Impact of prior virological failure and nucleos(t)ide genotypic resistance mutations on the efficacy of switching from ritonavir-boosted protease inhibitors to raltegravir

José L. Blanco, Ana Gonzalez-Cordón, Josep M. Llibre, Marta Calvo, Felix Gutierrez, Daniel Podzamczer, Montserrat Laguno, Emilio Fumero, Javier Murillas, Josep Mallolas, Maria Martinez-Rebollar, Montserrat Lonca, Iñaki Perez, Josep M. Gatell, Esteban Martinez

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    6 Citations (Scopus)

    Abstract

    © 2015 International Medical Press. Background: The virological efficacy of switching from a ritonavir-boosted protease inhibitor (PI/r)-to a raltegravir (RAL)-containing regimen remains controversial according to the results of SWITCHMRK and SPIRAL studies. The aim of this analysis is to assess the impact of prior resistance mutations to nucleos(t)ides and other potential factors on the virological outcome. Methods: This was a substudy of the prospective, openlabel, multicentre SPIRAL study. Demographic, virological variables, prior episodes of virological failures (VF) and archived resistance mutations to nucleos(t)ides were identified from databases and its impact measured by genotypic sensitive scores (GSS) according to the genotypic resistance interpretation algorithm from the Stanford HIV Drug Resistance Database on outcome was analysed. Results: Of 250 patients (128 RAL and 122 PI/r) included in the main SPIRAL study, 74 (30%) had previous VF with prior genotypic resistance tests (GRT). Median time of virological suppression prior to inclusion in SPIRAL study was 63.5 months. GSS for backbone nucleos(t)ides was <1 in 15/38 (39%) in the RAL arm and in 9/36 (25%) in the PI/r arm (P=0.13). Among those with nucleos(t)ides GSS <1, 0/15 (0%) in the RAL versus 2/9 (22%) in the PI/r arm developed VF (P=0.13). Moreover 0/11 subjects with null or residual (GSS≤0.5) backbone activity developed VF in the RAL arm. Conclusions: The 48-week virological efficacy of switching from a PI/r to RAL in subjects with long-term virological suppression was not compromised by a reduction of the nucleos(t)ide backbone activity.
    Original languageEnglish
    Pages (from-to)487-492
    JournalAntiviral Therapy
    Volume20
    Issue number5
    DOIs
    Publication statusPublished - 1 Jan 2015

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