1
|
Gallucci L, Bazire J, Davidson AD, Shytaj IL. Broad-spectrum antiviral activity of two structurally analogous CYP3A inhibitors against pathogenic human coronaviruses in vitro. Antiviral Res 2024; 221:105766. [PMID: 38042417 DOI: 10.1016/j.antiviral.2023.105766] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/19/2023] [Accepted: 11/24/2023] [Indexed: 12/04/2023]
Abstract
Coronaviruses pose a permanent risk of outbreaks, with three highly pathogenic species and strains (SARS-CoV, MERS-CoV, SARS-CoV-2) having emerged in the last twenty years. Limited antiviral therapies are currently available and their efficacy in randomized clinical trials enrolling SARS-CoV-2 patients has not been consistent, highlighting the need for more potent treatments. We previously showed that cobicistat, a clinically approved inhibitor of Cytochrome P450-3A (CYP3A), has direct antiviral activity against early circulating SARS-CoV-2 strains in vitro and in Syrian hamsters. Cobicistat is a derivative of ritonavir, which is co-administered as pharmacoenhancer with the SARS-CoV-2 protease inhibitor nirmatrelvir, to inhibit its metabolization by CPY3A and preserve its antiviral efficacy. Here, we used automated image analysis for a screening and parallel comparison of the anti-coronavirus effects of cobicistat and ritonavir. Our data show that both drugs display antiviral activity at low micromolar concentrations against multiple SARS-CoV-2 variants in vitro, including epidemiologically relevant Omicron subvariants. Despite their close structural similarity, we found that cobicistat is more potent than ritonavir, as shown by significantly lower EC50 values in monotherapy and higher levels of viral suppression when used in combination with nirmatrelvir. Finally, we show that the antiviral activity of both cobicistat and ritonavir is maintained against other human coronaviruses, including HCoV-229E and the highly pathogenic MERS-CoV. Overall, our results demonstrate that cobicistat has more potent anti-coronavirus activity than ritonavir and suggest that dose adjustments could pave the way to the use of both drugs as broad-spectrum antivirals against highly pathogenic human coronaviruses.
Collapse
Affiliation(s)
- Lara Gallucci
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK
| | - James Bazire
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK
| | - Andrew D Davidson
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK.
| | - Iart Luca Shytaj
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK.
| |
Collapse
|
2
|
Puri S, Yadav TT, Chouhan M, Kumar K. Synthetic and Clinical Perspectives of Evotaz: An Overview. Mini Rev Med Chem 2024; 24:372-390. [PMID: 37424344 DOI: 10.2174/1389557523666230707151553] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 04/25/2023] [Accepted: 06/09/2023] [Indexed: 07/11/2023]
Abstract
Viruses cause a variety of diseases in the human body. Antiviral agents are used to prevent the production of disease-causing viruses. These agents obstruct and kill the virus's translation and replication. Because viruses share the metabolic processes of the majority of host cells, finding targeted medicines for the virus is difficult. In the ongoing search for better antiviral agents, the USFDA approved EVOTAZ, a new drug discovered for the treatment of Human Immunodeficiency Virus (HIV). It is a once-daily (OD) fixed-dose combination of Cobicistat, a cytochrome P450 (CYP) enzyme inhibitor, and Atazanavir, a protease inhibitor. The combination drug was created in such a way that it can inhibit both CYP enzymes and proteases at the same time, resulting in the virus's death. The drug is not effective in children under the age of 18; however, it is still being studied for various parameters. This review article focuses on EVOTAZ's preclinical and clinical aspects, as well as its efficacy and safety profiles.
Collapse
Affiliation(s)
- Sachin Puri
- Shobhaben Pratapbhai Patel School of Pharmacy & Technology Management, SVKM's NMIMS, V.L. Mehta Road, Vile Parle (W), Mumbai, India
| | - Tanuja T Yadav
- Shobhaben Pratapbhai Patel School of Pharmacy & Technology Management, SVKM's NMIMS, V.L. Mehta Road, Vile Parle (W), Mumbai, India
| | - Mangilal Chouhan
- Department of Pharmaceutical Sciences, Mohanlal Sukhadia University, Udaipur, Rajasthan, 313001, India
| | - Kapil Kumar
- School of Pharmaceutical Sciences, Apeejay Stya University, Gurugram, Haryana, 122103, India
| |
Collapse
|
3
|
Brooks KM, Pau AK, Swaim D, Bunn HT, Adeojo L, Peloquin CA, Kumar P, Kovacs JA, George JM. Pharmacokinetics, Safety, and Tolerability of Once-Daily Darunavir With Cobicistat and Weekly Isoniazid/Rifapentine. J Acquir Immune Defic Syndr 2023; 94:468-473. [PMID: 37955446 PMCID: PMC10651166 DOI: 10.1097/qai.0000000000003301] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 08/21/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Once-weekly isoniazid with rifapentine (HP) for 3 months is a recommended treatment for latent tuberculosis infection in persons with HIV. HP reduces exposures of certain antiretroviral medications, resulting in limited options for the concomitant use of these therapies. Here, we examined the pharmacokinetics (PK), safety, and tolerability of darunavir/cobicistat with HP. METHODS This was an open-label, fixed sequence, two-period crossover study in persons without HIV. Participants received darunavir 800 mg/cobicistat 150 mg once-daily alone for 4 days, then continued darunavir/cobicistat once-daily for days 5-19 with HP coadministration on days 5, 12, and 19. Intensive PK assessments were performed on days 4, 14, and 19. PK parameters were determined using noncompartmental methods. Geometric mean ratios with 90% confidence intervals (CIs) were calculated and compared between phases using mixed-effects models. RESULTS Thirteen participants were enrolled. Two withdrew after day 4, and one withdrew after day 14. Of the 3 withdrawals, 2 were attributed to drug-related adverse events. Darunavir area under the concentration-time curve, maximum concentrations (Cmax), and concentrations at 24 hours postdose (C24h) were reduced by 71%, 41%, and 96% ∼48-72 hours after HP administration (day 14), respectively, and 36%, 17%, and 89% with simultaneous HP administration (day 19), respectively. On day 14, 45% of the predose and 73% of C24h concentrations were below the darunavir EC50 (0.055 µg/mL). CONCLUSIONS Darunavir exposures were significantly decreased with HP coadministration. Temporal relationships between HP coadministration and the extent of induction or mixed inhibition/induction of darunavir metabolism were apparent. Coadministration of darunavir/cobicistat with 3HP should be avoided.
Collapse
Affiliation(s)
- Kristina M Brooks
- Clinical Pharmacokinetic Research Laboratory, Clinical Center Pharmacy Department, NIH Clinical Center, Bethesda, MD, USA
- Currently, Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Alice K Pau
- National Institute of Allergy and Infectious Diseases, Bethesda, MD
| | - Doris Swaim
- Clinical Research Directorate, Frederick National Laboratory for Cancer Research, Frederick, MD
| | - Haden T Bunn
- Clinical Pharmacokinetic Research Laboratory, Clinical Center Pharmacy Department, NIH Clinical Center, Bethesda, MD, USA
- Currently, Pumas-AI, Inc., Centreville, VA
| | - Lilian Adeojo
- Clinical Pharmacokinetic Research Laboratory, Clinical Center Pharmacy Department, NIH Clinical Center, Bethesda, MD, USA
- Currently, Arcus Biosciences, Hayward, CA
| | - Charles A Peloquin
- University of Florida College of Pharmacy and Emerging Pathogens Institute, Gainesville, FL
| | - Parag Kumar
- Clinical Pharmacokinetic Research Laboratory, Clinical Center Pharmacy Department, NIH Clinical Center, Bethesda, MD, USA
- Currently, Gilead Sciences, Inc., Foster City, CA
| | - Joseph A Kovacs
- Critical Care Medicine Department, NIH Clinical Center, Bethesda, MD; and
| | - Jomy M George
- Clinical Pharmacokinetic Research Laboratory, Clinical Center Pharmacy Department, NIH Clinical Center, Bethesda, MD, USA
- Currently, Office of Regulatory Affairs, Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, NIH, Rockville, MD
| |
Collapse
|
4
|
Farinacci D, Iannone V, D'Angelillo A, Borghetti A, Passerotto RA, Lamanna F, Di Giambenedetto S. Two-Drug Regimen Containing Darunavir: Metabolic Evaluation of an Old Dual Therapy. AIDS Res Hum Retroviruses 2023; 39:633-635. [PMID: 37409412 DOI: 10.1089/aid.2023.0023] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
Regimens containing darunavir are one of the first one with two drugs that demonstrated good efficacy as a simplification strategy. We wanted to describe the characteristics of patients followed in our center on a dual therapy regimen containing darunavir evaluating the metabolic aspects during follow-ups. We collected data from 208 patients switching to lamivudine plus darunavir with either ritonavir or cobicistat between 2010 and 2019. In all patients we found an increase in low-density lipoprotein (LDL), with no rising in creatinine, total cholesterol, or triglycerides. Twenty-five patients reached 120 weeks of follow-up. In these patients, no significant metabolic changes were described without concomitant treatment with drugs for dyslipidemia. These regimens seem to be more tolerable in metabolic profile compared with the data concerning three-drug therapies, leading only to a slight increase in LDL. The main reason for discontinuation was for a single-tablet therapy. None of the patients started treatment for dyslipidemia.
Collapse
Affiliation(s)
- Damiano Farinacci
- ASL Viterbo, UOC Medicina Protetta-Malattie Infettive, Viterbo, Italy
| | - Valentina Iannone
- Dipartimento di Sicurezza e Bioetica Sezione Malattie Infettive, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Anna D'Angelillo
- ASL Viterbo, UOC Medicina Protetta-Malattie Infettive, Viterbo, Italy
- Dipartimento di Sicurezza e Bioetica Sezione Malattie Infettive, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Alberto Borghetti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Malattie Infettive, Roma, Italia
| | - Rosa Anna Passerotto
- Dipartimento di Sicurezza e Bioetica Sezione Malattie Infettive, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Francesco Lamanna
- Dipartimento di Sicurezza e Bioetica Sezione Malattie Infettive, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Simona Di Giambenedetto
- Dipartimento di Sicurezza e Bioetica Sezione Malattie Infettive, Università Cattolica del Sacro Cuore, Roma, Italia
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Malattie Infettive, Roma, Italia
| |
Collapse
|
5
|
Podzamczer D, Imaz A, Lopez-Lirola A, Knobel H, Masiá M, Fanciulli C, Hernández C, Lagarde M, Gutierrez A, Curran A, Morano L, Montero-Alonso M, Troya J, Rigo R, Casadellà M, Navarro-Alcaraz A, Ardila F, Parera M, Bernal E, Echeverria P, Estrada V, Hidalgo-Tenorio C, Macias J, Prieto P, Portilla J, Valencia E, Vivancos MJ, Rivero A. Switching to bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) plus darunavir/cobicistat in heavily antiretroviral-experienced, virologically suppressed HIV-infected adults receiving complex regimens. J Antimicrob Chemother 2023; 78:2696-2701. [PMID: 37725999 DOI: 10.1093/jac/dkad285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/25/2023] [Indexed: 09/21/2023] Open
Abstract
OBJECTIVES To evaluate the efficacy and safety of the two-pill regimen bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) plus darunavir/cobicistat as a switching strategy in heavily treatment-experienced people living with HIV (PLWH). METHODS Multicentre, prospective, single-arm pilot clinical trial. Participants were virologically suppressed adults receiving a stable antiretroviral regimen of at least three pills from at least three drug families due to previous virological failures and/or toxicities with no documented resistance to integrase strand transfer inhibitors or darunavir (≥15 points, Stanford). Clinical and laboratory assessments were performed at 0, 4, 12, 24, 36 and 48 weeks. HIV-1 proviral DNA was amplified and sequenced by Illumina at baseline. Plasma bictegravir concentrations were determined in 22 patients using UHPLC-MS/MS. The primary study endpoint was viral load (VL)< 50 copies/mL at Week 48 (ITT). RESULTS We enrolled 63 participants (92% men) with median baseline CD4 count of 515 cells/mm3 (IQR: 334.5-734.5), 24 years on ART (IQR: 15.9-27.8). The median number of pills was 4 (range: 3-10). At baseline, proviral DNA was amplified in 39 participants: 33/39 had resistance mutations. Three participants discontinued owing to toxicity. At 48 weeks, 95% had VL < 50 copies/mL by ITT and 100% by PP analysis. A modest increase was observed in the bictegravir plasma concentration, and a significant decrease in estimated glomerular filtration rate was observed only at Week 4, probably related to interaction with renal transporters. CONCLUSIONS Our data suggest that BIC/FTC/TAF + darunavir/cobicistat is an effective, well-tolerated regimen that may improve convenience and, potentially, long-term success in stable heavily pre-treated PLWH.
Collapse
Affiliation(s)
| | - Arkaitz Imaz
- Infectious Diseases Department, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Hospitalet del Llobregat, Hospital Universitario de Bellvitge, Spain
| | - Ana Lopez-Lirola
- Infectious Diseases Department, Hospital universitario de Canarias, San Cristóbal de la Laguna, Spain
| | - Hernando Knobel
- Infectious Diseases Department, Hospital del Mar, Barcelona, Spain
| | - Mar Masiá
- Infectious Diseases Department, Hospital Universitario general de Elche, Elche, Spain
| | - Chiara Fanciulli
- Infectious Diseases Department, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Cristina Hernández
- Infectious Diseases Department, Hospital Príncipe de Asturias, Alcalá de Henares, Spain
| | - María Lagarde
- Infectious Diseases Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Angela Gutierrez
- Infectious Diseases Department, Hospital Universitario de la Princesa, Madrid, Spain
| | - Adrià Curran
- Infectious Diseases Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Luis Morano
- Infectious Diseases Department, Hospital Universitario Álvaro Cunqueiro, Vigo, Spain
| | - Marta Montero-Alonso
- Infectious Diseases Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Jesús Troya
- Infectious Diseases Department, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Raúl Rigo
- Infectious Diseases Department, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Hospitalet del Llobregat, Hospital Universitario de Bellvitge, Spain
| | - María Casadellà
- Microbial Genomics Group, IrsiCaixa-Institut de Recerca de la SIDA, Badalona, Spain
| | | | - Fernando Ardila
- Infectious Diseases Department, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Hospitalet del Llobregat, Hospital Universitario de Bellvitge, Spain
| | - Mariona Parera
- Microbial Genomics Group, IrsiCaixa-Institut de Recerca de la SIDA, Badalona, Spain
| | - Enrique Bernal
- Infectious Diseases Department, Hospital Universitario Reina Sofía, Murcia, Spain
| | - Patricia Echeverria
- Infectious Diseases Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Vicente Estrada
- Infectious Diseases Department, Hospital Clínico San Carlos, Madrid, Spain
| | - Carmen Hidalgo-Tenorio
- Infectious Diseases Department, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Juan Macias
- Instituto de Biomedicina de Sevilla, Departamento de Medicina, CIBERINFEC, Unidad de Enfermedades Infecciosas y Microbiología, IBiS/Hospital Universitario Virgen de Valme/CSIC/Universidad de Sevilla, Sevilla, Spain
| | - Paula Prieto
- Infectious Diseases Department, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Joaquín Portilla
- Infectious Diseases Department, Hospital General Universitario de Alicante, Alicante, Spain
| | - Eulalia Valencia
- Infectious Diseases Department, Hospital Universitario La Paz, Madrid, Spain
| | - María Jesús Vivancos
- Infectious Diseases Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Antonio Rivero
- Department of Infectious Diseases, Hospital Universitario Reina Sofia, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba (UCO), Córdoba, Spain
- CIBERINFEC, ISCIII-CIBER de Enfermedades Infecciosas Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
6
|
Singh VD, Singh VK, Daharwal SJ. Utilization of Chemometric-Aided UV Spectrophotometric Methods for Concurrent Assessment of Emtricitabine, Tenofovir Disoproxil Fumarate, Elvitegravir, and Cobicistat in Tablet Formulation. J AOAC Int 2023; 106:1673-1681. [PMID: 37289523 DOI: 10.1093/jaoacint/qsad067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 04/11/2023] [Accepted: 05/21/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Emtricitabine (ETC), tenofovir disoproxil fumarate (TNF), elvitegravir (EVG), and cobicistat (CBS) are antiviral drugs used to treat human immunodeficiency virus (HIV) infections. OBJECTIVE To develop chemometric-aided UV spectrophotometric methods for concurrent estimation of the aforementioned drugs used to treat HIV. This method can be used to reduce modification of the calibration model by assessing the absorbance at various points in the zero-order spectra within the selected wavelength range. Additionally, it eliminates interfering signals and provides sufficient resolution in multi-component systems. METHODS Two chemometric-assisted UV spectrophotometric methods, namely, partial least-squares (PLS) and principal component regression (PCR) models, were established for the concurrent assessment of EVG, CBS, TNF, and ETC in tablet formulations. The proposed methods were applied to decrease complexity of overlapped spectra and to achieve maximum sensitivity and the lowest error. These approaches were performed in accordance with International Council on Harmonization (ICH) criteria and compared to the reported HPLC method. RESULTS The proposed methods were used to assess EVG, CBS, TNF, and ETC in the ranges of 5-30, 5-30 , 5-50, and 5-50 µg/mL, respectively, with an excellent correlation coefficient (r2 ≥ 0.998). The accuracy and precision results were found to be within the acceptable limits. No statistical difference was observed between the proposed and reported studies. CONCLUSION The chemometric-aided UV spectrophotometric approaches could be considered as alternatives to chromatographic procedures in the pharmaceutical industry for routine analysis and testing of readily accessible commercial formulations. HIGHLIGHTS Novel chemometric-assisted UV spectrophotometric techniques were developed for assessment of multicomponent antiviral combinations in single-tablet formulations. The proposed methods were performed without using harmful solvents, tedious preparation, or expensive instruments. The proposed methods were compared statistically with a reported HPLC method. Assessment of EVG, CBS, TNF, and ETC was performed without interference from excipients in their multicomponent formulations.
Collapse
Affiliation(s)
- Veena Devi Singh
- Shri Rawatpura Sarkar College of Pharmacy, Shri Rawatpura Sarkar University, Dhaneli, Raipur, Chhattisgarh 492015, India
- University Institute of Pharmacy, Pt. Ravishankar Shukla University, Raipur, Chhattisgarh 492010, India
| | - Vijay Kumar Singh
- Shri Rawatpura Sarkar College of Pharmacy, Shri Rawatpura Sarkar University, Dhaneli, Raipur, Chhattisgarh 492015, India
| | - Sanjay J Daharwal
- University Institute of Pharmacy, Pt. Ravishankar Shukla University, Raipur, Chhattisgarh 492010, India
| |
Collapse
|
7
|
Bruzzesi E, Gabrieli A, Bernasconi D, Marchetti G, Calcagno A, Ripamonti D, Antinori A, Squillace N, Cingolani A, Muscatello A, Bandera A, Gori A, Rusconi S, Nozza S. HIV-DNA decrease during treatment in primary HIV-1 infection with three different drug regimens: Italian Network of Acute HIV Infection (INACTION) clinical trial. J Med Virol 2023; 95:e29114. [PMID: 37752816 DOI: 10.1002/jmv.29114] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 09/06/2023] [Accepted: 09/10/2023] [Indexed: 09/28/2023]
Abstract
As the introduction of antiretroviral therapy (ART) during primary HIV-1 infection (PHI) could restrict the establishment of HIV reservoirs, we aimed to assess the effect of three different ART regimens on HIV-DNA load in people living with HIV (PLWH), who started ART in PHI. Randomized, open-label, multicentric study, including subjects in PHI (defined as an incomplete HIV-1 Western blot and detectable plasma HIV-RNA) in the Italian Network of Acute HIV Infection cohort. Participants were randomly assigned (10:10:8) to a fixed-dose combination of tenofovir alafenamide fumarate (TAF) 10 mg plus emtricitabine (FTC) 200 mg, darunavir 800 mg, and cobicistat 150 mg once daily (group A), or TAF 25 mg plus FTC 200 mg, dolutegravir 50 mg once daily (group B), or an intensified four-drug regimen (TAF 10 mg plus FTC 200 mg, dolutegravir 50 mg, darunavir 800 mg, and cobicistat 150 mg once daily) (group C). The primary endpoint was the decrease of HIV-DNA copies/106 peripheral blood mononuclear cells (PBMCs) at weeks (W) 12 and 48. Secondary endpoints were increased in CD4+ cells and in CD4+/CD8+ ratio and percentage of PLWH reaching undetectable HIV-RNA. HIV-DNA was quantified by Droplet Digital PCR (Biorad QX100) and normalized to RPP30 reference gene. This study was registered in ClinicalTrials.gov (number NCT04225325). Among 78 participants enrolled, 30 were randomized to group 1, 28 to group 2, and 20 to group 3. At baseline, median CD4+ count was 658/µL (476-790), HIV-RNA 5.37 (4.38, 6.12) log10 copies/mL, without statistical difference in their change among groups at weeks 12 and 48 (p = 0.432 and 0.234, respectively). The trial was prematurely discontinued for slow accrual and for COVID-19 pandemic-associated restrictions. In the per-protocol analysis, PLWH (n = 72) with undetectable viral load was 54.3% at W12 and 86.4% at W48. Interestingly, the CD4/CD8 ratio progressively increased over time, up to normalization in almost half of the cohort by week 48, despite a deflection in group 3; no difference was observed by the Fiebig stage (I-III vs. IV-VI). HIV-DNA decreased from 4.46 (4.08, 4.81) log10 copies/106 PBMCs to 4.22 (3.79, 4.49) at week 12, and 3.87 (3.46, 4.34) at week 48, without difference among groups. At multivariable analysis, HIV-DNA delta at W48 was associated only with the increase of CD4+ count by 100 cells/mm3 but not with the Fiebig stage, the CD4+/CD8+ ratio, and treatment arm, despite a higher decrease in group 3. Six adverse events were recorded during our study, which did not cause any withdrawal from the study. We observed a decrease in HIV-DNA from baseline to W48 in PLWH treated during PHI, associated with an increase in CD4+ count, unrelated to the treatment arm.
Collapse
Affiliation(s)
| | - Arianna Gabrieli
- Dipartimento di Scienze Biomediche e Cliniche (DIBIC), Milan, Italy
| | - Davide Bernasconi
- Bicocca Bioinformatics Biostatistics and Bioimaging Centre - B4 School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Giulia Marchetti
- Clinic of Infectious Diseases, Department of Health Sciences, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
- School of Medicine and Surgery, University of Milan, Milan, Italy
| | - Andrea Calcagno
- Unit of Infectious Diseases, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Diego Ripamonti
- Infectious Disease Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Andrea Antinori
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Nicola Squillace
- Infectious Disease Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Antonella Cingolani
- Istituto Clinica di Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy
- UOC Malattie Infettive, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Antonio Muscatello
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan
| | - Alessandra Bandera
- School of Medicine and Surgery, University of Milan, Milan, Italy
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan
| | - Andrea Gori
- School of Medicine and Surgery, University of Milan, Milan, Italy
| | - Stefano Rusconi
- School of Medicine and Surgery, University of Milan, Milan, Italy
- SC Malattie Infettive, Ospedale di Legnano, ASST Ovest Milanese, Legnano, Italy
| | - Silvia Nozza
- Vita-Salute San Raffaele University, Milan, Italy
- Infectious Diseases Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| |
Collapse
|
8
|
Rotea-Salvo S, Martínez-Pradeda A, Fernández-Oliveira C, Giménez-Arufe V, Balboa-Barreiro V, Margusino-Framiñán L, Mena-De-Cea Á, Vázquez-Rodríguez P, Castro-Iglesias Á, López-Calvo S, Martín-Herranz I, Míguez-Rey E, Cid-Silva P. Renal profile of patients treated with elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide fumarate and dolutegravir/abacavir/lamivudine: 120-week results from a real-world cohort. Eur J Hosp Pharm 2023; 30:221-226. [PMID: 34649965 PMCID: PMC10359784 DOI: 10.1136/ejhpharm-2021-002896] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 09/28/2021] [Indexed: 11/03/2022] Open
Abstract
Elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide fumarate (EVG/c/FTC/TAF) and dolutegravir/abacavir/lamivudine (DTG/ABC/3TC) are currently available for HIV patients. OBJECTIVES This study evaluated modifications in the renal safety profile in a large real-world cohort of patients who had received EVG/c/FTC/TAF or DTG/ABC/3TC. METHODS A retrospective observational study of HIV-infected patients who received EVG/c/FTC/TAF or DTG/ABC/3TC between March 2015 and June 2019 at a reference hospital in north-western Spain was conducted. Epidemiological, clinical, immunovirological data and information regarding antiretroviral therapy were recorded. The statistical differences between treatments were calculated. RESULTS A total of 457 patients were evaluated, 266 using EVG/c/FTC/TAF and 191 using DTG/ABC/3TC. Up to week 120, serum creatinine improved in both study groups among experienced patients (EVG/c/FTC/TAF 1.01±0.24 vs 0.91±0.19, p<0.001; DTG/ABC/3TC 1.08±0.24 vs 1.02±0.31, p<0.001), while in naïve patients serum creatinine remained stable compared with baseline. Statistically significant differences were found in serum creatinine when comparing both treatments at week 48 in experienced (0.94±0.21 vs 1.09±0.28, p<0.001) and naïve patients (0.89±0.16 vs 1.06±0.20, p=0.001), and among experienced patients at week 120 (0.91±0.19 vs 1.02±0.31, p=0.015) for the EVG/c/FTC/TAF and DTG/ABC/3TC groups, respectively. During the follow-up, 39 patients in EVG/c/FTC/TAF and 33 in DTG/ABC/3TC (p=0.449) discontinued treatment. The main reason for stopping treatment was adverse events, which were similar in both groups. CONCLUSIONS During the follow-up, patients experienced changes that were not clinically relevant in both treatment groups. Differences in renal events were not found.
Collapse
Affiliation(s)
- Sandra Rotea-Salvo
- Service of Pharmacy, Universitary Hospital of A Coruña (CHUAC), SERGAS, A Coruña, Galicia, Spain
| | | | - Carla Fernández-Oliveira
- Service of Pharmacy, Universitary Hospital of A Coruña (CHUAC), SERGAS, A Coruña, Galicia, Spain
| | - Victor Giménez-Arufe
- Service of Pharmacy, Universitary Hospital of A Coruña (CHUAC), SERGAS, A Coruña, Galicia, Spain
| | - Vanesa Balboa-Barreiro
- Clinical Epidemiology and Biostatistics Unit, Biomedical Research Institute of A Coruña (INIBIC), Universitary Hospital of A Coruña (CHUAC), SERGAS. University of A Coruña (UDC), A Coruña, Galicia, Spain
| | - Luis Margusino-Framiñán
- Service of Pharmacy, Universitary Hospital of A Coruña (CHUAC), SERGAS, A Coruña, Galicia, Spain
- Division of Clinical Virology, Biomedical Research Institute of A Coruña (INIBIC), Universitary Hospital of A Coruña (CHUAC), SERGAS. University of A Coruña (UDC), A Coruña, Galicia, Spain
| | - Álvaro Mena-De-Cea
- Division of Clinical Virology, Biomedical Research Institute of A Coruña (INIBIC), Universitary Hospital of A Coruña (CHUAC), SERGAS. University of A Coruña (UDC), A Coruña, Galicia, Spain
- Service of Infectious Internal Medicine, Universitary Hospital of A Coruña (CHUAC), SERGAS, A Coruña, Galicia, Spain
| | - Pilar Vázquez-Rodríguez
- Division of Clinical Virology, Biomedical Research Institute of A Coruña (INIBIC), Universitary Hospital of A Coruña (CHUAC), SERGAS. University of A Coruña (UDC), A Coruña, Galicia, Spain
- Service of Infectious Internal Medicine, Universitary Hospital of A Coruña (CHUAC), SERGAS, A Coruña, Galicia, Spain
| | - Ángeles Castro-Iglesias
- Division of Clinical Virology, Biomedical Research Institute of A Coruña (INIBIC), Universitary Hospital of A Coruña (CHUAC), SERGAS. University of A Coruña (UDC), A Coruña, Galicia, Spain
- Service of Infectious Internal Medicine, Universitary Hospital of A Coruña (CHUAC), SERGAS, A Coruña, Galicia, Spain
| | - Soledad López-Calvo
- Division of Clinical Virology, Biomedical Research Institute of A Coruña (INIBIC), Universitary Hospital of A Coruña (CHUAC), SERGAS. University of A Coruña (UDC), A Coruña, Galicia, Spain
- Service of Infectious Internal Medicine, Universitary Hospital of A Coruña (CHUAC), SERGAS, A Coruña, Galicia, Spain
| | - Isabel Martín-Herranz
- Service of Pharmacy, Universitary Hospital of A Coruña (CHUAC), SERGAS, A Coruña, Galicia, Spain
| | - Enrique Míguez-Rey
- Division of Clinical Virology, Biomedical Research Institute of A Coruña (INIBIC), Universitary Hospital of A Coruña (CHUAC), SERGAS. University of A Coruña (UDC), A Coruña, Galicia, Spain
- Service of Infectious Internal Medicine, Universitary Hospital of A Coruña (CHUAC), SERGAS, A Coruña, Galicia, Spain
| | - Purificación Cid-Silva
- Service of Pharmacy, Universitary Hospital of A Coruña (CHUAC), SERGAS, A Coruña, Galicia, Spain
- Division of Clinical Virology, Biomedical Research Institute of A Coruña (INIBIC), Universitary Hospital of A Coruña (CHUAC), SERGAS. University of A Coruña (UDC), A Coruña, Galicia, Spain
| |
Collapse
|
9
|
Huang YS, Cheng CY, Sun HY, Cheng SH, Lu PL, Lee CH, Lee YT, Tsai HC, Yang CJ, Liu CE, Liou BH, Lin SP, Huang SH, Ho MW, Tang HJ, Hung CC. Week 96 Results of Switching from Tenofovir Disoproxil Fumarate-Based Antiretroviral Therapy to Coformulated Elvitegravir, Cobicistat, Emtricitabine, and Tenofovir Alafenamide among HIV/Hepatitis B Virus-Coinfected Patients. Microbiol Spectr 2023; 11:e0512522. [PMID: 36988457 PMCID: PMC10269761 DOI: 10.1128/spectrum.05125-22] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/28/2023] [Indexed: 03/30/2023] Open
Abstract
Data regarding the durability of tenofovir alafenamide (TAF)-containing antiretroviral therapy (ART) in maintaining hepatitis B virus (HBV) viral suppression among HIV/HBV-coinfected patients are limited. Between February and October 2018, 274 HIV/HBV-coinfected participants who had achieved HIV RNA of <50 copies/mL with tenofovir disoproxil fumarate (TDF)-containing ART and switched to elvitegravir/cobicistat/emtricitabine/TAF were prospectively enrolled. Serial plasma HIV and HBV viral loads, HBV and hepatitis D virus (HDV) serology, renal parameters, metabolic profiles, and bone mineral density (BMD) were assessed through 96 weeks. At baseline and weeks 48, 72, and 96, 5.8%, 5.1%, 5.8%, and 5.1% of the participants had plasma HBV DNA of ≥20 IU/mL, and 0%, 0.7%, 1.5%, and 2.2% had HIV RNA of ≥50 copies/mL, respectively. Hepatitis B surface antigen (HBsAg) loss occurred in 1.5% of 274 participants, and hepatitis B e-antigen (HBeAg) loss or seroconversion occurred in 14.3% of 35 HBeAg-positive participants. Compared with baseline, the median urine protein-to-creatinine ratio (79 versus 63 mg/g, P < 0.001) and β2-microglobulin-to-creatinine ratio (165 versus 83 μg/g, P < 0.001) continued to decrease at week 96. BMD of the spine and hip slightly increased (mean change, +0.9% and +0.5%, respectively). The median triglycerides, total cholesterol, low-density lipoprotein (LDL)-cholesterol and high-density lipoprotein (HDL)-cholesterol increased from baseline to week 96 (116 versus 141, 166 versus 190, 99 versus 117, and 42 versus 47 mg/dL, respectively; all P < 0.001), and most of the increases occurred in the first 48 weeks of the switch. Our study showed that switching from TDF-containing ART to elvitegravir/cobicistat/emtricitabine/TAF maintained HBV and HIV viral suppression through 96 weeks among HIV/HBV-coinfected patients. Proteinuria continued to improve, while fasting lipids increased and BMD stabilized at 96 weeks after the switch. IMPORTANCE Elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide as a maintenance therapy showed durable and high rates of viral suppression for HIV/HBV-coinfected patients, with only 5.1% and 2.2% of patients having HBV DNA of ≥20 IU/mL and HIV RNA of ≥50 copies/mL, respectively, at 96 weeks. Our study fills the data gap on the long-term clinical effectiveness of tenofovir alafenamide-containing antiretroviral therapy in people living with HIV who have HBV coinfection.
Collapse
Affiliation(s)
- Yu-Shan Huang
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chien-Yu Cheng
- Department of Infectious Diseases, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
- School of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hsin-Yun Sun
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Shu-Hsing Cheng
- Department of Infectious Diseases, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
- School of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Po-Liang Lu
- Department of Internal Medicine, Kaohsiung Medical University and College of Medicine, Kaohsiung, Taiwan
| | - Chen-Hsiang Lee
- Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yuan-Ti Lee
- Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Hung-Chin Tsai
- Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chia-Jui Yang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chun-Eng Liu
- Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Bo-Huang Liou
- Department of Internal Medicine, Hsinchu MacKay Memorial Hospital, Hsinchu City, Taiwan
| | - Shih-Ping Lin
- Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Sung-Hsi Huang
- Department of Internal Medicine, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan
- Department of Tropical Medicine and Parasitology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Mao-Wang Ho
- Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Hung-Jen Tang
- Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
- Department of Health and Nutrition, Chia Nan University of Pharmacy and Sciences, Tainan, Taiwan
| | - Chien-Ching Hung
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Tropical Medicine and Parasitology, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan
| | - on behalf of the Taiwan HIV Study Group
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Infectious Diseases, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
- School of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
- School of Public Health, Taipei Medical University, Taipei, Taiwan
- Department of Internal Medicine, Kaohsiung Medical University and College of Medicine, Kaohsiung, Taiwan
- Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
- Department of Internal Medicine, Hsinchu MacKay Memorial Hospital, Hsinchu City, Taiwan
- Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan
- Department of Tropical Medicine and Parasitology, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
- Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
- Department of Health and Nutrition, Chia Nan University of Pharmacy and Sciences, Tainan, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan
| |
Collapse
|
10
|
Mondesert E, Reynes J, Makinson A, Bargnoux AS, Plawecki M, Morquin D, Cristol JP, Badiou S. Cystatin C in addition to creatinine for better assessment of glomerular renal function decline in people with HIV receiving antiretroviral therapy. AIDS 2023; 37:447-454. [PMID: 36695357 DOI: 10.1097/qad.0000000000003434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To compare the estimated glomerular filtration rate (eGFR) using the creatinine equation (eGFRcreat) or the cystatin C equation (eGFRcys) in people with HIV (PWH) under antiretroviral drugs. We specifically included patients with an eGFRcreat around 60 ml/min per 1.73 m2 to evaluate agreement on stage 2 and 3 chronic kidney disease (CKD) classification. DESIGN eGFRcreat, eGFRcys and resulting CKD staging were determined in 262 consecutive patients with HIV-1 (PWH) with a suppressed viral load (<200 copies/ml) under antiretroviral drugs and having impaired renal function (eGFRcreat between 45 and 80 ml/min per 1.73 m2). Antiretroviral drugs regimens were classified into eight groups: cobicistat (COBI)+elvitegravir (EVG), ritonavir (RTV)+protease inhibitor, dolutegravir (DTG), DTG+rilpivirine (RPV), RPV, raltegravir (RAL), bictegravir (BIC), and other antiretroviral drugs. RESULTS Mean eGFRcys was higher than mean eGFRcreat (77.7 ± 0.5 vs. 67.9 ± 7.9 ml/min per 1.73 m2, P < 0.0001). The differences were significant in five treatment groups with COBI/EVG; DTG; DTG+RPV; RPV; RAL. CKD classification was modified for 51% of patients when using eGFRcys instead of eGFRcreat, with reclassification to less severe stages in 37% and worse stages in 14%. CONCLUSION This study highlighted significant differences in eGFR depending on the renal marker used in PWH, having a significant impact on CKD classification. eGFRcys should be an additive tool for patients having eGFRcreat around 60 ml/min per 1.73 m2 for better identification of renal impairment.
Collapse
Affiliation(s)
| | - Jacques Reynes
- Department of Infectious Diseases, University Hospital of Montpellier, Institut National de la Santé et de Recherche Médicale U1175 and University of Montpellier
| | - Alain Makinson
- Department of Infectious Diseases, University Hospital of Montpellier, Institut National de la Santé et de Recherche Médicale U1175 and University of Montpellier
| | - Anne-Sophie Bargnoux
- Department of Biochemistry, University Hospital of Montpellier
- PhyMedExp, Université de Montpellier, INSERM, CNRS, Montpellier, France
| | - Maëlle Plawecki
- Department of Biochemistry, University Hospital of Montpellier
- PhyMedExp, Université de Montpellier, INSERM, CNRS, Montpellier, France
| | - David Morquin
- Department of Infectious Diseases, University Hospital of Montpellier, Institut National de la Santé et de Recherche Médicale U1175 and University of Montpellier
| | - Jean-Paul Cristol
- Department of Biochemistry, University Hospital of Montpellier
- PhyMedExp, Université de Montpellier, INSERM, CNRS, Montpellier, France
| | - Stéphanie Badiou
- Department of Biochemistry, University Hospital of Montpellier
- PhyMedExp, Université de Montpellier, INSERM, CNRS, Montpellier, France
| |
Collapse
|
11
|
Marin RC, Bungau SG, Tit DM, Negru PA, Radu AF, Moleriu RD. Immune recovery among Romanian HIV/AIDS patients receiving darunavir/ritonavir or darunavir/cobicistat regimens in cART management: A three-year study. Biomed Pharmacother 2023; 161:114427. [PMID: 36822019 DOI: 10.1016/j.biopha.2023.114427] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/16/2023] [Accepted: 02/17/2023] [Indexed: 02/23/2023] Open
Abstract
Approximately two-thirds of Romanian HIV patients were parenterally infected with the F subtype of HIV in early childhood. They are now in the context of immunological aging, with immunosuppression posing an additional challenge in developing the most effective and well-tolerated regimens. The risk of an improper immune recovery is higher in these patients than in newly diagnosed patients. The primary goal of this retrospective study was to conduct a comparative analysis of the immune recovery, measured at three time points, on 462 HIV-infected patients who were registered at the "Matei Balş National Institute of Infectious Diseases", Bucharest, Romania, between 2018 and 2021, as follows: darunavir (DRV) 600 mg plus ritonavir (RTV) 100 mg (twice daily) was given to 384 patients, while DRV 800 mg plus cobicistat (COBI) 150 mg was given to 78 patients (once daily). The immune response was assessed by counting T lymphocytes, CD4 count cells/mm3, and the CD4/CD8 lymphocyte count ratio. Additionally, the study assessed the relationship between the immune and virological responses to therapy. Using various statistical tests, the results revealed that the immune response is normal in both groups, but with a statistically significant difference (p < 0.05) for the DRV/c group. Statistical associations between RNA viral plasma load and immune response (CD4 count and CD4/CD8 ratio) were assessed at all three visits and showed an insignificant association for the first two time points; however, at the final visit, the outcomes changed and reached statistical significance for both groups.
Collapse
Affiliation(s)
- Ruxandra-Cristina Marin
- Doctoral School of Biological and Biomedical Sciences, University of Oradea, 410087 Oradea, Romania.
| | - Simona Gabriela Bungau
- Doctoral School of Biological and Biomedical Sciences, University of Oradea, 410087 Oradea, Romania; Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania.
| | - Delia Mirela Tit
- Doctoral School of Biological and Biomedical Sciences, University of Oradea, 410087 Oradea, Romania; Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania.
| | - Paul Andrei Negru
- Doctoral School of Biological and Biomedical Sciences, University of Oradea, 410087 Oradea, Romania.
| | - Andrei-Flavius Radu
- Doctoral School of Biological and Biomedical Sciences, University of Oradea, 410087 Oradea, Romania.
| | - Radu Dumitru Moleriu
- Department of Mathematics, Faculty of Mathematics and Computer Science, West University of Timisoara, 300223 Timisoara, Romania.
| |
Collapse
|
12
|
Andrade A, Fuchs EJ, Marzinke MA, Abdul Massih S, Breakey J, Beselman S, McNicholl I, Hendrix CW. EVG/COBI/FTC/TAF Bioequivalence Comparing Whole Tablets with Tablets Dissolved in Tap Water. AIDS Res Hum Retroviruses 2023; 39:38-43. [PMID: 36301928 PMCID: PMC9910106 DOI: 10.1089/aid.2022.0085] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Medication adherence can be challenging for persons with difficulty swallowing tablets. We investigated the bioequivalence of a dissolved tablet when compared with that of a whole tablet of the fixed-dose combination elvitegravir (EVG)/cobicistat (COBI)/emtricitabine (FTC)/tenofovir (TFV) alafenamide fumarate (TAF). A within-subject fixed-order two-period open-label study was conducted in 12 HIV-negative research participants after obtaining informed consent. Participants took a single dose each of the whole tablet and dissolved tablet under direct observation, separated by a 14-day washout period. The dissolved tablet was prepared by adding one whole EVG/COBI/FTC/TAF tablet to 120 mL tap water and stirring. Both dosage types were taken with a standardized meal. Plasma samples were obtained for 72 h postdose. Plasma EVG, FTC, TAF, and TFV were analyzed with liquid chromatographic-tandem mass spectrometric methods. Peak plasma concentration (Cmax) and the area under the concentration-time curve extrapolated to infinity (AUC0-∞) were estimated using WinNonlin software (v.8.3). The primary outcome was bioequivalence consistent with FDA guidance using the 90% confidence interval or the geometric mean ratio. Of 12 participants, 7 were black (58%) and 5 were white (42%), 4 were women (33%), 8 were men (67%), and the mean age was 43.6 years (23-54). There were no complaints about taste with the dissolved tablet. Bioequivalence was established only for FTC. EVG Cmax and AUC0-∞ were higher by 18% and 12%, respectively, when taking the dissolved compared with the whole tablet. TAF AUC0-∞ and Cmax were both 8% lower, whereas TFV Cmax and AUC0-∞ were 8% and 5% lower, respectively, when taken after dissolution. EVG/COBI/FTC/TAF dissolved rapidly in water and had no unpleasant taste. Increases in EVG and decreases in TAF and TFV concentrations were observed when taking dissolved EVG/COBI/FTC/TAF. These changes were judged to be clinically insignificant. Dissolving EVG/COBI/FTC/TAF in water may be suitable for those with pill swallowing challenges. The trial was registered on (//clinicaltrials.gov NCT03717129).
Collapse
Affiliation(s)
| | - Edward J. Fuchs
- Division of Clinical Pharmacology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mark A. Marzinke
- Division of Clinical Pharmacology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sandra Abdul Massih
- Division of Clinical Pharmacology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jennifer Breakey
- Division of Clinical Pharmacology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sasha Beselman
- Division of Clinical Pharmacology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Craig W. Hendrix
- Division of Clinical Pharmacology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
13
|
Solana-Altabella A, Monte-Boquet E, Montero M, Pérez-Huertas P, Cuéllar-Monreal MJ, Salavert M, Poveda-Andrés JL. Observational study to evaluate discontinuation of monotherapy with cobicistat-boosted darunavir in patients with human immunodeficiency virus. Medicine (Baltimore) 2022; 101:e32208. [PMID: 36626459 PMCID: PMC9750541 DOI: 10.1097/md.0000000000032208] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
To evaluate the reasons for changing to monotherapy with protease inhibitors, together with the proportion and reasons for the interruption to treatment, in patients who have been treated at some point with cobicistat-boosted darunavir (DRV/c). Outpatients in a tertiary hospital. Observational retrospective study to evaluate monotherapy with DRV/c (800 mg/150 mg) in adult patients with human immunodeficiency virus infection, from December 2014 to July 2022. Demographic variables, viral load, cluster of differentiation 4 lymphocyte lymphocyte count, and antiretroviral therapy were assessed. 42 patients were included. 36% of the patients were undergoing monotherapy at the time of the analysis. The main reason for discontinuation was poor adherence. At time of analysis, 80% of the patients in monotherapy had an undetectable viral load. Antiretroviral therapy recommendations advise against exposing the patient to functional monotherapy with a single drug due to the high risk of virological failure and the onset of resistance to a single drug. Following the analysis of the results, DRV/c in monotherapy is not an effective strategy in the medium and long term due to factors such as lack of adherence or virological failure, although it can be maintained in specific circumstances. Therefore, patients undergoing monotherapy require close monitoring.
Collapse
Affiliation(s)
- Antonio Solana-Altabella
- Pharmacy Department, Hospital Universitario y Politécnico La Fe
- Instituto de Investigación Sanitaria La Fe (IISLAFE)
- * Correspondence: Antonio Solana-Altabella, Pharmacy Department. Hospital Universitario y Politécnico La Fe (e-mail: )
| | | | - Marta Montero
- Infectious Disease Unit, Hospital Universitario y Politécnico La Fe
| | | | | | - Miguel Salavert
- Infectious Disease Unit, Hospital Universitario y Politécnico La Fe
| | | |
Collapse
|
14
|
Fan L, Li L, Gao L, Hu Y, Yu A, Zhang D, Qiu C, Huang R, Wu Y, Ma P. Advantages of switching to elvitegravir/cobicistat/emtricitabine/tenofovir therapy in virologically-suppressed people living with human immunodeficiency virus/acquired immune deficiency syndrome. Chin Med J (Engl) 2022; 135:2747-2749. [PMID: 36574215 PMCID: PMC9945251 DOI: 10.1097/cm9.0000000000002503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Indexed: 12/28/2022] Open
Affiliation(s)
- Lina Fan
- Department of Infectious Diseases, Tianjin Second People's Hospital, Tianjin 300192, China
| | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Patel K, Huo Y, Jao J, Powis KM, Williams PL, Kacanek D, Yee LM, Chadwick EG, Shiau S, Jacobson DL, Brummel SS, Sultan-Beyer L, Kahlert CR, Zash R, Seage GR. Dolutegravir in Pregnancy as Compared with Current HIV Regimens in the United States. N Engl J Med 2022; 387:799-809. [PMID: 36053505 PMCID: PMC9744124 DOI: 10.1056/nejmoa2200600] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Data on the effectiveness and safety of dolutegravir-based antiretroviral therapy (ART) for human immunodeficiency virus type 1 (HIV-1) infection in pregnancy as compared with other ART regimens commonly used in the United States and Europe, particularly when initiated before conception, are limited. METHODS We conducted a study involving pregnancies in persons with HIV-1 infection in the Pediatric HIV/AIDS Cohort Study whose initial ART in pregnancy included dolutegravir, atazanavir-ritonavir, darunavir-ritonavir, oral rilpivirine, raltegravir, or elvitegravir-cobicistat. Viral suppression at delivery and the risks of infants being born preterm, having low birth weight, and being small for gestational age were compared between each non-dolutegravir-based ART regimen and dolutegravir-based ART. Supplementary analyses that included participants in the Swiss Mother and Child HIV Cohort Study were conducted to improve the precision of our results. RESULTS Of the pregnancies in the study, 120 were in participants who received dolutegravir, 464 in those who received atazanavir-ritonavir, 185 in those who received darunavir-ritonavir, 243 in those who received rilpivirine, 86 in those who received raltegravir, and 159 in those who received elvitegravir-cobicistat. The median age at conception was 29 years; 51% of the pregnancies were in participants who started ART before conception. Viral suppression was present at delivery in 96.7% of the pregnancies in participants who received dolutegravir; corresponding percentages were 84.0% for atazanavir-ritonavir, 89.2% for raltegravir, and 89.8% for elvitegravir-cobicistat (adjusted risk differences vs. dolutegravir, -13.0 percentage points [95% confidence interval {CI}, -17.0 to -6.1], -17.0 percentage points [95% CI, -27.0 to -2.4], and -7.0 percentage points [95% CI, -13.3 to -0.0], respectively). The observed risks of preterm birth were 13.6 to 17.6%. Adjusted risks of infants being born preterm, having low birth weight, or being small for gestational age did not differ substantially between non-dolutegravir-based ART and dolutegravir. Results of supplementary analyses were similar. CONCLUSIONS Atazanavir-ritonavir and raltegravir were associated with less frequent viral suppression at delivery than dolutegravir. No clear differences in adverse birth outcomes were observed with dolutegravir-based ART as compared with non-dolutegravir-based ART, although samples were small. (Funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and others.).
Collapse
Affiliation(s)
- Kunjal Patel
- From the Department of Epidemiology (K.P., P.L.W., G.R.S.), the Center for Biostatistics in AIDS Research (K.P., Y.H., P.L.W., D.K., D.L.J., S.S.B., G.R.S.), and the Department of Immunology and Infectious Diseases (K.M.P.), Harvard T.H. Chan School of Public Health, the Departments of Pediatrics and Medicine, Massachusetts General Hospital (K.M.P.), and the Department of Medicine, Beth Israel Deaconess Medical Center (R.Z.) - all in Boston; the Departments of Pediatrics (J.J., E.G.C.) and Obstetrics and Gynecology (L.M.Y.), Northwestern University Feinberg School of Medicine, Chicago; the Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ (S.S.); and the Department of Gynecology, University Hospital Zurich, Zurich (L.S.-B.), and Department of Infectious Diseases and Hospital Epidemiology, Children's Hospital of Eastern Switzerland, St. Gallen (C.R.K.) - both in Switzerland
| | - Yanling Huo
- From the Department of Epidemiology (K.P., P.L.W., G.R.S.), the Center for Biostatistics in AIDS Research (K.P., Y.H., P.L.W., D.K., D.L.J., S.S.B., G.R.S.), and the Department of Immunology and Infectious Diseases (K.M.P.), Harvard T.H. Chan School of Public Health, the Departments of Pediatrics and Medicine, Massachusetts General Hospital (K.M.P.), and the Department of Medicine, Beth Israel Deaconess Medical Center (R.Z.) - all in Boston; the Departments of Pediatrics (J.J., E.G.C.) and Obstetrics and Gynecology (L.M.Y.), Northwestern University Feinberg School of Medicine, Chicago; the Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ (S.S.); and the Department of Gynecology, University Hospital Zurich, Zurich (L.S.-B.), and Department of Infectious Diseases and Hospital Epidemiology, Children's Hospital of Eastern Switzerland, St. Gallen (C.R.K.) - both in Switzerland
| | - Jennifer Jao
- From the Department of Epidemiology (K.P., P.L.W., G.R.S.), the Center for Biostatistics in AIDS Research (K.P., Y.H., P.L.W., D.K., D.L.J., S.S.B., G.R.S.), and the Department of Immunology and Infectious Diseases (K.M.P.), Harvard T.H. Chan School of Public Health, the Departments of Pediatrics and Medicine, Massachusetts General Hospital (K.M.P.), and the Department of Medicine, Beth Israel Deaconess Medical Center (R.Z.) - all in Boston; the Departments of Pediatrics (J.J., E.G.C.) and Obstetrics and Gynecology (L.M.Y.), Northwestern University Feinberg School of Medicine, Chicago; the Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ (S.S.); and the Department of Gynecology, University Hospital Zurich, Zurich (L.S.-B.), and Department of Infectious Diseases and Hospital Epidemiology, Children's Hospital of Eastern Switzerland, St. Gallen (C.R.K.) - both in Switzerland
| | - Kathleen M Powis
- From the Department of Epidemiology (K.P., P.L.W., G.R.S.), the Center for Biostatistics in AIDS Research (K.P., Y.H., P.L.W., D.K., D.L.J., S.S.B., G.R.S.), and the Department of Immunology and Infectious Diseases (K.M.P.), Harvard T.H. Chan School of Public Health, the Departments of Pediatrics and Medicine, Massachusetts General Hospital (K.M.P.), and the Department of Medicine, Beth Israel Deaconess Medical Center (R.Z.) - all in Boston; the Departments of Pediatrics (J.J., E.G.C.) and Obstetrics and Gynecology (L.M.Y.), Northwestern University Feinberg School of Medicine, Chicago; the Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ (S.S.); and the Department of Gynecology, University Hospital Zurich, Zurich (L.S.-B.), and Department of Infectious Diseases and Hospital Epidemiology, Children's Hospital of Eastern Switzerland, St. Gallen (C.R.K.) - both in Switzerland
| | - Paige L Williams
- From the Department of Epidemiology (K.P., P.L.W., G.R.S.), the Center for Biostatistics in AIDS Research (K.P., Y.H., P.L.W., D.K., D.L.J., S.S.B., G.R.S.), and the Department of Immunology and Infectious Diseases (K.M.P.), Harvard T.H. Chan School of Public Health, the Departments of Pediatrics and Medicine, Massachusetts General Hospital (K.M.P.), and the Department of Medicine, Beth Israel Deaconess Medical Center (R.Z.) - all in Boston; the Departments of Pediatrics (J.J., E.G.C.) and Obstetrics and Gynecology (L.M.Y.), Northwestern University Feinberg School of Medicine, Chicago; the Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ (S.S.); and the Department of Gynecology, University Hospital Zurich, Zurich (L.S.-B.), and Department of Infectious Diseases and Hospital Epidemiology, Children's Hospital of Eastern Switzerland, St. Gallen (C.R.K.) - both in Switzerland
| | - Deborah Kacanek
- From the Department of Epidemiology (K.P., P.L.W., G.R.S.), the Center for Biostatistics in AIDS Research (K.P., Y.H., P.L.W., D.K., D.L.J., S.S.B., G.R.S.), and the Department of Immunology and Infectious Diseases (K.M.P.), Harvard T.H. Chan School of Public Health, the Departments of Pediatrics and Medicine, Massachusetts General Hospital (K.M.P.), and the Department of Medicine, Beth Israel Deaconess Medical Center (R.Z.) - all in Boston; the Departments of Pediatrics (J.J., E.G.C.) and Obstetrics and Gynecology (L.M.Y.), Northwestern University Feinberg School of Medicine, Chicago; the Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ (S.S.); and the Department of Gynecology, University Hospital Zurich, Zurich (L.S.-B.), and Department of Infectious Diseases and Hospital Epidemiology, Children's Hospital of Eastern Switzerland, St. Gallen (C.R.K.) - both in Switzerland
| | - Lynn M Yee
- From the Department of Epidemiology (K.P., P.L.W., G.R.S.), the Center for Biostatistics in AIDS Research (K.P., Y.H., P.L.W., D.K., D.L.J., S.S.B., G.R.S.), and the Department of Immunology and Infectious Diseases (K.M.P.), Harvard T.H. Chan School of Public Health, the Departments of Pediatrics and Medicine, Massachusetts General Hospital (K.M.P.), and the Department of Medicine, Beth Israel Deaconess Medical Center (R.Z.) - all in Boston; the Departments of Pediatrics (J.J., E.G.C.) and Obstetrics and Gynecology (L.M.Y.), Northwestern University Feinberg School of Medicine, Chicago; the Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ (S.S.); and the Department of Gynecology, University Hospital Zurich, Zurich (L.S.-B.), and Department of Infectious Diseases and Hospital Epidemiology, Children's Hospital of Eastern Switzerland, St. Gallen (C.R.K.) - both in Switzerland
| | - Ellen G Chadwick
- From the Department of Epidemiology (K.P., P.L.W., G.R.S.), the Center for Biostatistics in AIDS Research (K.P., Y.H., P.L.W., D.K., D.L.J., S.S.B., G.R.S.), and the Department of Immunology and Infectious Diseases (K.M.P.), Harvard T.H. Chan School of Public Health, the Departments of Pediatrics and Medicine, Massachusetts General Hospital (K.M.P.), and the Department of Medicine, Beth Israel Deaconess Medical Center (R.Z.) - all in Boston; the Departments of Pediatrics (J.J., E.G.C.) and Obstetrics and Gynecology (L.M.Y.), Northwestern University Feinberg School of Medicine, Chicago; the Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ (S.S.); and the Department of Gynecology, University Hospital Zurich, Zurich (L.S.-B.), and Department of Infectious Diseases and Hospital Epidemiology, Children's Hospital of Eastern Switzerland, St. Gallen (C.R.K.) - both in Switzerland
| | - Stephanie Shiau
- From the Department of Epidemiology (K.P., P.L.W., G.R.S.), the Center for Biostatistics in AIDS Research (K.P., Y.H., P.L.W., D.K., D.L.J., S.S.B., G.R.S.), and the Department of Immunology and Infectious Diseases (K.M.P.), Harvard T.H. Chan School of Public Health, the Departments of Pediatrics and Medicine, Massachusetts General Hospital (K.M.P.), and the Department of Medicine, Beth Israel Deaconess Medical Center (R.Z.) - all in Boston; the Departments of Pediatrics (J.J., E.G.C.) and Obstetrics and Gynecology (L.M.Y.), Northwestern University Feinberg School of Medicine, Chicago; the Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ (S.S.); and the Department of Gynecology, University Hospital Zurich, Zurich (L.S.-B.), and Department of Infectious Diseases and Hospital Epidemiology, Children's Hospital of Eastern Switzerland, St. Gallen (C.R.K.) - both in Switzerland
| | - Denise L Jacobson
- From the Department of Epidemiology (K.P., P.L.W., G.R.S.), the Center for Biostatistics in AIDS Research (K.P., Y.H., P.L.W., D.K., D.L.J., S.S.B., G.R.S.), and the Department of Immunology and Infectious Diseases (K.M.P.), Harvard T.H. Chan School of Public Health, the Departments of Pediatrics and Medicine, Massachusetts General Hospital (K.M.P.), and the Department of Medicine, Beth Israel Deaconess Medical Center (R.Z.) - all in Boston; the Departments of Pediatrics (J.J., E.G.C.) and Obstetrics and Gynecology (L.M.Y.), Northwestern University Feinberg School of Medicine, Chicago; the Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ (S.S.); and the Department of Gynecology, University Hospital Zurich, Zurich (L.S.-B.), and Department of Infectious Diseases and Hospital Epidemiology, Children's Hospital of Eastern Switzerland, St. Gallen (C.R.K.) - both in Switzerland
| | - Sean S Brummel
- From the Department of Epidemiology (K.P., P.L.W., G.R.S.), the Center for Biostatistics in AIDS Research (K.P., Y.H., P.L.W., D.K., D.L.J., S.S.B., G.R.S.), and the Department of Immunology and Infectious Diseases (K.M.P.), Harvard T.H. Chan School of Public Health, the Departments of Pediatrics and Medicine, Massachusetts General Hospital (K.M.P.), and the Department of Medicine, Beth Israel Deaconess Medical Center (R.Z.) - all in Boston; the Departments of Pediatrics (J.J., E.G.C.) and Obstetrics and Gynecology (L.M.Y.), Northwestern University Feinberg School of Medicine, Chicago; the Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ (S.S.); and the Department of Gynecology, University Hospital Zurich, Zurich (L.S.-B.), and Department of Infectious Diseases and Hospital Epidemiology, Children's Hospital of Eastern Switzerland, St. Gallen (C.R.K.) - both in Switzerland
| | - Leila Sultan-Beyer
- From the Department of Epidemiology (K.P., P.L.W., G.R.S.), the Center for Biostatistics in AIDS Research (K.P., Y.H., P.L.W., D.K., D.L.J., S.S.B., G.R.S.), and the Department of Immunology and Infectious Diseases (K.M.P.), Harvard T.H. Chan School of Public Health, the Departments of Pediatrics and Medicine, Massachusetts General Hospital (K.M.P.), and the Department of Medicine, Beth Israel Deaconess Medical Center (R.Z.) - all in Boston; the Departments of Pediatrics (J.J., E.G.C.) and Obstetrics and Gynecology (L.M.Y.), Northwestern University Feinberg School of Medicine, Chicago; the Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ (S.S.); and the Department of Gynecology, University Hospital Zurich, Zurich (L.S.-B.), and Department of Infectious Diseases and Hospital Epidemiology, Children's Hospital of Eastern Switzerland, St. Gallen (C.R.K.) - both in Switzerland
| | - Christian R Kahlert
- From the Department of Epidemiology (K.P., P.L.W., G.R.S.), the Center for Biostatistics in AIDS Research (K.P., Y.H., P.L.W., D.K., D.L.J., S.S.B., G.R.S.), and the Department of Immunology and Infectious Diseases (K.M.P.), Harvard T.H. Chan School of Public Health, the Departments of Pediatrics and Medicine, Massachusetts General Hospital (K.M.P.), and the Department of Medicine, Beth Israel Deaconess Medical Center (R.Z.) - all in Boston; the Departments of Pediatrics (J.J., E.G.C.) and Obstetrics and Gynecology (L.M.Y.), Northwestern University Feinberg School of Medicine, Chicago; the Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ (S.S.); and the Department of Gynecology, University Hospital Zurich, Zurich (L.S.-B.), and Department of Infectious Diseases and Hospital Epidemiology, Children's Hospital of Eastern Switzerland, St. Gallen (C.R.K.) - both in Switzerland
| | - Rebecca Zash
- From the Department of Epidemiology (K.P., P.L.W., G.R.S.), the Center for Biostatistics in AIDS Research (K.P., Y.H., P.L.W., D.K., D.L.J., S.S.B., G.R.S.), and the Department of Immunology and Infectious Diseases (K.M.P.), Harvard T.H. Chan School of Public Health, the Departments of Pediatrics and Medicine, Massachusetts General Hospital (K.M.P.), and the Department of Medicine, Beth Israel Deaconess Medical Center (R.Z.) - all in Boston; the Departments of Pediatrics (J.J., E.G.C.) and Obstetrics and Gynecology (L.M.Y.), Northwestern University Feinberg School of Medicine, Chicago; the Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ (S.S.); and the Department of Gynecology, University Hospital Zurich, Zurich (L.S.-B.), and Department of Infectious Diseases and Hospital Epidemiology, Children's Hospital of Eastern Switzerland, St. Gallen (C.R.K.) - both in Switzerland
| | - George R Seage
- From the Department of Epidemiology (K.P., P.L.W., G.R.S.), the Center for Biostatistics in AIDS Research (K.P., Y.H., P.L.W., D.K., D.L.J., S.S.B., G.R.S.), and the Department of Immunology and Infectious Diseases (K.M.P.), Harvard T.H. Chan School of Public Health, the Departments of Pediatrics and Medicine, Massachusetts General Hospital (K.M.P.), and the Department of Medicine, Beth Israel Deaconess Medical Center (R.Z.) - all in Boston; the Departments of Pediatrics (J.J., E.G.C.) and Obstetrics and Gynecology (L.M.Y.), Northwestern University Feinberg School of Medicine, Chicago; the Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ (S.S.); and the Department of Gynecology, University Hospital Zurich, Zurich (L.S.-B.), and Department of Infectious Diseases and Hospital Epidemiology, Children's Hospital of Eastern Switzerland, St. Gallen (C.R.K.) - both in Switzerland
| |
Collapse
|
16
|
Gaur AH, Panetta JC, Smith AM, Dallas RH, Freeman BB, Stewart TB, Tang L, John E, Branum KC, Patel ND, Ost S, Heine RN, Richardson JL, Hammill JT, Bebrevska L, Gusovsky F, Maki N, Yanagi T, Flynn PM, McCarthy JS, Chalon S, Guy RK. Combining SJ733, an oral ATP4 inhibitor of Plasmodium falciparum, with the pharmacokinetic enhancer cobicistat: An innovative approach in antimalarial drug development. EBioMedicine 2022; 80:104065. [PMID: 35598441 PMCID: PMC9127571 DOI: 10.1016/j.ebiom.2022.104065] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 04/07/2022] [Accepted: 05/04/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND SJ733, a newly developed inhibitor of P. falciparum ATP4, has a favorable safety profile and rapid antiparasitic effect but insufficient duration to deliver a single-dose cure of malaria. We investigated the safety, tolerability, and pharmacokinetics of a multidose SJ733 regimen and a single-dose pharmacoboost approach using cobicistat to inhibit CYP3A4, thereby increasing exposure. METHODS Two multidose unboosted cohorts (n = 9) (SJ733, 300 mg and 600 mg daily for 3 days) followed by three single-dose boosted cohorts combining SJ733 (n = 18) (75-, 300-, or 600-mg single dose) with cobicistat (150-mg single dose) as a pharmacokinetic booster were evaluated in healthy volunteers (ClinicalTrials.gov: NCT02661373). FINDINGS All participants tolerated SJ733 well, with no serious adverse events (AEs), dose-limiting toxicity, or clinically significant electrocardiogram or laboratory test findings. All reported AEs were Grade 1, clinically insignificant, and considered unlikely or unrelated to SJ733. Compared to unboosted cohorts, the SJ733/cobicistat-boosted cohorts showed a median increase in area under the curve and maximum concentration of 3·9 × and 2·6 ×, respectively, and a median decrease in the ratio of the major CYP3A-produced metabolite SJ506 to parent drug of 4·6 × . Incorporating these data in a model of parasite dynamics indicated that a 3-day regimen of SJ733/cobicistat (600 mg/150 mg daily) relative to a single 600-mg dose ± cobicistat would increase parasite clearance from 106 to 1012 parasites/µL. INTERPRETATION The multidose and pharmacoboosted approaches to delivering SJ733 were well-tolerated and significantly increased drug exposure and prediction of cure. This study supports the further development of SJ733 and demonstrates an innovative pharmacoboost approach for an antimalarial. FUNDING Global Health Innovative Technology Fund, Medicines for Malaria Venture, National Institutes of Health, and American Lebanese Syrian Associated Charities.
Collapse
Affiliation(s)
- Aditya H Gaur
- Translational Trials Unit, MS 600, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, United States.
| | - John C Panetta
- Translational Trials Unit, MS 600, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, United States
| | - Amber M Smith
- University of Tennessee Health Science Center, Memphis, TN, United States
| | - Ronald H Dallas
- Translational Trials Unit, MS 600, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, United States
| | - Burgess B Freeman
- Translational Trials Unit, MS 600, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, United States
| | - Tracy B Stewart
- Translational Trials Unit, MS 600, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, United States
| | - Li Tang
- Translational Trials Unit, MS 600, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, United States
| | | | - Kristen C Branum
- Translational Trials Unit, MS 600, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, United States
| | - Nehali D Patel
- Translational Trials Unit, MS 600, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, United States
| | - Shelley Ost
- University of Tennessee Health Science Center, Memphis, TN, United States
| | - Ryan N Heine
- Translational Trials Unit, MS 600, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, United States
| | - Julie L Richardson
- Translational Trials Unit, MS 600, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, United States
| | - Jared T Hammill
- University of Kentucky College of Pharmacy, Lexington, KY, United States
| | | | | | | | | | - Patricia M Flynn
- Translational Trials Unit, MS 600, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, United States
| | - James S McCarthy
- Department of Clinical Tropical Medicine, QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
| | | | - R Kiplin Guy
- University of Kentucky College of Pharmacy, Lexington, KY, United States
| |
Collapse
|
17
|
Ranzenigo M, Gianotti N, Galli L, Poli A, Mastrangelo A, Bruzzesi E, Chiurlo M, Nozza S, Bossolasco S, Spagnuolo V, Mancusi D, Termini R, Carini E, Lazzarin A, Castagna A. Switching from a Non-Protease inhibitor-Based Regimen To the Fixed Dose Combination of Darunavir/Cobicistat/Emtricitabine/Tenofovir Alafenamide in Clinical Practice. Drug Des Devel Ther 2022; 16:1975-1982. [PMID: 35783200 PMCID: PMC9249346 DOI: 10.2147/dddt.s358976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 06/14/2022] [Indexed: 11/23/2022] Open
Abstract
Background Methods Results Conclusion
Collapse
Affiliation(s)
- Martina Ranzenigo
- Vita-Salute San Raffaele University, Milan, Italy
- Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nicola Gianotti
- Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Laura Galli
- Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Poli
- Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Mastrangelo
- Vita-Salute San Raffaele University, Milan, Italy
- Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elena Bruzzesi
- Vita-Salute San Raffaele University, Milan, Italy
- Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Chiurlo
- Vita-Salute San Raffaele University, Milan, Italy
- Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Silvia Nozza
- Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Simona Bossolasco
- Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Vincenzo Spagnuolo
- Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Daniela Mancusi
- Medical Affairs Department, Infectious Disease and Vaccines & PAH, Janssen-Cilag SpA, Cologno Monzese, Italy
- Correspondence: Daniela Mancusi, Medical Affairs Department, Infectious Disease and Vaccines & PAH, Janssen-Cilag SpA, Via Buonarroti 23, Cologno Monzese (MI), 20093, Italy, Tel +0039-345 9581944, Email
| | - Roberta Termini
- Medical Affairs Department, Infectious Disease and Vaccines & PAH, Janssen-Cilag SpA, Cologno Monzese, Italy
| | - Elisabetta Carini
- Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Adriano Lazzarin
- Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonella Castagna
- Vita-Salute San Raffaele University, Milan, Italy
- Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| |
Collapse
|
18
|
Emond B, Rossi C, Côté-Sergent A, Bookhart B, Anderson D, Lefebvre P, Lafeuille MH, Donga P. Body mass index increase and weight gain among people living with HIV-1 initiated on single-tablet darunavir/cobicistat/emtricitabine/tenofovir alafenamide or bictegravir/emtricitabine/tenofovir alafenamide in the United States. Curr Med Res Opin 2022; 38:287-298. [PMID: 34812097 DOI: 10.1080/03007995.2021.2007006] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE This study evaluated body mass index (BMI) and weight changes in people living with human immunodeficiency virus (HIV-1; PLWH) initiated on single-tablet darunavir/cobicistat/emtricitabine/tenofovir alafenamide (DRV/c/FTC/TAF) or bictegravir/FTC/TAF (BIC/FTC/TAF). METHODS Electronic medical record (EMR) data for treatment-naïve or virologically suppressed adults with HIV-1 who initiated treatment with DRV/c/FTC/TAF or BIC/FTC/TAF (index date) were obtained from Decision Resources Group's EMRs (17 July 2017-1 March 2020). Inverse probability of treatment weighting was used to account for differences in baseline characteristics between the two cohorts. BMI and weight changes from pre-index to 3, 6, 9 and 12 months following the index date were compared using weighted mean differences (MDs). The time until an increase in BMI or weight ≥5% or ≥10% was compared using weighted hazard ratios (HRs). RESULTS The weighted DRV/c/FTC/TAF and BIC/FTC/TAF cohorts comprised 1116 and 1134 PLWH, respectively (mean age = ∼49 years, females: ∼28%). Larger increases in BMI and weight from pre-index to each post-index time point were observed in PLWH initiating BIC/FTC/TAF vs DRV/c/FTC/TAF (12 months: MD in BMI = 1.23 kg/m2, p < .001; MD in weight = 2.84 kg [6.26 lbs], p = .008). PLWH receiving BIC/FTC/TAF were significantly more likely to experience weight gain ≥5% (HR = 1.76, p = .004) and ≥10% (HR = 2.01, p = .020), and BMI increase ≥5% (HR = 1.77, p = .004) and ≥10% (HR = 1.76, p = .044) than those receiving DRV/c/FTC/TAF. CONCLUSIONS BIC/FTC/TAF was associated with greater BMI and weight increases compared to DRV/c/FTC/TAF. Weight gain and its sequelae may add to the clinical burden of PLWH and should be considered among other factors when selecting antiretroviral single-tablet regimens.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Prina Donga
- Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| |
Collapse
|
19
|
Xia H, Huang XJ, Hu Y, Gao LY, Wu Y, Wu H, Yan ZF, Ma P. Switching from efavirenz to elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide reduces central nervous system symptoms in people living with HIV. Chin Med J (Engl) 2021; 134:2850-2856. [PMID: 34653085 PMCID: PMC8667980 DOI: 10.1097/cm9.0000000000001824] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Central nervous system (CNS) symptoms after efavirenz (EFV) treatment in people living with human immunodeficiency virus (HIV) could persist and impact their quality of life. We assessed the impact of EFV-based regimen replacement with elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide (E/C/F/TAF), which is considered an alternative option for subjects who do not tolerate EFV. Most specifically, we assessed the safety and the efficacy of E/C/F/TAF and its effects on the participants' neuropsychiatric toxicity symptoms in a real-life setting. METHODS A prospective cohort study was conducted among virologic suppressed HIV-positive participants receiving EFV-based regimens with ongoing CNS toxicity ≥ grade 2. The participants were switched to single-pill combination regimens E/C/F/TAF and followed up for 48 weeks. The neuropsychiatric toxicity symptoms were measured using a CNS side effects questionnaire, as well as the Hospital Anxiety and Depression Scale and the Pittsburgh Sleep Quality Index. The primary outcome measure was the proportion of participants experiencing grade 2 or higher CNS toxicity after EFV switch off at weeks 12, 24, and 48. Secondary endpoints included virologic and immunological responses and the effect on fasting lipids at week 48 after switch. RESULTS One hundred ninety-six participants (96.9% men, median age: 37.5 years, median: 3.7 years on prior EFV-containing regimens) were included in the study. Significant improvements in anxiety and sleep disturbance symptoms were observed at 12, 24, and 48 weeks after switching to E/C/F/TAF (P < 0.05). No significant change in depression symptom scores was observed. At 48 weeks after switch, HIV viral load <50 copies/mL was maintained in all of the participants, median fasting lipid levels were moderately increased (total cholesterol [TC]: 8.2 mg/dL, low-density lipoprotein cholesterol [LDL-C]: 8.5 mg/dL, high-density lipoprotein cholesterol [HDL-C]: 2.9 mg/dL, and triglyceride (TG): 1.6 mg/dL, and the TC:HDL-C ratio remained stable. CONCLUSIONS The single-pill combination regimens E/C/F/TAF is safe and well tolerated. This study reveals that switching from EFV to E/C/F/TAF significantly reduces neuropsychiatric toxicity symptoms in people living with HIV with grade 2 or higher CNS complaints.
Collapse
Affiliation(s)
- Huan Xia
- Department of Infectious Diseases, Tianjin Second People's Hospital, Tianjin 300192, China
| | - Xiao-Jie Huang
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China
| | - Yue Hu
- Department of Infectious Diseases, Tianjin Second People's Hospital, Tianjin 300192, China
| | - Li-Ying Gao
- Department of Infectious Diseases, Tianjin Second People's Hospital, Tianjin 300192, China
| | - Yue Wu
- Department of Infectious Diseases, Tianjin Second People's Hospital, Tianjin 300192, China
| | - Hao Wu
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China
| | - Zhong-Fang Yan
- Department of Infectious Diseases, Tianjin Second People's Hospital, Tianjin 300192, China
| | - Ping Ma
- Department of Infectious Diseases, Tianjin Second People's Hospital, Tianjin 300192, China
| |
Collapse
|
20
|
Lai CC, Chao CM, Hsueh PR. Clinical efficacy of antiviral agents against coronavirus disease 2019: A systematic review of randomized controlled trials. J Microbiol Immunol Infect 2021; 54:767-775. [PMID: 34253490 PMCID: PMC8233451 DOI: 10.1016/j.jmii.2021.05.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 05/18/2021] [Indexed: 12/12/2022]
Abstract
Despite aggressive efforts on containment measures for the coronavirus disease 2019 (COVID-19) pandemic around the world, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is continuously spreading. Therefore, there is an urgent need for an effective antiviral agent. To date, considerable research has been conducted to develop different approaches to COVID-19 therapy. In addition to early observational studies, which could be limited by study design, small sample size, non-randomized design, or different timings of treatment, an increasing number of randomized controlled trials (RCTs) investigating the clinical efficacy and safety of antiviral agents are being carried out. This study reviews the updated findings of RCTs regarding the clinical efficacy of eight antiviral agents against COVID-19, including remdesivir, lopinavir/ritonavir, favipiravir, sofosbuvir/daclatasvir, sofosbuvir/ledipasvir, baloxavir, umifenovir, darunavir/cobicistat, and their combinations. Treatment with remdesivir could accelerate clinical improvement; however, it lacked additional survival benefits. Moreover, 5-day regimen of remdesivir might show adequate effectiveness in patients with mild to moderate COVID-19. Favipiravir was only marginally effective regarding clinical improvement and virological assessment based on the results of small RCTs. The present evidence suggests that sofosbuvir/daclatasvir may improve survival and clinical outcomes in patients with COVID-19. However, the sample sizes for analysis were relatively small, and all studies were exclusively conducted in Iran. Further larger RCTs in other countries are warranted to support these findings. In contrast, the present findings of limited RCTs did not indicate the use of lopinavir/ritonavir, sofosbuvir/ledipasvir, baloxavir, umifenovir, and darunavir/cobicistat in the treatment of patients hospitalized for COVID-19.
Collapse
Affiliation(s)
- Chih-Cheng Lai
- Department of Internal Medicine, Kaohsiung Veterans General Hospital, Tainan Branch, Tainan, Taiwan
| | - Chien-Ming Chao
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan
| | - Po-Ren Hsueh
- Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
| |
Collapse
|
21
|
Dash PK, Boix V. Fixed-dose darunavir/cobicistat in pregnancy of HIV-infected women, pharmacokinetic concerns. AIDS 2021; 35:1301-1303. [PMID: 34076615 DOI: 10.1097/qad.0000000000002886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Prasanta K Dash
- Department of Pharmacology and Experimental Neuroscience, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Vicente Boix
- Unit of Infectious Diseases, Hospital General Universitario de Alicante, ISABIAL, Alicante
- Departamento de Medicina Clínica, Universidad Miguel Hernandez, Elche, Spain
| |
Collapse
|
22
|
Momper JD, Wang J, Stek A, Shapiro DE, Scott GB, Paul ME, Febo IL, Burchett S, Smith E, Chakhtoura N, Denson K, Rungruengthanakit K, George K, Yang DZ, Capparelli EV, Mirochnick M, Best BM. Pharmacokinetics of darunavir and cobicistat in pregnant and postpartum women with HIV. AIDS 2021; 35:1191-1199. [PMID: 34076612 PMCID: PMC8173003 DOI: 10.1097/qad.0000000000002857] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 11/26/2022]
Abstract
OBJECTIVE To evaluate darunavir and cobicistat pharmacokinetics during pregnancy compared with postpartum and in infant washout samples after delivery. DESIGN Nonrandomized, open-label, parallel-group, multicenter phase-IV prospective study of darunavir and cobicistat pharmacokinetics in pregnant women with HIV and their children in the United States. METHODS Intensive steady-state 24-h pharmacokinetic profiles were performed after administration of 800 mg of darunavir and 150 mg of cobicistat orally in fixed dose combination once-daily during the second trimester, third trimester, and postpartum. Infant washout samples were collected after birth. Darunavir and cobicistat were measured in plasma by validated HPLC-UV and liquid chromatography with tandem mass spectrometry detection (LC-MS)/MS assays, respectively. A two-tailed Wilcoxon signed-rank test (α = 0.10) was employed for paired within-participant comparisons. RESULTS A total of 29 pregnant women receiving darunavir and cobicistat once-daily enrolled in the study. Compared with paired postpartum data, darunavir AUC0--24 was 53% lower in the second trimester [n = 12, P = 0.0024, geometric mean of ratio (GMR)=0.47, 90% confidence interval (CI) 0.33 - 0.68] and 56% lower in the third trimester (n = 18, P < 0.0001, GMR = 0.44, 90% CI 0.36 - 0.54), whereas cobicistat AUC0--24 was 50% lower in the second trimester (n = 12, P = 0.0024, GMR = 0.50, 90% CI 0.36-0.69) and 56% lower in the third trimester (n = 18, P < 0.0001, GMR = 0.44, 90% CI 0.35-0.55). Placental transfer of darunavir and cobicistat was limited. CONCLUSION Standard darunavir/cobicistat dosing during pregnancy results in significantly lower exposure during pregnancy, which may increase the risk of virologic failure and perinatal transmission.
Collapse
Affiliation(s)
| | - Jiajia Wang
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Alice Stek
- University of Southern California, Los Angeles, CA
| | - David E Shapiro
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA
| | | | | | - Irma L Febo
- University of Puerto Rico, School of Medicine, San Juan, PR
| | - Sandra Burchett
- Harvard Medical School and Boston Children's Hospital, Boston, MA
| | | | - Nahida Chakhtoura
- National Institute of Child Health and Human Development, Bethesda, MD
| | - Kayla Denson
- Frontier Science & Technology Research Foundation, Inc, Amherst, NY, USA
| | | | | | - Derek Z Yang
- University of California, San Diego, La Jolla, CA
| | | | | | | |
Collapse
|
23
|
Lathouwers E, Weinsteiger S, Baugh B, Ghys A, Jezorwski J, Mohsine EG, Van Landuyt E, De Meyer S. Week 96 resistance analyses of the once-daily, single-tablet regimen (STR) darunavir/cobicistat/emtricitabine/tenofovir alafenamide (D/C/F/TAF) in adults living with HIV-1 from the phase 3 randomized AMBER and EMERALD trials. J Med Virol 2021; 93:3985-3990. [PMID: 33300183 DOI: 10.1002/jmv.26721] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 10/16/2020] [Accepted: 12/06/2020] [Indexed: 11/07/2022]
Abstract
In AMBER and EMERALD, darunavir/cobicistat/emtricitabine/tenofovir alafenamide (D/C/F/TAF) 800/150/200/10 mg demonstrated high virological response and low virological failure (VF) through week 96. Week 96 resistance analyses are presented. Post-baseline samples for genotyping/phenotyping were analyzed from protocol-defined-VFs with viral load (VL) ≥ 400 copies/ml at failure/later time points. Post-hoc analyses were deep sequencing (AMBER) and HIV-1 proviral DNA sequencing from baseline samples (VL < 50 copies/ml) (EMERALD). Through week 96 across studies, no darunavir, primary protease inhibitor (PI), or tenofovir resistance-associated-mutations (RAMs) occurred in patients continuing (N = 1125) or switching to D/C/F/TAF (N = 715). M184I/V (emtricitabine RAM) was detected in one patient in each arm of AMBER. In EMERALD D/C/F/TAF patients with prior VF and baseline genoarchive data (N = 98), 4% had darunavir RAMs, 36% emtricitabine RAMs, mainly at position 184 (32%), 4% tenofovir RAMs, and 19% ≥3 thymidine-analogue-associated-mutations at screening. The predicted phenotype showed 0% had reduced susceptibility to darunavir, 37% to emtricitabine, and 22% to tenofovir. All achieved VL < 50 copies/ml at week 96/prior discontinuation, with no VF. D/C/F/TAF has a high barrier to resistance; no darunavir, primary PI, or tenofovir RAMs occurred through 96 weeks in AMBER and EMERALD. In EMERALD, baseline archived darunavir, emtricitabine, and tenofovir RAMs in patients with prior VF did not preclude virologic response.
Collapse
Affiliation(s)
| | | | - Bryan Baugh
- Janssen Research & Development LLC, Raritan, New Jersey, USA
| | - Anne Ghys
- Janssen Pharmaceutica NV, Beerse, Belgium
| | - John Jezorwski
- Janssen Research & Development, Pennington, New Jersey, USA
| | | | | | | |
Collapse
|
24
|
Perez-Valero I, Llibre JM, Castagna A, Pulido F, Molina JM, Esser S, Margot N, Shao Y, Temme L, Piontkowsky D, McNicholl IR, Haubrich R. Switching to Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide in Adults With HIV and M184V/I Mutation. J Acquir Immune Defic Syndr 2021; 86:490-495. [PMID: 33315694 PMCID: PMC7899215 DOI: 10.1097/qai.0000000000002595] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 07/30/2020] [Accepted: 11/17/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND The ability of elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide (E/C/F/TAF) to maintain virologic suppression in participants with M184V and/or M184I resistance mutations from historical genotypic reports when switching from a tenofovir disoproxil fumarate-based or abacavir (ABC)-based regimen was investigated. SETTING Phase IIIb, 48-week, open-label, single-arm, multicenter, clinical trial (NCT02616029). METHODS Virologically suppressed adults with HIV and documented M184V/I on historical genotypic records switched to E/C/F/TAF from a tenofovir disoproxil fumarate-based or ABC-based regimen. The primary end point was HIV-1 RNA of <50 copies per milliliter at week 12 using pure virologic response (PVR). Secondary end points included HIV-1 RNA of <50 copies per milliliter at weeks 24/48 (PVR) and at weeks 12, 24, and 48 (Food and Drug Administration snapshot algorithm), and change in CD4+ count at weeks 12, 24, and 48. RESULTS M184V alone was reported in 82.8% of 64 participants; 9.4% and 7.8% had M184I and M184V/I, respectively, and 43.8% had archived M184V/I (baseline DNA). All (62/62 with available data, 100%, 95% confidence interval 94.2% to 100%) participants maintained PVR at weeks 12, 24, and 48. By Food and Drug Administration snapshot algorithm, one participant had HIV-1 RNA of ≥50 copies per milliliter (week 12); confirmatory HIV-1 RNA was <50 copies per milliliter. No significant changes were observed in CD4+ cell count. Drug-related adverse events (AEs) were reported by 10 (15.6%) participants. Six (9.4%) and 5 (7.8%) participants had grade 3-4 AEs or serious AEs, respectively (none drug related). CONCLUSIONS The presence of the resistance mutations M184V/I did not jeopardize the efficacy of switching to E/C/F/TAF in virologically suppressed adults. High rates of virologic suppression were maintained throughout 48 weeks of therapy and treatment was well tolerated.
Collapse
Affiliation(s)
| | - Josep M. Llibre
- Fundación Lucha contra el SIDA and Infectious Diseases, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | | | - Federico Pulido
- Unidad VIH, Hospital Universitario 12 de Octubre, imas12, UCM, Madrid, Spain
| | - Jean-Michel Molina
- Department of Infectious Diseases, Saint-Louis Hospital and University of Paris, Paris, France
| | | | | | | | | | | | | | | |
Collapse
|
25
|
Huang YS, Cheng CY, Liou BH, Lu PL, Cheng SH, Lee YT, Liu CE, Sun HY, Yang CJ, Tang HJ, Lin SP, Ho MW, Huang SH, Tsai HC, Lee CH, Hung CC. Efficacy and Safety of Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide as Maintenance Treatment in HIV/HBV-Coinfected Patients. J Acquir Immune Defic Syndr 2021; 86:473-481. [PMID: 33273214 DOI: 10.1097/qai.0000000000002589] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 11/23/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND The efficacy and safety of switching from tenofovir disoproxil fumarate-based antiretroviral therapy to coformulated elvitegravir, cobicistat, emtricitabine, and tenofovir alafenamide (E/C/F/TAF) has not been widely investigated in HIV/hepatitis B virus (HBV)-coinfected Asian population. METHODS Between February and October 2018, HIV/HBV-coinfected patients who had achieved HIV viral suppression with tenofovir disoproxil fumarate-containing regimens were switched to E/C/F/TAF. Assessments of plasma HBV and HIV viral load, HBV serology, renal function, lipid profiles, and bone mineral density (BMD) were performed at weeks 24 and 48 after switch. RESULTS A total of 274 HIV/HBV-coinfected participants were enrolled, with 12.8% testing HBeAg-positive and 94.2% having plasma HBV DNA <20 IU/mL at baseline. At weeks 24 and 48, 92.7% and 89.8% achieved plasma HBV DNA <20 IU/mL; 4.7% and 5.1% had HBV DNA ≥20 IU/mL; and 2.6% and 5.1% had no data, respectively. At weeks 24 and 48, 95.6% and 94.2% of participants maintained HIV RNA <50 copies/mL, respectively. Compared with baseline, the median urine β2-microglobulin-to-creatinine ratio at week 48 decreased significantly from 165 to 90 μg/g (P < 0.001). The mean BMD of the spine and hip improved at week 48 (+1.77% and +1.33%, respectively). Significantly higher lipid profiles were observed after switch to E/C/F/TAF. Thirteen (4.7%) patients withdrew from the study before week 48, with 7 (2.6%) patients because of adverse effects. CONCLUSIONS Switch to E/C/F/TAF maintained HBV and HIV viral suppression and resulted in the improvement of proteinuria and BMD of the spine and hip but increased lipid levels in HIV/HBV-coinfected patients at week 48.
Collapse
Affiliation(s)
- Yu-Shan Huang
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chien-Yu Cheng
- Department of Infectious Diseases, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
- School of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Bo-Huang Liou
- Department of Internal Medicine, Hsinchu MacKay Memorial Hospital, Hsinchu City, Taiwan
| | - Po-Liang Lu
- Department of Internal Medicine, Kaohsiung Medical University Hospital and College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shu-Hsing Cheng
- Department of Infectious Diseases, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
- School of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Yuan-Ti Lee
- Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Chun-Eng Liu
- Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Hsin-Yun Sun
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chia-Jui Yang
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Hung-Jen Tang
- Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
- Department of Health and Nutrition, Chia Nan University of Pharmacy and Sciences, Tainan, Taiwan
| | - Shih-Ping Lin
- Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Mao-Wang Ho
- Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Sung-Hsi Huang
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
- Department of Tropical Medicine and Parasitology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hung-Chin Tsai
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; and
| | - Chen-Hsiang Lee
- Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chien-Ching Hung
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Tropical Medicine and Parasitology, National Taiwan University College of Medicine, Taipei, Taiwan
| |
Collapse
|
26
|
Brooks KM, Momper JD, Pinilla M, Stek AM, Barr E, Weinberg A, Deville JG, Febo IL, Cielo M, George K, Denson K, Rungruengthanakit K, Shapiro DE, Smith E, Chakhtoura N, Rooney JF, Haubrich R, Espina R, Capparelli EV, Mirochnick M, Best BM. Pharmacokinetics of tenofovir alafenamide with and without cobicistat in pregnant and postpartum women living with HIV. AIDS 2021; 35:407-417. [PMID: 33252495 PMCID: PMC8238253 DOI: 10.1097/qad.0000000000002767] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 12/30/2022]
Abstract
OBJECTIVE To evaluate the pharmacokinetics of tenofovir alafenamide (TAF) 10 mg with cobicistat and 25 mg without boosting in pregnant and postpartum women with HIV and to characterize TAF placental transfer and infant washout pharmacokinetics. DESIGN Open-label, multicenter phase IV prospective study of TAF pharmacokinetics during pregnancy, postpartum, delivery, and infant washout. METHODS Pregnant women receiving TAF 10 mg with cobicistat or TAF 25 mg without boosting as part of clinical care had intensive pharmacokinetic assessments performed during the second and third trimesters, and 6-12 weeks postpartum. Maternal and cord blood samples were collected at delivery, and washout pharmacokinetic samples were collected in infants. TAF concentrations were quantified using liquid chromatography/mass spectrometry. Comparisons between pregnancy and postpartum were made using geometric mean ratios (90% confidence intervals) and Wilcoxon signed-rank tests. RESULTS Thirty-one pregnant women receiving TAF 10 mg with cobicistat-boosting and 27 women receiving TAF 25 mg without boosting were enrolled. TAF exposures did not significantly differ between pregnancy and postpartum when administered as 10 mg with cobicistat. Antepartum TAF exposures with the 25 mg dose were 33-43% lower in comparison with postpartum, but comparable with those measured in nonpregnant adults. TAF was below the lower limit of quantitation in 43 of 44 cord blood, 41 of 45 maternal blood at delivery, and all infant washout samples. CONCLUSION TAF exposures were comparable or higher than those measured in nonpregnant adults during pregnancy and postpartum. These findings provide reassurance on adequate TAF exposures during pregnancy, and support efforts to expand the use of TAF in pregnant women with HIV.
Collapse
Affiliation(s)
- Kristina M Brooks
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Jeremiah D Momper
- Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, San Diego, California
| | - Mauricio Pinilla
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Alice M Stek
- Department of Obstetrics and Gynecology, University of Southern California School of Medicine, Los Angeles, California
| | | | - Adriana Weinberg
- Departments of Pediatrics, Medicine and Pathology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Jaime G Deville
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Irma L Febo
- Department of Pediatrics, School of Medicine, University of Puerto Rico, San Juan, Puerto Rico
| | - Mikhaela Cielo
- Department of Pediatrics, University of Southern California School of Medicine, Los Angeles, California
| | | | - Kayla Denson
- Frontier Science & Technology Research Foundation, Inc., Amherst, New York, USA
| | | | - David E Shapiro
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | - Nahida Chakhtoura
- Maternal and Pediatric Infectious Disease Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Bethesda, Maryland
| | | | | | - Rowena Espina
- Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, San Diego, California
| | - Edmund V Capparelli
- Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, San Diego, California
- Pediatrics Department, University of California San Diego - Rady Children's Hospital San Diego, San Diego, California
| | - Mark Mirochnick
- Division of Neonatology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Brookie M Best
- Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, San Diego, California
- Pediatrics Department, University of California San Diego - Rady Children's Hospital San Diego, San Diego, California
| |
Collapse
|
27
|
Ma R, Zhang Q, Zhang YS, Xu B, Tong ZW, Zhao CS, Zhao RG. Preoperative rapid suppression of viral load by elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide regimen in human immunodeficiency virus-positive fracture patients significantly reduces postoperative complications. Chin Med J (Engl) 2020; 133:2892-2893. [PMID: 33273345 PMCID: PMC7717808 DOI: 10.1097/cm9.0000000000001185] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Rui Ma
- Department of Orthopedics, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Qiang Zhang
- Department of Orthopedics, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Yao-Shen Zhang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Biao Xu
- Department of Orthopedics, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Zhi-Wen Tong
- No.1 Department of General Surgery, The Fourth People's Hospital of Qinghai Province, Xining, Qinghai 810000, China
| | - Chang-Song Zhao
- Department of Orthopedics, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Ru-Gang Zhao
- Department of Orthopedics, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| |
Collapse
|
28
|
Lu S, Wei N, Jiang J, Wu L, Sheng J, Zhou J, Fang Q, Chen Y, Zheng S, Chen F, Liang T, Hu S. First report of manic-like symptoms in a COVID-19 patient with no previous history of a psychiatric disorder. J Affect Disord 2020; 277:337-340. [PMID: 32858315 PMCID: PMC7439825 DOI: 10.1016/j.jad.2020.08.031] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 06/04/2020] [Accepted: 08/13/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND In December 2019, the novel coronavirus (SARS-CoV-2) infection was first reported in Wuhan city, central China, which has spread rapidly. The common clinical features of patients with SARS-CoV-2 infection included fever, fatigue, and damage to the respiratory or digestive system. However, it is still unclear whether SARS-CoV-2 infection could cause damage to the central nervous system (CNS) inducing psychiatric symptoms. CASE REPORT Herein, we present the first case of SARS-CoV-2 infection with manic-like symptoms and describe the diagnosis, clinical course, and treatment of the case, focusing on the identifications of SARS-CoV-2 in the specimen of cerebrospinal fluid (CSF). The patient developed manic-like symptoms when his vital signs recovered on illness day 17. After manic-like attack, the detection of SARS-CoV-2 specific IgG antibody in CSF was positive, while the reverse transcriptase-polymerase chain reaction (RT-PCR) on CSF for the SARS-CoV-2 was negative. The patient received Olanzapine for treatment and his mood problems concurrently improved as indicated by scores of Young Manic Rating Scale (YMRS). LIMITATION This is a single case report only, and the RT-PCR test for SARS-CoV-2 in CSF was not performed simultaneously when SARS-CoV-2 was positive in samples of sputum and stool. CONCLUSION This first case of COVID-19 patient with manic-like symptoms highlights the importance of evaluation of mental health status and may contribute to our understanding of potential risk of CNS impairments by SARS-CoV-2 infection.
Collapse
Affiliation(s)
- Shaojia Lu
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Key Laboratory of Mental Disorder's Management of Zhejiang Province, Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou, Zhejiang, China
| | - Ning Wei
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Key Laboratory of Mental Disorder's Management of Zhejiang Province, Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou, Zhejiang, China
| | - Jiajun Jiang
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Key Laboratory of Mental Disorder's Management of Zhejiang Province, Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou, Zhejiang, China
| | - Lingling Wu
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Key Laboratory of Mental Disorder's Management of Zhejiang Province, Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou, Zhejiang, China
| | - Jifang Sheng
- Department of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jianying Zhou
- Department of Respiratory, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Qiang Fang
- Department of Intensive Care Unit, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yu Chen
- Department of Clinical Laboratory, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Shufa Zheng
- Department of Clinical Laboratory, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Feng Chen
- Department of Radiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Tingbo Liang
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang Provincial Key Laboratory of Pancreatic Disease, Hangzhou, Zhejiang, China.
| | - Shaohua Hu
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Key Laboratory of Mental Disorder's Management of Zhejiang Province, Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou, Zhejiang, China.
| |
Collapse
|
29
|
Roberto P, Francesco L, Emanuela C, Giorgia G, Pasquale N, Sara D. Current treatment of COVID-19 in renal patients: hope or hype? Intern Emerg Med 2020; 15:1389-1398. [PMID: 32986137 PMCID: PMC7520511 DOI: 10.1007/s11739-020-02510-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 09/12/2020] [Indexed: 12/28/2022]
Abstract
To date the severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2), known as COVID-19, is for clinicians the most difficult global therapeutic problem. In this landscape, the management of patients with chronic kidney disease, acute kidney injury or patients undergoing immunosuppressant therapies for kidney transplant or glomerular diseases, represent a clinical challenge for nephrologists, especially in patients with severe acute lung involvement. Therefore in this setting, due to the lack of anti-COVID treatment schedules, tailored management is mandatory to reduce the side effects, as consequence of impaired renal function and drugs interactions. We report the main treatment actually used against SARS-CoV-2, underlining its possible use in the nephropatic patients and the central role of nephrologists to improve the clinical outcome.
Collapse
Affiliation(s)
- Palumbo Roberto
- Nephology and Dialysis Department, Sant'Eugenio Hospital, Rome, Italy
| | | | - Cordova Emanuela
- Nephology and Dialysis Department, Sant'Eugenio Hospital, Rome, Italy
| | | | | | - Dominijanni Sara
- Nephology and Dialysis Department, Sant'Eugenio Hospital, Rome, Italy.
| |
Collapse
|
30
|
Desai A, Santonocito OG, Caltagirone G, Kogan M, Ghetti F, Donadoni I, Porro F, Savevski V, Poretti D, Ciccarelli M, Martinelli Boneschi F, Voza A. Effectiveness of Streptococcus Pneumoniae Urinary Antigen Testing in Decreasing Mortality of COVID-19 Co-Infected Patients: A Clinical Investigation. ACTA ACUST UNITED AC 2020; 56:medicina56110572. [PMID: 33138045 PMCID: PMC7693839 DOI: 10.3390/medicina56110572] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 09/24/2020] [Revised: 10/17/2020] [Accepted: 10/27/2020] [Indexed: 02/06/2023]
Abstract
Background and objectives: Streptococcus pneumoniae urinary antigen (u-Ag) testing has recently gained attention in the early diagnosis of severe and critical acute respiratory syndrome coronavirus-2/pneumococcal co-infection. The aim of this study is to assess the effectiveness of Streptococcus pneumoniae u-Ag testing in coronavirus disease 2019 (COVID-19) patients, in order to assess whether pneumococcal co-infection is associated with different mortality rate and hospital stay in these patients. Materials and Methods: Charts, protocols, mortality, and hospitalization data of a consecutive series of COVID-19 patients admitted to a tertiary hospital in northern Italy during COVID-19 outbreak were retrospectively reviewed. All patients underwent Streptococcus pneumoniae u-Ag testing to detect an underlying pneumococcal co-infection. Covid19+/u-Ag+ and Covid19+/u-Ag- patients were compared in terms of overall survival and length of hospital stay using chi-square test and survival analysis. Results: Out of 575 patients with documented pneumonia, 13% screened positive for the u-Ag test. All u-Ag+ patients underwent treatment with Ceftriaxone and Azithromycin or Levofloxacin. Lopinavir/Ritonavir or Darunavir/Cobicistat were added in 44 patients, and hydroxychloroquine and low-molecular-weight heparin (LMWH) in 47 and 33 patients, respectively. All u-Ag+ patients were hospitalized. Mortality was 15.4% and 25.9% in u-Ag+ and u-Ag- patients, respectively (p = 0.09). Survival analysis showed a better prognosis, albeit not significant, in u-Ag+ patients. Median hospital stay did not differ among groups (10 vs. 9 days, p = 0.71). Conclusions: The routine use of Streptococcus pneumoniae u-Ag testing helped to better target antibiotic therapy with a final trend of reduction in mortality of u-Ag+ COVID-19 patients having a concomitant pneumococcal infection. Randomized trials on larger cohorts are necessary in order to draw definitive conclusion.
Collapse
Affiliation(s)
- Antonio Desai
- Emergency Department, Humanitas Clinical and Research Center, IRCCS, 20089 Milan, Italy; (G.C.); (M.K.); (F.G.); (I.D.); (F.P.); (A.V.)
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Italy
- Correspondence: ; Tel.: +39-0282-247-053
| | - Orazio Giuseppe Santonocito
- Department of Diagnostic and Interventional Radiology, Humanitas Clinical and Research Center IRCCS, Rozzano, 20089 Milan, Italy; (O.G.S.); (D.P.)
| | - Giuseppe Caltagirone
- Emergency Department, Humanitas Clinical and Research Center, IRCCS, 20089 Milan, Italy; (G.C.); (M.K.); (F.G.); (I.D.); (F.P.); (A.V.)
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Italy
| | - Maria Kogan
- Emergency Department, Humanitas Clinical and Research Center, IRCCS, 20089 Milan, Italy; (G.C.); (M.K.); (F.G.); (I.D.); (F.P.); (A.V.)
| | - Federica Ghetti
- Emergency Department, Humanitas Clinical and Research Center, IRCCS, 20089 Milan, Italy; (G.C.); (M.K.); (F.G.); (I.D.); (F.P.); (A.V.)
| | - Ilaria Donadoni
- Emergency Department, Humanitas Clinical and Research Center, IRCCS, 20089 Milan, Italy; (G.C.); (M.K.); (F.G.); (I.D.); (F.P.); (A.V.)
| | - Francesca Porro
- Emergency Department, Humanitas Clinical and Research Center, IRCCS, 20089 Milan, Italy; (G.C.); (M.K.); (F.G.); (I.D.); (F.P.); (A.V.)
| | - Victor Savevski
- Artificial Intelligence Center, Humanitas Clinical and Research Center, IRCCS, 20089 Milan, Italy;
| | - Dario Poretti
- Department of Diagnostic and Interventional Radiology, Humanitas Clinical and Research Center IRCCS, Rozzano, 20089 Milan, Italy; (O.G.S.); (D.P.)
| | - Michele Ciccarelli
- Pneumology Department, Humanitas Clinical and Research Center, IRCCS, 20089 Milan, Italy;
| | - Filippo Martinelli Boneschi
- Dino Ferrari Centre, Neuroscience Section, Department of Pathophysiology and Transplantation (DEPT), University of Milan, 20122 Milan, Italy;
- Neurology Unit and MS Centre, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Antonio Voza
- Emergency Department, Humanitas Clinical and Research Center, IRCCS, 20089 Milan, Italy; (G.C.); (M.K.); (F.G.); (I.D.); (F.P.); (A.V.)
| |
Collapse
|
31
|
Kim EJ, Choi SH, Park JS, Kwon YS, Lee J, Kim Y, Lee SY, Choi EY. Use of Darunavir-Cobicistat as a Treatment Option for Critically Ill Patients with SARS-CoV-2 Infection. Yonsei Med J 2020; 61:826-830. [PMID: 32882767 PMCID: PMC7471078 DOI: 10.3349/ymj.2020.61.9.826] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/11/2020] [Accepted: 07/28/2020] [Indexed: 01/17/2023] Open
Abstract
We retrospectively reviewed patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections who were admitted to an intensive care unit in Daegu, South Korea. The outcomes of patients who did (cases) or did not (controls) receive darunavir-cobicistat (800-150 mg) therapy were compared. Fourteen patients received darunavir-cobicistat treatment, and 96 received other antiviral therapy (controls). Overall, the darunavir-cobicistat group comprised patients with milder illness, and the crude mortality rate of all patients in the darunavir-cobicistat group was lower than that in the controls [odds ratio (OR) 0.20, 95% confidence interval (CI) 0.04-0.89, p=0.035]. After 1:2 propensity-score matching, there were 14 patients in the darunavir-cobicistat group, and 28 patients in the controls. In propensity score-matched analysis, the darunavir-cobicistat group had lower mortality than the controls (OR 0.07, 95% CI 0.01-0.52, p=0.009). In conclusion, darunavir-cobicistat therapy was found to be associated with a significant survival benefit in critically ill patients with SARS-CoV-2 infection.
Collapse
Affiliation(s)
- Eun Jin Kim
- Division of Pulmonary and Critical Care Medicine, Daegu Catholic University Medical Center, Daegu, Korea
| | - Sun Ha Choi
- Division of Pulmonary and Critical Care Medicine, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Jae Seok Park
- Division of Pulmonology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
| | - Yong Shik Kwon
- Division of Pulmonology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
| | - Jaehee Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Yeonjae Kim
- Division of Pulmonary and Critical Care Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Shin Yup Lee
- Division of Pulmonary and Critical Care Medicine, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Eun Young Choi
- Division of Pulmonary and Critical Care Medicine, Yeungnam University Medical Center, Daegu, Korea.
| |
Collapse
|
32
|
Abstract
Supplemental Digital Content is available in the text.
Collapse
Affiliation(s)
- Giulio Guagliumi
- Interventional Cardiology, Cardiovascular Department(G.G., I.P., D.P.), Ospedale Papa Giovanni XXIII Bergamo, Italy
| | - Aurelio Sonzogni
- Pathology Unit(A.S.), Ospedale Papa Giovanni XXIII Bergamo, Italy
| | - Irene Pescetelli
- Interventional Cardiology, Cardiovascular Department(G.G., I.P., D.P.), Ospedale Papa Giovanni XXIII Bergamo, Italy
| | - Dario Pellegrini
- Interventional Cardiology, Cardiovascular Department(G.G., I.P., D.P.), Ospedale Papa Giovanni XXIII Bergamo, Italy
| | | |
Collapse
|
33
|
Stroppa EM, Toscani I, Citterio C, Anselmi E, Zaffignani E, Codeluppi M, Cavanna L. Coronavirus disease-2019 in cancer patients. A report of the first 25 cancer patients in a western country (Italy). Future Oncol 2020; 16:1425-1432. [PMID: 32403946 PMCID: PMC7222528 DOI: 10.2217/fon-2020-0369] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [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: 04/20/2020] [Accepted: 04/28/2020] [Indexed: 12/15/2022] Open
Abstract
Background: We describe cancer patients with coronavirus disease-2019 (COVID-19) infection treated at the Piacenza's general hospital (north Italy). Materials & methods: 25 cancer patients infected by COVID-19 admitted at the Piacenza's general hospital from 21 February to 18 March 2020. Outcome from the infection were compared with infected noncancer patients. Results: 20 patients (80%) were treated with antiviral therapy and hydroxychloroquine and five (20%) received hydroxychloroquine alone. Nine (36%) patients died, while 16 (64%) overcome the infection. In the control group the mortality was 16.13% and the overcome from infection was 83.87%. Conclusion: Mortality for COVID-19 was greater in cancer patients when compared with noncancer patients, worse prognosis for older age, women and patients treated with hydroxychloroquine alone. However, the comparisons did not reach statistical significance in most cases. This could be due to the small sample size that is the main limitation of the study.
Collapse
Affiliation(s)
- Elisa Maria Stroppa
- Oncology & Hematology Department, Oncology Unit, Piacenza General Hospital, Via Taverna 49, Piacenza, 29121, Italy
| | - Ilaria Toscani
- Oncology & Hematology Department, Oncology Unit, Piacenza General Hospital, Via Taverna 49, Piacenza, 29121, Italy
| | - Chiara Citterio
- Oncology & Hematology Department, Oncology Unit, Piacenza General Hospital, Via Taverna 49, Piacenza, 29121, Italy
| | - Elisa Anselmi
- Oncology & Hematology Department, Oncology Unit, Piacenza General Hospital, Via Taverna 49, Piacenza, 29121, Italy
| | - Elena Zaffignani
- Oncology & Hematology Department, Oncology Unit, Piacenza General Hospital, Via Taverna 49, Piacenza, 29121, Italy
| | - Mauro Codeluppi
- Infectious Diseases Unit, Piacenza General Hospital, Via Taverna 49, Piacenza, 29121, Italy
| | - Luigi Cavanna
- Oncology & Hematology Department, Oncology Unit, Piacenza General Hospital, Via Taverna 49, Piacenza, 29121, Italy
| |
Collapse
|
34
|
Llibre JM, Álvarez H, Yzusqui M. Clinical Impact of Virological Failure and Resistance Analysis Definitions used in Pivotal Clinical Trials of Initial Antiretroviral Treatment: A Systematic Review. AIDS Rev 2019; 20:158-170. [PMID: 30264825 DOI: 10.24875/aidsrev.18000006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
There are no standardized criteria to characterize confirmed protocol-defined virological failure (PDVF) nor the inclusion criteria for the resistance analysis population (RAP) in Phase III randomized clinical trials (RCTs) of initial antiretroviral therapy (ART). We assessed the clinical impact of mismatching between virological non-response (HIV-1 RNA ≥50 copies/mL), confirmed PDVF (48 weeks), and RAP definition in studies with the newest first-line ART. A systematic review of all Phase III RCTs was performed, including preferred once-daily ART (EACS European AIDS guidelines) or recently approved by the US Food and Drug Administration. We identified 16 treatment arms (14 RCTs) with 6175 participants treated with dolutegravir, bictegravir, elvitegravir/cobicistat, raltegravir, darunavir/cobicistat, rilpivirine, or doravirine. Plasma HIV-1 RNA thresholds for PDVF or RAP ranged from 40 to 50, 200, 400, and 500 copies/mL. This led to discrepancies between trials regarding the participants defined as virological non-responders, PDVF, or included in RAP. Overall, 85/296 (29%) patients with PDVF were not genotyped. There was a linear correlation between the threshold of HIV RNA chosen to perform genotyping and rates of participants with PDVF but not genotyped. Only eight treatment arms genotyped all participants with PDVF. Most of the remaining eight arms genotyped roughly < 50% of those with PDVF. In summary, the absence of standardized definitions of VF and criteria for resistance testing in pivotal Phase III RCTs of the first-line ART leads to the possibility of underreporting of resistance mutations when genotypes are only performed at higher viral load cutoffs. Stringent homogeneous criteria should be defined to ensure that all participants with PDVF (e.g., confirmed HIV RNA ≥ 50 copies/mL and the second > 200 copies/mL) undergo genotyping.
Collapse
Affiliation(s)
- Josep M Llibre
- Infectious Diseases and "Fight AIDS" Foundation, University Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Hortensia Álvarez
- Infectious Diseases Unit, Internal Medicine Department, University Hospital of Ferrol, A Coruña, Spain
| | - Miguel Yzusqui
- Department of Internal Medicine, Hospital Nuestra Señora del Prado, Talavera de la Reina, Toledo, Spain
| |
Collapse
|
35
|
Galizzi N, Galli L, Poli A, Spagnuolo V, Castagna A, Gianotti N. Glomerular filtration rate estimated by cystatin C formulas in HIV-1 patients treated with dolutegravir, rilpivirine or cobicistat. New Microbiol 2018; 41:256-261. [PMID: 30252923] [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] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 01/03/2019] [Indexed: 06/08/2023]
Abstract
As dolutegravir (DTG), rilpivirine (RPV) and cobicistat affect creatinine, but not cystatin C, tubular transport or serum concentration, the aim of the study was to compare estimated glomerular filtration rates (eGFRs) calculated by means of a standard creatinine formula with those calculated by means of the cystatin C formula in patients receiving these drugs. This was a cross-sectional study of HIV-1 infected patients with eGFR <90 ml/min/1.73 m2 (CKD-EPI-creatinine formula) on-treatment with regimens including DTG, RVP or cobicistat; cystatin C was measured after the switch to these regimens. eGFR was calculated by means of the CKD-EPI formulas (CKD-EPI-creatinine: eGFRcrea; CKD-EPI-cystatin C: eGFRcyst). eGFRcyst was compared with the last eGFR assessed before (eGFRcrea pre) and after the switch (eGFRcrea post). The primary end-point of the study was the difference between eGFRcyst and eGFRcrea post. One hundred and twenty patients were included. eGFRcrea pre was 80 (70-92) ml/min/1.73 m2. eGFRcrea post was significantly lower than eGFRcyst (65 [59-75] vs. 80 [69-95] mL/ min/1.73m2; p<0.001); eGFRcyst did not differ from eGFRcrea pre (p=0.544). The difference between eGFRcyst and eGFRcrea post was not significantly different among regimen groups (p=0.056). In HIV-patients with reduced eGFR treated with DTG, RPV or cobicistat, measuring eGFR by means of the CKD-EPI cystatin C formula is probably more relevant.
Collapse
Affiliation(s)
- Nadia Galizzi
- Infectious Diseases, IRCCS Istituto Scientifico San Raffaele, via Stamira D'Ancona 20, 20127 Milano, Italy
- Università Vita-Salute San Raffaele, Via Olgettina 58, 20132 Milano, Italy
| | - Laura Galli
- Infectious Diseases, IRCCS Istituto Scientifico San Raffaele, via Stamira D'Ancona 20, 20127 Milano, Italy
| | - Andrea Poli
- Infectious Diseases, IRCCS Istituto Scientifico San Raffaele, via Stamira D'Ancona 20, 20127 Milano, Italy
| | - Vincenzo Spagnuolo
- Infectious Diseases, IRCCS Istituto Scientifico San Raffaele, via Stamira D'Ancona 20, 20127 Milano, Italy
- Università Vita-Salute San Raffaele, Via Olgettina 58, 20132 Milano, Italy
| | - Antonella Castagna
- Infectious Diseases, IRCCS Istituto Scientifico San Raffaele, via Stamira D'Ancona 20, 20127 Milano, Italy
- Università Vita-Salute San Raffaele, Via Olgettina 58, 20132 Milano, Italy
| | - Nicola Gianotti
- Infectious Diseases, IRCCS Istituto Scientifico San Raffaele, via Stamira D'Ancona 20, 20127 Milano, Italy
| |
Collapse
|
36
|
González-Domenech CM, Palacios R, Santos J. [Pharmacological aspects of darunavir/cobicistat]. Enferm Infecc Microbiol Clin 2018; 34 Suppl 1:30-33. [PMID: 28081761 DOI: 10.1016/s0213-005x(17)30006-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
| | - Rosario Palacios
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, España; UGC de Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Hospital Virgen de la Victoria, Málaga, España
| | - Jesús Santos
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, España; UGC de Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Hospital Virgen de la Victoria, Málaga, España.
| |
Collapse
|
37
|
Gutierrez-Valencia A, Benmarzouk-Hidalgo OJ, Llaves S, Fernandez-Magdaleno T, Espinosa N, Viciana P, Lopez-Cortes LF. Pharmacokinetic interactions between cobicistat-boosted elvitegravir and darunavir in HIV-infected patients. J Antimicrob Chemother 2017; 72:816-819. [PMID: 27999051 DOI: 10.1093/jac/dkw487] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 10/10/2016] [Indexed: 11/12/2022] Open
Abstract
Objectives To evaluate if there are significant drug-drug interactions between cobicistat-boosted elvitegravir and 800 mg darunavir once daily taken simultaneously, as has been suggested previously. Methods The study population consisted of three groups of unselected volunteers taking a regimen of elvitegravir, cobicistat, emtricitabine and tenofovir disoproxil fumarate (150, 150, 200 and 300 mg, respectively) co-formulated in a single tablet plus 800 mg darunavir (group A); only co-formulated elvitegravir, cobicistat, emtricitabine and tenofovir disoproxil fumarate (group B); and cobicistat-boosted darunavir (800 mg darunavir + 150 mg cobicistat) plus two nucleos(t)ide analogues (group C). Elvitegravir, cobicistat and darunavir concentrations at the end of the dosing interval ( C 24 ) were quantified using a validated LC with tandem MS method. Results A total of 170 samples were obtained from 24, 32 and 32 patients in groups A, B and C, respectively. In group A, the elvitegravir C 24 were similar to those in group B (233.67 versus 250.39 ng/mL) ( P = 0.406) and the darunavir C 24 were similar to those in group C (1293.54 versus 1319.34 ng/mL) ( P = 0.908). The cobicistat C 24 were comparable in groups A and B (20.2 versus 20.9 ng/mL) and slightly higher in group C (27.7 ng/mL) ( P = 0.059). Conclusions The results provide evidence of similar elvitegravir and darunavir C 24 concentrations when these drugs are co-administered as co-formulated elvitegravir, cobicistat, emtricitabine and tenofovir disoproxil fumarate plus 800 mg darunavir or dosed separately.
Collapse
|
38
|
Squillace N, Ricci E, Quirino T, Gori A, Bandera A, Carenzi L, De Socio GV, Orofino G, Martinelli C, Madeddu G, Rusconi S, Maggi P, Celesia BM, Cordier L, Vichi F, Calza L, Falasca K, Di Biagio A, Pellicanò GF, Bonfanti P. Safety and tolerability of Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Disoproxil fumarate in a real life setting: Data from surveillance cohort long-term toxicity antiretrovirals/antivirals (SCOLTA) project. PLoS One 2017. [PMID: 28632758 PMCID: PMC5478131 DOI: 10.1371/journal.pone.0179254] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objectives The study aim was to evaluate the impact on Liver and Kidney toxicity of the single tablet regimen Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Disoproxil Fumarate (EVG/COBI/FTC/TDF) on Antiretroviral Therapy (ART) experienced or naïve patients. Methods Patients initiating EVG/COBI/FTC/TDF were enrolled in the SCOLTA project, a multicenter observational study reporting grade 3–4 Adverse Events in subjects beginning new antiretroviral drug regimens. In this analysis, patients were evaluated at T0 (baseline), T1 (six months) and at T2 (twelve months). Results A total of 329 patients were enrolled, and 280 (85.1%) of these had at least one follow-up visit. Median observation time was 11 months (IQR 7.0–15.5). Two hundred and two patients (72.1%) were ART experienced and 78 (27.9%) ART naive. Prevalence of HCV-co-infection was 21.4%. At T1, we observed a significant decline in estimated glomerular filtration rate (eGFR), both in experienced and naive patients (mean change from T0–7.5 ± 12.8 ml/min, -15.5 ± 17.8 ml/min, respectively, p = 0.0005), which was confirmed at T2 (mean change from T0–8.2 ± 15.8 ml/min, -17.6 ± 19.4 ml/min, respectively, p = 0.001). Regarding aspartate aminotransferase (AST) and alanine transaminase (ALT) grade 1–2 modifications, no significant differences were observed between experienced and naïve subjects, but an increased prevalence of abnormal liver function test was observed in patients with chronic HCV infection (p<0.001). Conclusions A significant decline in eGFR was observed in patients initiating EVG/COBI/FTC/TDF in the first 6 months, with no significant worsening occurring at 12 months vs. 6 months of therapy. Patients with chronic HCV infection were at higher risk to develop abnormal liver tests.
Collapse
Affiliation(s)
- Nicola Squillace
- Infectious Diseases Clinic, Azienda Socio Sanitaria Territoriale di MONZA, San Gerardo Hospital-University of Milano-Bicocca, Monza, Italy
- * E-mail:
| | - Elena Ricci
- Department of Infectious Diseases, Azienda Socio Sanitaria Territoriale Fatebenefratelli Sacco, Milano, Italy
| | - Tiziana Quirino
- Unit of Infectious Diseases, Azienda Socio Sanitaria Territoriale della Valle Olona–Busto Arsizio (VA), Italy
| | - Andrea Gori
- Infectious Diseases Clinic, Azienda Socio Sanitaria Territoriale di MONZA, San Gerardo Hospital-University of Milano-Bicocca, Monza, Italy
| | - Alessandra Bandera
- Infectious Diseases Clinic, Azienda Socio Sanitaria Territoriale di MONZA, San Gerardo Hospital-University of Milano-Bicocca, Monza, Italy
| | - Laura Carenzi
- Department of Infectious Diseases, Azienda Socio Sanitaria Territoriale Fatebenefratelli Sacco, Milano, Italy
| | | | - Giancarlo Orofino
- Unit of Infectious Diseases, Amedeo di Savoia Hospital, Torino, Italy
| | | | - Giordano Madeddu
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Stefano Rusconi
- Infectious Diseases, Department of Biomedical and Clinical Science Luigi Sacco, University of Milan, Milan, Italy
| | - Paolo Maggi
- Infectious Disease Clinic, University of Bari, Italy
| | | | - Laura Cordier
- Department of Infectious Diseases, Azienda Socio Sanitaria Territoriale Fatebenefratelli Sacco, Milano, Italy
| | - Francesca Vichi
- Unit of Infectious Diseases, Santa Maria Annunziata Hospital, Firenze, Italy
| | - Leonardo Calza
- Department of Infectious Diseases, S.Orsola Malpighi Hospital, Bologna, Italy
| | - Katia Falasca
- Clinic of Infectious Diseases, Department of Medicine and Science of Aging, University “G. d’Annunzio” Chieti-Pescara, Chieti, Italy
| | - Antonio Di Biagio
- Infectious Diseases, San Martino Hospital Genoa, University of Genoa, Genoa, Italy
| | | | - Paolo Bonfanti
- Unit of Infectious Diseases, A. Manzoni Hospital, Lecco, Italy
| | | |
Collapse
|
39
|
Yunquera-Romero L, Asensi-Díez R, Del Rio-Valencia JC, Muñoz-Castillo I, Castaño-Carracedo MA. [Darunavir/cobicistat monotherapy. Experience in a tertiary hospital]. Rev Esp Quimioter 2016; 29:308-317. [PMID: 27888600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Ritonavir-boosted protease inhibitor (IP/r) monotherapy: darunavir/ritonavir (DRV/r) or lopinavir/ritonavir (LPV/r) monotherapy is only provided in the major treatment guidelines in pretreated patients to prevent toxicity associated with nucleoside/nucleotide reverse transcriptase inhibitor (NRTI), reduce costs and simplify antiretroviral treatment. To start IP/r monotherapy, according to GESIDA guidelines 2016, patients need to meet the following criteria: absence of chronic hepatitis B, plasma viral load <50 copies/ mL for at least 6 months and absence of protease inhibitors mutations or previous virologic failures to IP/r. Currently, there are no studies that evaluate the efficacy and safety of darunavir/cobicistat (DRV/COBI) monotherapy. METHODS This prospective study analyzed pretreated HIV patients with DRV/r monotherapy that were switched to DRV/COBI monotherapy. The aim of the study is to describe the effectiveness and safety of the DRV/COBI monotherapy. RESULTS Seventy-eight patients were evaluated. Patients had a median of 31.29 months of DRV/r monotherapy before DRV/COBI monotherapy. Nine of the 78 patients developed "blips" (plasma viral load: 50-200 copies/ml) and four patients had plasma viral load ≥200 copies/mL. An 83.3% (65/78) of the patients remained with undetectable plasma viral load. As for safety, there were no significant differences in lipid profile, liver function (transaminases) and renal function between DRV/r and DRV/COBI monotherapy. CONCLUSIONS DRV/COBI monotherapy seems to be effective and safe (lipid profile, liver and kidney function). However, it will be necessary to design specific studies comparing DRV/r vs DRV/COBI monotherapy to confirm these results.
Collapse
Affiliation(s)
| | - R Asensi-Díez
- Rocío Asensi-Díez, Servicio de Farmacia. Hospital Regional Universitario de Málaga. Avenida de Carlos Haya s/n. CP.29010. Málaga, Spain.
| | | | | | | |
Collapse
|
40
|
Elliot ER, Theodoraki A, Jain LR, Marshall NJ, Boffito M, Baldeweg SE, Waters LJ. Iatrogenic Cushing's syndrome due to drug interaction between glucocorticoids and the ritonavir or cobicistat containing HIV therapies. Clin Med (Lond) 2016; 16:412-418. [PMID: 27697800 PMCID: PMC6297313 DOI: 10.7861/clinmedicine.16-5-412] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Ritonavir and cobicistat, used as pharmacokinetic enhancers in combination with some antiretrovirals (ARVs) for the treatment of HIV, are potent inhibitors of the CYP3A4 isoenzyme. Most glucocorticoids are metabolised via the CYP3A4 pathway and iatrogenic Cushing's syndrome (ICS), with possible secondary adrenal insufficiency (SAI), is a recognised complication following co-administration with ritonavir or cobicistat. A structured approach for identifying and managing potentially affected individuals has not been established.We systematically identified patients with ICS/SAI and found substantial heterogeneity in clinical practice across three large London HIV centres. While this significant drug interaction and its complications are now well-recognised, it is apparent that there is no standardised approach to management or guidance for the general physician. Here we describe the management of ICS/SAI in our current practice, review the available evidence and suggest practice recommendations.
Collapse
Affiliation(s)
| | | | | | - Neal J Marshall
- Ian Charleson Centre for HIV Medicine, Royal Free London NHS Foundation Trust, London, UK
| | | | | | | |
Collapse
|
41
|
Squires K, Kityo C, Hodder S, Johnson M, Voronin E, Hagins D, Avihingsanon A, Koenig E, Jiang S, White K, Cheng A, Szwarcberg J, Cao H. Integrase inhibitor versus protease inhibitor based regimen for HIV-1 infected women (WAVES): a randomised, controlled, double-blind, phase 3 study. Lancet HIV 2016; 3:e410-e420. [PMID: 27562742 DOI: 10.1016/s2352-3018(16)30016-9] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 04/01/2016] [Accepted: 04/04/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Women are under-represented in HIV antiretroviral therapy (ART) studies. Guidelines for selection of ART as initial therapy in patients with HIV-1 infection do not contain sex-specific treatment. We aimed to assess the safety and efficacy of the single tablet integrase inhibitor regimen containing elvitegravir, cobicistat, emtricitabine, and tenofovir disoproxil fumarate compared with a boosted protease inhibitor regimen of ritonavir-boosted atazanavir with emtricitabine and tenofovir disoproxil fumarate. METHODS In this international, randomised, controlled, double-blind, phase 3 study (Women AntiretroViral Efficacy and Safety study [WAVES]), we recruited treatment-naive HIV-infected women with an estimated creatinine clearance of 70 mL/min or higher from 80 centres in 11 countries. Women were randomly assigned (1:1) to receive elvitegravir, cobicistat, emtricitabine, and tenofovir disoproxil fumarate (integrase inhibitor regimen) or ritonavir-boosted atazanavir with emtricitabine and tenofovir disoproxil fumarate (protease inhibitor based regimen); regimens were masked with matching placebos. Randomisation was done by a computer-generated allocation sequence (block size four) and was stratified by HIV-1 RNA viral load and race. Investigators, patients, study staff, and those assessing outcomes were masked to treatment group. All participants who received one dose of study drug were included in the primary efficacy and safety analyses. The main outcome was the proportion of patients with plasma HIV-1 RNA less than 50 copies per mL at week 48 as defined by US Food and Drug Administration snapshot algorithm (prespecified non-inferiority margin of 12%). This study is registered with ClinicalTrials.gov, number NCT01705574. FINDINGS Between Nov 28, 2012, and March 12, 2014, 575 women were enrolled. 289 were randomly assigned to receive the integrase inhibitor regimen and 286 to receive the protease inhibitor based regimen. 252 (87%) women in the integrase inhibitor group had plasma HIV-1 RNA less than 50 copies per mL at week 48 compared with 231 (81%) women in the protease inhibitor group (adjusted difference 6·5%; 95% CI 0·4-12·6). No participant had virological failure with resistance in the integrase inhibitor group compared with three participants ([1%]; all Met184Val/Ile) in the protease inhibitor group. 19 women in the protease inhibitor group discontinued because of adverse events compared with five in the integrase inhibitor group. INTERPRETATION WAVES shows that clinical trials of ART regimens in global and diverse populations of treatment-naive women are possible. The findings support guidelines recommending integrase inhibitor based regimens in first-line antiretroviral therapy. FUNDING Gilead Sciences.
Collapse
Affiliation(s)
| | - Cissy Kityo
- Joint Clinical Research Centre, Clinical Research, Kampala, Uganda
| | | | | | - Evgeny Voronin
- Regional Clinic in Infectious Hospital, St Petersburg, Russia
| | | | - Anchalee Avihingsanon
- HIV-NAT, Thai Red Cross AIDS Research Center and Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Ellen Koenig
- Zona Universitaria/IDEV, Santo Domingo, Dominican Republic
| | | | | | | | | | - Huyen Cao
- Gilead Sciences, Foster City, CA, USA.
| |
Collapse
|
42
|
Pozniak A, Arribas JR, Gathe J, Gupta SK, Post FA, Bloch M, Avihingsanon A, Crofoot G, Benson P, Lichtenstein K, Ramgopal M, Chetchotisakd P, Custodio JM, Abram ME, Wei X, Cheng A, McCallister S, SenGupta D, Fordyce MW. Switching to Tenofovir Alafenamide, Coformulated With Elvitegravir, Cobicistat, and Emtricitabine, in HIV-Infected Patients With Renal Impairment: 48-Week Results From a Single-Arm, Multicenter, Open-Label Phase 3 Study. J Acquir Immune Defic Syndr 2016; 71:530-7. [PMID: 26627107 PMCID: PMC4804743 DOI: 10.1097/qai.0000000000000908] [Citation(s) in RCA: 130] [Impact Index Per Article: 16.3] [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: 09/15/2015] [Accepted: 11/02/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Tenofovir alafenamide (TAF) is a novel tenofovir prodrug with improved renal and bone safety compared with TDF-containing regimens. We report the 48 week safety and efficacy of a once-daily single tablet regimen of elvitegravir 150 mg (E), cobicistat 150 mg (C), emtricitabine 200 mg (F), and TAF 10 mg (E/C/F/TAF) in HIV-1-infected patients with mild to moderate renal impairment. METHODS We enrolled virologically suppressed HIV-1-infected subjects with estimated creatinine clearance (CrCl) 30-69 mL/min in a single-arm, open-label study to switch regimens to E/C/F/TAF. The primary endpoint was the change from baseline in glomerular filtration rate estimated using various formulae. This study is registered with ClinicalTrials.gov, number NCT01818596. FINDINGS We enrolled and treated 242 patients with mean age 58 years, 18% Black, 39% hypertension, 14% diabetes. Through week 48, no significant change in estimated CrCl was observed. Two patients (0.8%) discontinued study drug for decreased creatinine clearance, neither had evidence of renal tubulopathy and both had uncontrolled hypertension. Subjects had significant improvements in proteinuria, albuminuria, and tubular proteinuria (P < 0.001 for all). Hip and spine bone mineral density significantly increased from baseline to week 48 (mean percent change +1.47 and +2.29, respectively, P < 0.05). Ninety-two percent (222 patients) maintained HIV-1 RNA <50 copies per milliliter at week 48. INTERPRETATION Switch to E/C/F/TAF was associated with minimal change in GFR. Proteinuria, albuminuria and bone mineral density significantly improved. These data support the efficacy and safety of once daily E/C/F/TAF in HIV+ patients with mild or moderate renal impairment without dose adjustment.
Collapse
Affiliation(s)
- Anton Pozniak
- Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Jose R. Arribas
- Department of Medicine, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | | | - Samir K. Gupta
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Frank A. Post
- King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Mark Bloch
- Holdsworth House Medical Practice, Sydney, Australia
| | - Anchalee Avihingsanon
- HIV-NAT, Thai Red Cross AIDS Research Centre and Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Nguyen T, McNicholl I, Custodio JM, Szwarcberg J, Piontkowsky D. Drug Interactions with Cobicistat- or Ritonavir-Boosted Elvitegravir. AIDS Rev 2016; 18:101-111. [PMID: 27196356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Cobicistat and ritonavir are structurally distinct compounds that both potently inhibit cytochrome P450 (CYP) 3A, the metabolizing enzyme primarily responsible for the elimination of several antiretroviral medications, and, as such, are pharmacokinetic boosters for antiretroviral agents that require longer dosing intervals. Recently, cobicistat was approved for the treatment of HIV-1 infection in treatment-naive adults as a component of a single-tablet regimen consisting of cobicistat-boosted elvitegravir plus emtricitabine and tenofovir disoproxil fumarate. While studies have demonstrated that boosting with either cobicistat or ritonavir results in comparable plasma exposure of the target antiretroviral agent, a better understanding of drug-drug interactions between cobicistat- and ritonavir-boosted antiretrovirals and other medications will inform treatment decisions in HIV-infected patients. In connection with their distinct structural properties, COBI and RTV differ with respect to their drug-drug interaction profiles. Compared with ritonavir, cobicistat lacks induction potential and is a more specific inhibitor of 3A and therefore, has reduced effects on other CYP isoforms. To date, more studies have assessed ritonavir drug-drug interactions with other medications than have assessed cobicistat drug-drug interactions. The objective of this article is to review the drug-drug interactions when cobicistat- or ritonavir-boosted elvitegravir, cobicistat, or elvitegravir/cobicistat/emtricitabine/tenofovir are coadministered with antiretroviral therapies or drugs that are either substrates, inducers, or inhibitors of the CYP3A metabolic pathway, as well as with drugs that alter intra-gastric pH or are substrates of P-gp, in order to inform the proper use of elvitegravir/cobicistat/emtricitabine/tenofovir.
Collapse
Affiliation(s)
- Thai Nguyen
- Medical Affairs, Gilead Sciences, Inc., Foster City, CA, USA
| | - Ian McNicholl
- Medical Affairs, Gilead Sciences, Inc., Foster City, CA, USA
| | | | | | | |
Collapse
|
44
|
Genvoya--a new 4-drug combination for HIV. Med Lett Drugs Ther 2016; 58:19-21. [PMID: 26859659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
|
45
|
Abstract
This article highlights important prescribing information for some drugs that received FDA approval within the past year. These include: atazanavir and cobicistat (Evotaz®), ceftazidime and avibactam (Avycaz®), edoxaban (Savaysa®), ivabradine (Corlanor®), liraglutide (rDNA origin) injection (Saxenda®), perindopril arginine and amlodipine besylate (Prestalia®), and secukinumab (Cosentyx®) subcutaneous injection.
Collapse
Affiliation(s)
- Olga M Klibanov
- Olga M. Klibanov is a professor of pharmacy, Wingate University, Wingate, N.C. Diep Phan is a student at Wingate University, Wingate, N.C. Kelli Ferguson is a student at Wingate University, Wingate, N.C
| | | | | |
Collapse
|
46
|
Curran A, Pérez-Valero I, Moltó J. Rezolsta® (Darunavir/Cobicistat): First Boosted Protease Inhibitor Co-formulated with Cobicistat. AIDS Rev 2015; 17:114-120. [PMID: 26035169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Rezolsta® (darunavir/cobicistat) is the first boosted protease inhibitor in a fixed-dose combination to be approved for the treatment of HIV infection. It contains darunavir, a protease inhibitor with a well-known safety and efficacy profile, and the new pharmacokinetic enhancer cobicistat. The convenience of this combination makes boosted darunavir easier to take, thus improving adherence. Exposure to darunavir is equivalent when it is administered with cobicistat or with ritonavir. Darunavir/cobicistat-based antiretroviral therapy has shown considerable efficacy and good tolerability in several clinical trials. Data from the single-arm, open-label, phase III GS-US-216-130 trial showed virological efficacy rates comparable to those from ARTEMIS and ODIN. Darunavir/cobicistat was well tolerated; most adverse events were mild and consisted of gastrointestinal disturbances. Cobicistat inhibits transporters of creatinine in kidney tubules, thus causing a minimal and reversible reduction in estimated glomerular filtration rate. Like ritonavir, cobicistat is a strong CYP3A4 inhibitor and, as such, shares most of its drug interactions. However, inhibition by cobicistat seems to be more specific than with ritonavir, and cobicistat has no inducer effect; therefore, differences in its drug interaction profile may be observed.
Collapse
Affiliation(s)
- Adrián Curran
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - José Moltó
- Fundación Lluita contra la SIDA, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| |
Collapse
|