Consultant and Grant Investigator, Consulting fee, Grant recipient and Research grant. ViiV Healthcare: Consultant and Grant Investigator, Consulting fee, Grant recipient and Research grant. Merck: Consultant and Grant Investigator, Consulting fee, Grant recipient and Research grant. Janssen: Consultant, Consulting fee. BMS, Gilead, Merck, GSK/ViiV: Grant Investigator, Grant recipient and Research grant. P. Cahn, Abbvie: Grant, Research grant. Merck: Grant, Advisory Board. ViiV Healthcare: Grant, Advisory Board. K. Squires, Merck & Co., Inc.: Ad Board, Ad Board. Gilead Sciences: Grant, Ad Board. VIIV: Ad Board, Ad Board. Bristol Myers Squibb: Ad Board, Ad Board. Janssen: Ad Board, Ad Board. Y. Zhou, Merck & Co., Inc.: Employee, Salary. X. Xu, Merck & Co., Inc.: Employee, Salary. A. Rodgers, Merck & Co., Inc.: Employee and Shareholder, Salary. S. Kumar, Merck & Co., Inc.: Employee and Shareholder, Salary. H. Teppler, Merck & Co., Inc.: Employee and Shareholder, Salary. E. Martin, Merck & Co., Inc.: Employee and Shareholder, Salary. G. Hanna, Merck & Co., Inc.: Employee and Shareholder, Salary. C. Hwang, Merck & Co., Inc.: Employee and Shareholder, Salary.
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Affiliation(s)
| | | | | | | | - Paul Sax
- Brigham and Women’s Hospital, Boston, Massachusetts
| | - Pedro Cahn
- Fundación Huésped, Buenos Aires, Argentina
| | - Kathleen Squires
- Sidney Kimmel Medical College of Thomas Jefferson University Philadelphia, Philadelphia, Pennsylvania
| | - Yan Zhou
- Merck & Co., Inc., Kenilworth, New Jersey
| | - Xia Xu
- Merck & Co., Inc., Kenilworth, New Jersey
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Jaworski JP, Cahn P. Preventive and therapeutic features of broadly neutralising monoclonal antibodies against HIV-1. Lancet HIV 2018; 5:e723-e731. [PMID: 30245003 DOI: 10.1016/s2352-3018(18)30174-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 07/02/2018] [Accepted: 07/10/2018] [Indexed: 12/25/2022]
Abstract
The viral plasticity and the vast diversity of HIV-1 circulating strains necessitates the identification of new approaches to control this global pandemic. New generation broadly neutralising monoclonal antibodies (bnMAbs) against the HIV-1 viral envelope protein (Env) can prevent virus acquisition, reduce viraemia, enhance immunity, and induce the killing of infected cells in animal models of HIV-1 infection. Most importantly, passively administered bnMAbs are effective at decreasing viraemia and delaying viral rebound in people chronically infected with HIV-1. Single antibody treatment is associated with the emergence of viral escape mutants, and virus suppression is not maintained in the long term. However, a combination of bnMAbs and bioengineered multivalent antibodies that target different sites on Env might increase the efficacy of immunotherapy, adding a new relevant tool for clinical use. The aim of this Review is to highlight the potential benefits of this novel prophylactic and therapeutic approach to fight HIV-1.
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Affiliation(s)
- Juan P Jaworski
- Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina; Instituto Nacional de Tecnología Agropecuaria, Buenos Aires, Argentina.
| | - Pedro Cahn
- Fundación Huésped, Buenos Aires, Argentina
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Sued O, Figueroa M, Cesar C, Patterson P, Yamamoto C, fink V, luna N, Gun A, Cahn P. Dual therapy (ritonavir boosted atazanavir + raltegravir) versus standard triple therapy (ritonavir boosted atazanavir + tenofovir/emtricitabine) in patients failing first line therapy: 48 week results from a randomized pilot study. Int J Infect Dis 2018. [DOI: 10.1016/j.ijid.2018.04.3476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Cahn P. Novel strategies for antiretroviral treatment. Int J Infect Dis 2018. [DOI: 10.1016/j.ijid.2018.04.3506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Sued O, Cassetti I, Cecchini D, Cahn P, de Murillo LB, Weiss SM, Mandell LN, Soni M, Jones DL. Physician-delivered motivational interviewing to improve adherence and retention in care among challenging HIV-infected patients in Argentina (COPA2): study protocol for a cluster randomized controlled trial. Trials 2018; 19:396. [PMID: 30041703 PMCID: PMC6056946 DOI: 10.1186/s13063-018-2758-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 06/25/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND "Challenging" HIV-infected patients, those not retained in treatment, represent a critical focus for positive prevention, as linkage to care, early initiation of antiretroviral therapy, adherence and retention in treatment facilitate viral suppression, thus optimizing health and reducing HIV transmission. Argentina was one of the first Latin American countries to guarantee HIV prevention, diagnosis and comprehensive care services, including antiretroviral medication, which removed cost and access as barriers. Yet, dropout occurs at every stage of the HIV continuum. An estimated 110,000 individuals are HIV-infected in Argentina; of these, 70% have been diagnosed and 54% were linked to care. However, only 36% have achieved viral suppression and 31% of those diagnosed delayed entry to care. To achieve meaningful reductions in HIV infection at the community level, innovative strategies must be developed to re-engage patients. Motivational Interviewing (MI) is a patient-centered approach and has been used by therapists in Central and South America to enhance motivation and commitment in substance use and risk reduction. Our pilot feasibility study utilized culturally tailored MI in physicians to target patients not retained in treatment in public and private clinics in Buenos Aires, Argentina. Results demonstrated that a physician-based MI intervention was feasible and effective in enhanced and sustained patient adherence, viral suppression, and patient-physician communication and attitudes about treatment among these patients at 6 and 9 months post baseline. METHODS/DESIGN This clinical trial seeks to extend these findings in public and private clinics in four urban population centers in Argentina, in which clinics (n = 6 clinics, six MDs per clinic site) are randomized to experimental (physician MI Intervention) (n = 3) or control (physician Standard of Care) (n = 3) conditions in a 3:3 ratio. Using a cluster randomized clinical trial design, the study will test the effectiveness of a physician-based MI intervention to improve and sustain retention, adherence, persistence, and viral suppression among "challenging" patients (n = 420) over 24 months. DISCUSSION Results are anticipated to have significant public health implications for the implementation of MI to re-engage and retain patients in HIV treatment and care and improve viral suppression through high levels of medication adherence. TRIAL REGISTRATION ClinicalTrials.gov, ID: NCT02846350 . Registered on 1 July 2016.
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Affiliation(s)
- Omar Sued
- Fundación Huésped, Pasaje Angel Peluffo 3932, C1202ABB Buenos Aires, Argentina
| | | | | | - Pedro Cahn
- Fundación Huésped, Pasaje Angel Peluffo 3932, C1202ABB Buenos Aires, Argentina
| | - Lina Bofill de Murillo
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1400 NW 10th Ave, Miami, FL USA
| | - Stephen M. Weiss
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1400 NW 10th Ave, Miami, FL USA
| | - Lissa N. Mandell
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1400 NW 10th Ave, Miami, FL USA
| | - Manasi Soni
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1400 NW 10th Ave, Miami, FL USA
| | - Deborah L. Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1400 NW 10th Ave, Miami, FL USA
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Barré‐Sinoussi F, Abdool Karim SS, Albert J, Bekker L, Beyrer C, Cahn P, Calmy A, Grinsztejn B, Grulich A, Kamarulzaman A, Kumarasamy N, Loutfy MR, El Filali KM, Mboup S, Montaner JSG, Munderi P, Pokrovsky V, Vandamme A, Young B, Godfrey‐Faussett P. Expert consensus statement on the science of HIV in the context of criminal law. J Int AIDS Soc 2018; 21:e25161. [PMID: 30044059 PMCID: PMC6058263 DOI: 10.1002/jia2.25161] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 06/21/2018] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Globally, prosecutions for non-disclosure, exposure or transmission of HIV frequently relate to sexual activity, biting, or spitting. This includes instances in which no harm was intended, HIV transmission did not occur, and HIV transmission was extremely unlikely or not possible. This suggests prosecutions are not always guided by the best available scientific and medical evidence. DISCUSSION Twenty scientists from regions across the world developed this Expert Consensus Statement to address the use of HIV science by the criminal justice system. A detailed analysis of the best available scientific and medical research data on HIV transmission, treatment effectiveness and forensic phylogenetic evidence was performed and described so it may be better understood in criminal law contexts. Description of the possibility of HIV transmission was limited to acts most often at issue in criminal cases. The possibility of HIV transmission during a single, specific act was positioned along a continuum of risk, noting that the possibility of HIV transmission varies according to a range of intersecting factors including viral load, condom use, and other risk reduction practices. Current evidence suggests the possibility of HIV transmission during a single episode of sex, biting or spitting ranges from no possibility to low possibility. Further research considered the positive health impact of modern antiretroviral therapies that have improved the life expectancy of most people living with HIV to a point similar to their HIV-negative counterparts, transforming HIV infection into a chronic, manageable health condition. Lastly, consideration of the use of scientific evidence in court found that phylogenetic analysis alone cannot prove beyond reasonable doubt that one person infected another although it can be used to exonerate a defendant. CONCLUSIONS The application of up-to-date scientific evidence in criminal cases has the potential to limit unjust prosecutions and convictions. The authors recommend that caution be exercised when considering prosecution, and encourage governments and those working in legal and judicial systems to pay close attention to the significant advances in HIV science that have occurred over the last three decades to ensure current scientific knowledge informs application of the law in cases related to HIV.
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Affiliation(s)
| | - Salim S Abdool Karim
- Mailman School of Public HealthColumbia UniversityNew YorkNYUSA
- Centre for the AIDS Program of Research in South AfricaUniversity of KwaZulu‐NatalDurbanSouth Africa
- Weill Medical CollegeCornell UniversityNew YorkNYUSA
| | - Jan Albert
- Department of Microbiology, Tumor and Cell BiologyKarolinska InstitutetStockholmSweden
| | - Linda‐Gail Bekker
- Institute of Infectious Disease and Molecular MedicineUniversity of Cape TownCape TownSouth Africa
| | - Chris Beyrer
- Department of EpidemiologyCenter for AIDS Research and Center for Public Health and Human RightsJohn Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - Pedro Cahn
- Infectious Diseases UnitJuan A. Fernandez Hospital Buenos AiresCABAArgentina
- Buenos Aires University Medical SchoolBuenos AiresArgentina
- Fundación HuéspedBuenos AiresArgentina
| | - Alexandra Calmy
- Infectious DiseasesGeneva University HospitalGenevaSwitzerland
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas‐FiocruzFiocruz, Rio de JaneiroBrazil
| | - Andrew Grulich
- Kirby InstituteUniversity of New South WalesSydneyNSWAustralia
| | | | | | - Mona R Loutfy
- Women's College Research InstituteTorontoCanada
- Women's College HospitalTorontoCanada
- Department of MedicineUniversity of TorontoTorontoCanada
| | - Kamal M El Filali
- Infectious Diseases UnitIbn Rochd Universtiy HospitalCasablancaMorocco
| | - Souleymane Mboup
- Institut de Recherche en Santéde Surveillance Epidemiologique et de FormationsDakarSenegal
| | - Julio SG Montaner
- Faculty of MedicineUniversity of British ColumbiaVancouverCanada
- BC Centre for Excellence in HIV/AIDSVancouverCanada
| | - Paula Munderi
- International Association of Providers of AIDS CareKampalaUganda
| | - Vadim Pokrovsky
- Russian Peoples’ Friendship University (RUDN‐ University)MoscowRussian Federation
- Central Research Institute of EpidemiologyFederal Service on Customers’ Rights Protection and Human Well‐being SurveillanceMoscowRussian Federation
| | - Anne‐Mieke Vandamme
- KU LeuvenDepartment of Microbiology and ImmunologyRega Institute for Medical Research, Clinical and Epidemiological VirologyLeuvenBelgium
- Center for Global Health and Tropical MedicineUnidade de MicrobiologiaInstituto de Higiene e Medicina TropicalUniversidade Nova de LisboaLisbonPortugal
| | - Benjamin Young
- International Association of Providers of AIDS CareWashingtonDCUSA
| | - Peter Godfrey‐Faussett
- UNAIDSGenevaSwitzerland
- Department of Infectious and Tropical DiseasesLondon School of Hygiene and Tropical MedicineLondonEngland
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Damilano GD, Sued O, Ruiz MJ, Ghiglione Y, Canitano F, Pando M, Turk G, Cahn P, Salomón H, Dilernia D. Computational comparison of availability in CTL/gag epitopes among patients with acute and chronic HIV-1 infection. Vaccine 2018; 36:4142-4151. [PMID: 29802001 DOI: 10.1016/j.vaccine.2018.04.086] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 04/23/2018] [Accepted: 04/29/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Recent studies indicate that there is selection bias for transmission of viral polymorphisms associated with higher viral fitness. Furthermore, after transmission and before a specific immune response is mounted in the recipient, the virus undergoes a number of reversions which allow an increase in their replicative capacity. These aspects, and others, affect the viral population characteristic of early acute infection. METHODS 160 singlegag-gene amplifications were obtained by limiting-dilution RT-PCR from plasma samples of 8 ARV-naïve patients with early acute infection (<30 days, 22 days average) and 8 ARV-naive patients with approximately a year of infection (10 amplicons per patient). Sanger sequencing and NGS SMRT technology (Pacific Biosciences) were implemented to sequence the amplicons. Phylogenetic analysis was performed by using MEGA 6.06. HLA-I (A and B) typing was performed by SSOP-PCR method. The chromatograms were analyzed with Sequencher 4.10. Epitopes and immune-proteosomal cleavages prediction was performed with CBS prediction server for the 30 HLA-A and -B alleles most prevalent in our population with peptide lengths from 8 to 14 mer. Cytotoxic response prediction was performed by using IEDB Analysis Resource. RESULTS After implementing epitope prediction analysis, we identified a total number of 325 possible viral epitopes present in two or more acute or chronic patients. 60.3% (n = 196) of them were present only in acute infection (prevalent acute epitopes) while 39.7% (n = 129) were present only in chronic infection (prevalent chronic epitopes). Within p24, the difference was equally dramatic with 59.4% (79/133) being acute epitopes (p < 0.05). This is consistent with progressive viral adaptation to immune response in time and further supported by the fact that cytotoxic responses prediction showed that acute epitopes are more likely to generate immune response than chronic epitopes. Interestingly, only 27.5% of acute epitopes match the population-level consensus sequence of the virus. CONCLUSIONS Our results indicate that certain non-consensus viral residues might be transmitted more frequently than consensus-residues when located in immunological relevant positions (epitopes). This observation might be relevant to the rationale behind development of an effective vaccineto reduce viral reservoir and induce functional cure of HIV infection based in prevalent acute epitopes.
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Affiliation(s)
- Gabriel Dario Damilano
- Instituto de Investigaciones Biomédicas en Retrovirus y SIDA Facultad de Medicina, Universidad de Buenos Aires, Argentina.
| | - Omar Sued
- Fundación Huésped, Buenos Aires, Argentina.
| | - Maria Julia Ruiz
- Instituto de Investigaciones Biomédicas en Retrovirus y SIDA Facultad de Medicina, Universidad de Buenos Aires, Argentina.
| | - Yanina Ghiglione
- Instituto de Investigaciones Biomédicas en Retrovirus y SIDA Facultad de Medicina, Universidad de Buenos Aires, Argentina.
| | - Flavia Canitano
- Instituto de Investigaciones Médicas Alfredo Lanari, Buenos Aires, Argentina.
| | - Maria Pando
- Instituto de Investigaciones Biomédicas en Retrovirus y SIDA Facultad de Medicina, Universidad de Buenos Aires, Argentina.
| | - Gabriela Turk
- Instituto de Investigaciones Biomédicas en Retrovirus y SIDA Facultad de Medicina, Universidad de Buenos Aires, Argentina.
| | - Pedro Cahn
- Fundación Huésped, Buenos Aires, Argentina.
| | - Horacio Salomón
- Instituto de Investigaciones Biomédicas en Retrovirus y SIDA Facultad de Medicina, Universidad de Buenos Aires, Argentina.
| | - Dario Dilernia
- Instituto de Investigaciones Biomédicas en Retrovirus y SIDA Facultad de Medicina, Universidad de Buenos Aires, Argentina; Emory University, Atlanta, USA.
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