期刊
JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES
卷 53, 期 4, 页码 464-471出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/QAI.0b013e3181bca4ec
关键词
raltegravir; efficacy; plasma concentration; HIV-1; drug resistance
资金
- Swiss National Science Foundation (SNF) [3345-062041, 3247B0-112594]
- Merck Sharp and Dohme Chibret, Glattbrugg, Switzerland
- SHCS [470, 564]
- Union Bank of Switzerland
- European Community [pp7/2007-2013, 223131]
Background: Raltegravir (RAL) achieved remarkable virologic suppression rates in randomized-clinical trials, but today efficacy data and factors for treatment failures in a routine clinical care setting are limited. Methods: First, factors associated with a switch to RAL were identified with a logistic regression including patients from the Swiss HIV Cohort Study with a history of 3 class failure (n = 423). Second, predictors for virologic outcome were identified in an intent-to-treat analysis including all patients who received RAL. Last observation carried forward imputation was used to determine week 24 response rate (HIV-1 RNA >= 50 copies/mL). Results: The predominant factor associated with a switch to RAL in patients with suppressed baseline RNA was a regimen containing enfuvirtide [odds ratio 41.9 (95% confidence interval: 11.6-151.6)]. Efficacy analysis showed an overall response rate of 80.9% (152/188), whereas 71.8% (84/117) and 95.8% (68/71) showed viral suppression when stratified for detectable and undetectable RNA at baseline, respectively. Overall CD4 cell counts increased significantly by 42 cells/mu L (P < 0.001). Characteristics of failures were a genotypic sensitivity score of the background regimen <= 1, very low RAL plasma concentrations, poor adherence, and high viral load at baseline. Conclusions: Virologic suppression rates in our routine clinical care setting were promising and comparable with data from previously published randomized-controlled trials.
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