Abstract BPD1/7
Efficacy of Raltegravir Once Daily in Switching Strategies in HIV-1 Infected Patients with Suppressed Viraemia Print
F. Caby1, M. Bonmarchand2, C. Soulie3, G. Peytavin4, R. Agher1, B. Revollo5, C. Delanoe5, R. Tubiana1, M.-A. Valantin5, A.-G. Marcelin5, C. Katlama5
1Hôpital Pitié-Salpêtrière, Infectious Diseases, Paris, France, 2Hôpital Pitié-Salpêtrière, Internal Medicine, Paris, France, 3Hôpital Pitié-Salpêtrière, Virology, Paris, France, 4Hôpital Bichat Claude Bernard, Pharmacology, Paris, France, 5Hôpital Pitié-Salpêtrière, Paris, France
Objectives: To evaluate the efficacy of raltegravir 800 mg QD to maintain virological success in patients with suppressed viremia.
Methods: In this observational study, HIV-1 infected patients were enrolled if raltegravir (RAL) was introduced at a dose of 800mg QD in a context of virological success defined by plasma (p) HIV-1 RNA < 50 copies/mL for 6 months at least. The primary end point was the proportion of patients with pHIV-1 RNA < 50 copies/mL at week 24.
Results: Seventy-one patients were included and followed up over 48 weeks. Of these, 17 (24%) received RAL 400mg BID for a median duration of 8 [1-28] months before having RAL 800mg QD. When starting RAL QD, patients had been treated for 14 [1-22] years and had already received 5 [1-15] ARV lines, their CD4-cell count was 588 [248-1328]/mm3 and CD4/CD8 ratio was 0.8 [0.2-2.0]. The backbone associated with RAL QD was tenofovir/emtricitabine in 40 (56%) patients, abacavir/lamivudine in 13 (18%) patients, etravirine in 7 (10%) patients, atazanavir in 7 (10%) patients, nevirapine in 3 patients and efavirenz in 1 patient. The proportion of patients with pHIV-1 RNA < 50 copies/mL was 99 [96-100] % at W24 and 96 [91-100] % at W48. Virological failure was observed in one patient at W24, two more patients at W48 and was associated with raltegravir resistance emergence in two cases. All of these three patients received RAL QD in association with two NRTIs and had previously experienced virological failure on NRTI regimens responsible for prior drug resistance mutations on the reverse transcriptase gene.
Conclusions: In this study, switching to RAL QD maintains virological suppression over 48 weeks as long as RAL is associated with a fully active backbone. This requires the entire ARV history and all previous HIV genotyping test results.

Assigned speakers:
Fabienne Caby , Hôpital Pitié-Salpêtrière , Paris , France

Assigned in sessions:
17.10.2013, 13:00-14:00, Special Session, Best Poster Discussion 1, Gold Hall