Antiretroviral drug reduction in highly experienced HIV-infected patients receiving a multidrug regimen: the ECOVIR study

Abstract Objectives In a context of life-long therapy, we asked whether it could be possible to reduce the number of antiretroviral drugs without jeopardizing viral suppression. Methods ECOVIR was a prospective study aiming to assess whether in patients on combination ART with ≥4 antiretrovirals for...

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Published in:Journal of antimicrobial chemotherapy 2019-09, Vol.74 (9), p.2716-2722
Main Authors: Valantin, Marc-Antoine, Durand, Lise, Wirden, Marc, Assoumou, Lambert, Caby, Fabienne, Soulié, Cathia, Nguyen, Thi Thu-Thuy, Tubiana, Roland, Kirstetter, Myriam, Junot, Helga, Marcelin, Anne-Geneviève, Peytavin, Gilles, Tilleul, Patrick, Katlama, Christine
Format: Article
Language:English
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Life Sciences
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Summary:Abstract Objectives In a context of life-long therapy, we asked whether it could be possible to reduce the number of antiretroviral drugs without jeopardizing viral suppression. Methods ECOVIR was a prospective study aiming to assess whether in patients on combination ART with ≥4 antiretrovirals for ≥24 weeks and virally suppressed for ≥48 weeks, a drug-reduced (DR) regimen could be proposed. The intervention consisted of discontinuing genotypically less susceptible drugs to reach a DR regimen with ≤3 antiretrovirals. The primary endpoint was the proportion of patients maintaining viral suppression at week (W) 24. Results From 89 eligible individuals for the study, a DR regimen was proposed in 86 (97%) patients, of whom 71 were switched to a DR regimen. Baseline characteristics [median (IQR)] were: age 58 (53–65) years, duration of treatment 24 (21–26) years and viral suppression 8 (6–11) years. The cumulative resistance profile showed full resistance to lamivudine/emtricitabine (91%), abacavir (74%), efavirenz/nevirapine (70%), rilpivirine (56%), darunavir (q24h/q12h) (42%/29%), lopinavir (69%), atazanavir (71%) and raltegravir (24%). The final DR regimen consisted of a two-drug or three-drug regimen in 54 patients (76%) and in 17 patients (24%), respectively. The success rate of a DR regimen at W24 was 93.9% (95% CI 84.4–97.6, Kaplan–Meier estimate). Four patients experienced virological failure (at W4, W8 and W12), all with plasma viral load (pVL)
ISSN:0305-7453
1460-2091
DOI:10.1093/jac/dkz255