Virologic and immunologic effectiveness of darunavir-based salvage therapy in HIV-1-infected adults in a Brazilian clinical practice setting: Results of a multicenter and retrospective cohort study

7Citations
Citations of this article
26Readers
Mendeley users who have this article in their library.

Abstract

Background: Darunavir has been proven efficacious for antiretroviral-experienced HIV-1-infected patients in randomized trials. However, effectiveness of darunavir-based salvage therapy is understudied in routine care in Brazil. Methods: Retrospective cohort study of HIV-1-infected patients from three public referral centers in Belo Horizonte, who received a darunavir-based therapy between 2008 and 2010, after virologic failure. Primary endpoint was the proportion of patients with viral load. <. 50. copies/mL at week 48. Change in CD4 cell count was also evaluated. Outcome measures were analyzed on an intent-to-treat basis applied to observational studies. Sensitivity analysis was conducted to evaluate the impact of missing data at week 48. Predictors of virologic failure were examined using rare-event, finite sample, bias-corrected logistic regression. Results: Among 108 patients, the median age was 44.2 years, and 72.2% were male. They had long-standing HIV-1 infection (median 11.6 years) and advanced disease (76.9% had an AIDS-defining event). All patients had previously received protease inhibitors and nucleoside reverse transcriptase inhibitors, 75% nonnucleoside reverse transcriptase inhibitors, and 4.6% enfuvirtide. The median length of protease inhibitor use was 8.9 years, and 90.8% of patients had prior exposure to unboosted protease inhibitor. Genotypic resistance profile showed a median of three primary protease inhibitor mutations and 10.2% had three or more darunavir resistance-associated mutations. Virologic success at week 48 was achieved by 78.7% (95% CI. = 69.7-86%) of patients and mean CD4 cell count increase from baseline was 131.5. cells/μL (95% CI. = 103.4-159.6). In multiple logistic regression analysis, higher baseline viral load (RR. = 1.04 per 10,000. copies/mL increase; 95% CI. = 1.01-1.09) and higher number of darunavir resistance-associated mutations (RR. = 1.23 per each; 95% CI. = 0.95-1.48) were independently associated with virologic failure. Conclusion: Virologic suppression is a realistic endpoint for most treatment-experienced patients who begin a darunavir-based therapy outside the controlled conditions of a randomized trial, at routine care settings. © 2013 Elsevier Editora Ltda.

Cite

CITATION STYLE

APA

Ribeiro, K. M., Biscione, F. M., Westin, M. R., Machado, D. P., Greco, D. B., & Tupinambás, U. (2014). Virologic and immunologic effectiveness of darunavir-based salvage therapy in HIV-1-infected adults in a Brazilian clinical practice setting: Results of a multicenter and retrospective cohort study. Brazilian Journal of Infectious Diseases, 18(1), 1–7. https://doi.org/10.1016/j.bjid.2013.04.001

Register to see more suggestions

Mendeley helps you to discover research relevant for your work.

Already have an account?

Save time finding and organizing research with Mendeley

Sign up for free