Virological failure to raltegravir in Spain: incidence, prevalence and clinical consequences
The objective of this study was to evaluate the incidence, prevalence and clinical consequences of virological failure (VF) to raltegravir-based regimens in Spain. A multicentre, retrospective, observational study was performed in 10 tertiary hospitals (January 2006 to June 2013). The study included...
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| creator | Santos, José Ramón Blanco, José Luis Masiá, Mar Gutiérrez, Félix Pérez-Elías, María Jesús Iribarren, José Antonio Force, Lluis Antela, Antonio Knobel, Hernando Salavert, Miguel López Bernaldo De Quirós, Juan Carlos Pino, María Paredes, Roger Clotet, Bonaventura |
| description | The objective of this study was to evaluate the incidence, prevalence and clinical consequences of virological failure (VF) to raltegravir-based regimens in Spain.
A multicentre, retrospective, observational study was performed in 10 tertiary hospitals (January 2006 to June 2013). The study included HIV-1-infected patients with loss of virological suppression (LVS; two consecutive HIV-1 RNA ≥50 copies/mL) while receiving raltegravir. VF and low-level viraemia (LLV) were defined as two consecutive HIV-1 RNA ≥200 copies/mL and 50 to |
| doi_str_mv | 10.1093/jac/dkv205 |
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A multicentre, retrospective, observational study was performed in 10 tertiary hospitals (January 2006 to June 2013). The study included HIV-1-infected patients with loss of virological suppression (LVS; two consecutive HIV-1 RNA ≥50 copies/mL) while receiving raltegravir. VF and low-level viraemia (LLV) were defined as two consecutive HIV-1 RNA ≥200 copies/mL and 50 to <200 copies/mL, respectively. Integrase strand-transfer inhibitor resistance was investigated at LVS. During the 48 weeks following LVS, recorded data included clinical characteristics, treatment discontinuations, AIDS-associated events and deaths. Effectiveness of therapy following LVS was evaluated by ITT and PP. Multivariate regression was used to assess predictors of efficacy.
Of the 15 009 HIV-infected patients in participating centres, 2782 (18.5%) had received raltegravir-based regimens. Of those, 192 (6.9%), 125 (4.5%) and 67 (2.4%) experienced LVS, VF and LLV, respectively. The incidence of VF was 1.8 (95% CI, 1.5-2.1) per 100 patients/year. The prevalence of VF was 4.5% (95% CI, 3.8%-5.3%). Integrase-associated mutations were found in 78.8% of patients with integrase genotyping results available. High-level resistance to dolutegravir was not observed. Salvage therapy failed in 34.1% of patients; progression to AIDS/death occurred in 8.3% during the first year following LVS. The latter was associated with intravenous drug use, time on raltegravir and lower CD4+ count nadir in patients who started raltegravir-based treatments as salvage regimens.
VF with raltegravir is infrequent, but often associated with major clinical complications in treatment-experienced patients.</description><identifier>ISSN: 0305-7453</identifier><identifier>EISSN: 1460-2091</identifier><identifier>DOI: 10.1093/jac/dkv205</identifier><identifier>PMID: 26490727</identifier><language>eng</language><publisher>England: Oxford Publishing Limited (England)</publisher><subject>Anti-HIV Agents - therapeutic use ; Antiretroviral drugs ; Drug resistance ; Drug Resistance, Viral ; Genotype ; HIV ; HIV Infections - drug therapy ; HIV Infections - virology ; HIV-1 - drug effects ; HIV-1 - genetics ; HIV-1 - isolation & purification ; Human immunodeficiency virus ; Human immunodeficiency virus 1 ; Humans ; Incidence ; Inhibitor drugs ; Prevalence ; Raltegravir Potassium - therapeutic use ; Retrospective Studies ; Ribonucleic acid ; RNA ; Spain ; Tertiary Care Centers ; Treatment Failure ; Viral Load ; Virology</subject><ispartof>Journal of antimicrobial chemotherapy, 2015-11, Vol.70 (11), p.3087-3095</ispartof><rights>The Author 2015. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.</rights><rights>Copyright Oxford Publishing Limited(England) Nov 2015</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c384t-48d25ae536acc98f7340bf705174499ab4fe99517c82993596276e176c62ab3a3</citedby><cites>FETCH-LOGICAL-c384t-48d25ae536acc98f7340bf705174499ab4fe99517c82993596276e176c62ab3a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26490727$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Santos, José Ramón</creatorcontrib><creatorcontrib>Blanco, José Luis</creatorcontrib><creatorcontrib>Masiá, Mar</creatorcontrib><creatorcontrib>Gutiérrez, Félix</creatorcontrib><creatorcontrib>Pérez-Elías, María Jesús</creatorcontrib><creatorcontrib>Iribarren, José Antonio</creatorcontrib><creatorcontrib>Force, Lluis</creatorcontrib><creatorcontrib>Antela, Antonio</creatorcontrib><creatorcontrib>Knobel, Hernando</creatorcontrib><creatorcontrib>Salavert, Miguel</creatorcontrib><creatorcontrib>López Bernaldo De Quirós, Juan Carlos</creatorcontrib><creatorcontrib>Pino, María</creatorcontrib><creatorcontrib>Paredes, Roger</creatorcontrib><creatorcontrib>Clotet, Bonaventura</creatorcontrib><creatorcontrib>Integrase Resistance Study Group in Spain (INI-VAIN Study Group)</creatorcontrib><creatorcontrib>Integrase Resistance Study Group in Spain INI-VAIN Study Group</creatorcontrib><title>Virological failure to raltegravir in Spain: incidence, prevalence and clinical consequences</title><title>Journal of antimicrobial chemotherapy</title><addtitle>J Antimicrob Chemother</addtitle><description>The objective of this study was to evaluate the incidence, prevalence and clinical consequences of virological failure (VF) to raltegravir-based regimens in Spain.
A multicentre, retrospective, observational study was performed in 10 tertiary hospitals (January 2006 to June 2013). The study included HIV-1-infected patients with loss of virological suppression (LVS; two consecutive HIV-1 RNA ≥50 copies/mL) while receiving raltegravir. VF and low-level viraemia (LLV) were defined as two consecutive HIV-1 RNA ≥200 copies/mL and 50 to <200 copies/mL, respectively. Integrase strand-transfer inhibitor resistance was investigated at LVS. During the 48 weeks following LVS, recorded data included clinical characteristics, treatment discontinuations, AIDS-associated events and deaths. Effectiveness of therapy following LVS was evaluated by ITT and PP. Multivariate regression was used to assess predictors of efficacy.
Of the 15 009 HIV-infected patients in participating centres, 2782 (18.5%) had received raltegravir-based regimens. Of those, 192 (6.9%), 125 (4.5%) and 67 (2.4%) experienced LVS, VF and LLV, respectively. The incidence of VF was 1.8 (95% CI, 1.5-2.1) per 100 patients/year. The prevalence of VF was 4.5% (95% CI, 3.8%-5.3%). Integrase-associated mutations were found in 78.8% of patients with integrase genotyping results available. High-level resistance to dolutegravir was not observed. Salvage therapy failed in 34.1% of patients; progression to AIDS/death occurred in 8.3% during the first year following LVS. The latter was associated with intravenous drug use, time on raltegravir and lower CD4+ count nadir in patients who started raltegravir-based treatments as salvage regimens.
VF with raltegravir is infrequent, but often associated with major clinical complications in treatment-experienced patients.</description><subject>Anti-HIV Agents - therapeutic use</subject><subject>Antiretroviral drugs</subject><subject>Drug resistance</subject><subject>Drug Resistance, Viral</subject><subject>Genotype</subject><subject>HIV</subject><subject>HIV Infections - drug therapy</subject><subject>HIV Infections - virology</subject><subject>HIV-1 - drug effects</subject><subject>HIV-1 - genetics</subject><subject>HIV-1 - isolation & purification</subject><subject>Human immunodeficiency virus</subject><subject>Human immunodeficiency virus 1</subject><subject>Humans</subject><subject>Incidence</subject><subject>Inhibitor drugs</subject><subject>Prevalence</subject><subject>Raltegravir Potassium - therapeutic use</subject><subject>Retrospective Studies</subject><subject>Ribonucleic acid</subject><subject>RNA</subject><subject>Spain</subject><subject>Tertiary Care Centers</subject><subject>Treatment Failure</subject><subject>Viral Load</subject><subject>Virology</subject><issn>0305-7453</issn><issn>1460-2091</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkctLAzEQxoMoWh8X_wBZ8CLi2sk78SbFFxQ8-DgJS5rNSmq6W5Nuwf_e1KoHT57mG-bHNzN8CB1iOMeg6XBq7LB-WxLgG2iAmYCSgMabaAAUeCkZpztoN6UpAAgu1DbaIYJpkEQO0Muzj13oXr01oWiMD310xaIrogkL9xrN0sfCt8XD3Pj2Iivra9dad1bMo1uasNKFaevCBt9-ediuTe69Xw3SPtpqTEju4Lvuoafrq8fRbTm-v7kbXY5LSxVblEzVhBvHqTDWatVIymDSSOBYMqa1mbDGaZ07q4jWlGtBpHBYCiuImVBD99DJ2nceu7w6LaqZT9aFYFrX9anCUnHCuOLiHyhRkC8BldHjP-i062ObH1lRHKhQGDJ1uqZs7FKKrqnm0c9M_KgwVKt4qhxPtY4nw0fflv1k5upf9CcP-gmUTYpm</recordid><startdate>201511</startdate><enddate>201511</enddate><creator>Santos, José Ramón</creator><creator>Blanco, José Luis</creator><creator>Masiá, Mar</creator><creator>Gutiérrez, Félix</creator><creator>Pérez-Elías, María Jesús</creator><creator>Iribarren, José Antonio</creator><creator>Force, Lluis</creator><creator>Antela, Antonio</creator><creator>Knobel, Hernando</creator><creator>Salavert, Miguel</creator><creator>López Bernaldo De Quirós, Juan Carlos</creator><creator>Pino, María</creator><creator>Paredes, Roger</creator><creator>Clotet, Bonaventura</creator><general>Oxford Publishing Limited (England)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QL</scope><scope>7QO</scope><scope>7T7</scope><scope>7U7</scope><scope>7U9</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>NAPCQ</scope><scope>P64</scope><scope>7X8</scope></search><sort><creationdate>201511</creationdate><title>Virological failure to raltegravir in Spain: incidence, prevalence and clinical consequences</title><author>Santos, José Ramón ; 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A multicentre, retrospective, observational study was performed in 10 tertiary hospitals (January 2006 to June 2013). The study included HIV-1-infected patients with loss of virological suppression (LVS; two consecutive HIV-1 RNA ≥50 copies/mL) while receiving raltegravir. VF and low-level viraemia (LLV) were defined as two consecutive HIV-1 RNA ≥200 copies/mL and 50 to <200 copies/mL, respectively. Integrase strand-transfer inhibitor resistance was investigated at LVS. During the 48 weeks following LVS, recorded data included clinical characteristics, treatment discontinuations, AIDS-associated events and deaths. Effectiveness of therapy following LVS was evaluated by ITT and PP. Multivariate regression was used to assess predictors of efficacy.
Of the 15 009 HIV-infected patients in participating centres, 2782 (18.5%) had received raltegravir-based regimens. Of those, 192 (6.9%), 125 (4.5%) and 67 (2.4%) experienced LVS, VF and LLV, respectively. The incidence of VF was 1.8 (95% CI, 1.5-2.1) per 100 patients/year. The prevalence of VF was 4.5% (95% CI, 3.8%-5.3%). Integrase-associated mutations were found in 78.8% of patients with integrase genotyping results available. High-level resistance to dolutegravir was not observed. Salvage therapy failed in 34.1% of patients; progression to AIDS/death occurred in 8.3% during the first year following LVS. The latter was associated with intravenous drug use, time on raltegravir and lower CD4+ count nadir in patients who started raltegravir-based treatments as salvage regimens.
VF with raltegravir is infrequent, but often associated with major clinical complications in treatment-experienced patients.</abstract><cop>England</cop><pub>Oxford Publishing Limited (England)</pub><pmid>26490727</pmid><doi>10.1093/jac/dkv205</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Anti-HIV Agents - therapeutic use Antiretroviral drugs Drug resistance Drug Resistance, Viral Genotype HIV HIV Infections - drug therapy HIV Infections - virology HIV-1 - drug effects HIV-1 - genetics HIV-1 - isolation & purification Human immunodeficiency virus Human immunodeficiency virus 1 Humans Incidence Inhibitor drugs Prevalence Raltegravir Potassium - therapeutic use Retrospective Studies Ribonucleic acid RNA Spain Tertiary Care Centers Treatment Failure Viral Load Virology |
| title | Virological failure to raltegravir in Spain: incidence, prevalence and clinical consequences |
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