Switch From Etravirine Twice Daily to Once Daily in Non-Nucleoside Reverse Transcriptase Inhibitor (NNRTI)-Resistant HIV-Infected Patients With Suppressed Viremia: The Monetra Study

Abstract

Background: Etravirine (ETR) is recommended as twice-daily dosing in pretreated patients. There are no data regarding the use of ETR once daily in HIV-experienced patients with prior resistance to first-generation non-nucleoside reverse transcripase inhibitors (NNRTIs).Objectives: To evaluate the capacity of once-daily ETR to maintain suppressed viremia over 48 weeks after switching from ETR twice daily in NNRTI-experienced patients.Methods: In this pilot open-label study, patients with plasma viral load (pVL) <50 copies/mL on a stable ETR 200 mg bid regimen were enrolled to switch to ETR 400 mg qd and followed up over 48 weeks. The primary endpoint was the proportion of patients with pVL <50 copies/mL at week 24. Secondary endpoints included the rate of pVL< 50 copies/mL at week 48, ETR pharmacokinetic parameters, and tolerability and resistance profile.Results: Twenty-four patients were included. They had extensive antiretroviral treatment for a median of 14 years (range, 1-19). All except for 2 had prior resistance to NNRTIs. Seven patients discontinued ETR once daily prior to week 48 for virological failure (3), protocol deviation (3), and side effects (1). At week 24, 95% of patients maintained pVL< 50 copies/mL (95% CI, 78.4-99.7) and 85% at week 48 (95%CI, 65.6-95.8). Two of the 3 patients with virological failure had ETR resistance mutations prior to initiation. The median ETR C_trough level remained stable after switching from twice daily 515 ng/mL (340-758) to once daily 422 ng/mL (264-655).Conclusion: These results suggest that ETR is effective as a once-daily regimen in patients with prior NNRTI experience when HIV is sensitive to ETR. The stability of C_trough concentrations on a once-daily regimen confirms the once-daily profile of the drug in experienced patients.     

Effectiveness and safety of rilpivirine,a non-nucleoside reverse transcriptase inhibitor,in treatment-naive adults infected with HIV-1: a meta-analysis

Objectives:

The aim of this study was to determine the effectiveness and safety of rilpivirine in treatment-naive adults infected with HIV-1.

Methods:

We ran duplicate searches of multiple databases and searchable websites of major HIV conferences (up to October 2013) to identify randomized controlled trials reporting the effectiveness and safety of rilpivirine in treatment-naive adults infected with HIV-1. Reference lists from retrieved articles were also reviewed. Data were extracted independently in duplicate using predefined data fields. All analyses used random-effects models to calculate the summary treatment effect estimates.

Results:

Four randomized controlled trials with a total of 2522 patients were included in the inclusion criteria. The primary efficacy endpoint was the proportion of patients with confirmed HIV-1 RNA levels of Conclusions:

Current evidence suggests a range of favorable effects and a generally favorable safety profile of rilpivirine in treatment-naive adults infected with HIV-1 at week 48.     

Transient Treatment Exclusively Containing Nucleoside Analogue Reverse Transcriptase Inhibitors in Highly Antiretroviral-Experienced Patients Preserves Viral Benefit When a Fully Active Therapy Was Initiated

Abstract

Background: We determined whether coformulated zidovudine/lamivudine/abacavir plus tenofovir could maintain immune status in comparison with a genotype-guided salvage regimen in highly pretreated patients. Method: This was a randomized pilot control-arm study. The primary endpoint was the proportion of patients who maintained their CD4+ T-cell count at Week 48. Results: Thirteen patients were randomized to the study arm and 10 to the control arm. At 48 weeks, 8 (64%) patients in the study arm and 10 (100%) in the control arm maintained their immune status (p = .09). No new AIDS-defining events occurred. Three patients (27%) in the study arm and 5 (50%) in the control arm achieved an undetectable viral load (p = .39). When a fully suppressive regimen was initiated, 69% of patients in the study arm (9 patients) and 60% (6 patients) in the control arm reached <50 copies at 96 weeks (p = .98). Conclusion: Although no statistically significant differences in immunological course were observed between the arms, the control group achieved better results after 48 weeks. This transient therapy could be reserved for specific patients in whom the risk of incomplete adherence or toxicity compromises efficacy while they are awaiting a fully active drug, without jeopardizing viral efficacy when a fully suppressive regimen is initiated.     

NucliSens HIV-1 QT和Amplicor HIV-1 monitor1.5方法测定HIV-1病毒载量的比较研究

目的进行NuchSens HIV-1 QT和Amplicor HIV-1 monitor 1．5检测相同临床样品HIV-1病毒载量值之间的比较研究。方法收集临床样本82份，使用两种方法测定病毒载量，对病毒载量值进行统计分析。结果未测到核酸的和两种方法病毒载量对数值之差小于0．5的占88．9％；用△log10 VL〈0．5的56份样本统计两种方法的相关性，相关系数为0．956。结论NucliSens HIV-1 QT和Amphcor HIV-1 monitor 1．5两种方法测定的HIV病毒载量值有很好的相关性。     

Localization of HTLV-1 and HIV-1 Proviral Sequences in Chromosomes of Persistently Infected Cells

Integration sites for HTLV-1 and HIV-1proviruses were detected by FISH on the chromosomes of HTHIV27 cells persistently infected by HIV-1 (strain IIIB). HTLV-1 signals were found on 9 loci of chromosomes 4, 6, 9, 15 and 16. Integration sites of GC-rich HTLV-1 provirus are located in GC-rich isochores, confirming an ‘isopycnic’ integration, namely an integration in which the GC level of the host sequences around the integration site match the GC level of the provirus. This conclusion is not only derived from the compositional map of human chromosomes, but also from HTLV-1 hybridization on compositional fractions of human DNA. Integration of GC-poor HIV- 1 provirus was found on 4 loci of chromosomes 2, 7, 17 and 19. One copy of a complete HIV-1 provirus, which is active, was integrated in H1 isochores, whereas other defective copies were located in GC-poor L isochores. These results are discussed in terms of regional integration of retroviral sequences. This revised version was published online in August 2006 with corrections to the Cover Date.     

重组人免疫缺陷病毒Ⅰ型逆转录酶的纯化及其动力学性质

目的纯化重组人免疫缺陷病毒Ⅰ型逆转录酶（ＨＩＶ－１ＲＴ），筛选新的ＨＩＶ－１ＲＴ抑制剂。方法在适宜的培养条件下诱导工程菌Ｅ．ｃｏｌｉＪＭ１０９（ＰＫＲＴ２）可高效表达重组人免疫缺陷病毒Ⅰ型（ＨＩＶ－１）逆转录酶（ＲＴ）。应用ＤＥＡＥ－纤维素和磷酸纤维素离子交换柱层析法从细菌裂解液中分离、纯化重组ＲＴ。结果１升细菌培养液可得到１．１ｍｇ产物。ＳＤＳ－聚丙烯酰胺凝胶电泳分析显示所纯化的重组ＲＴ为由两个分子量分别为６６ｋＤ和５１ｋＤ的亚基组成的杂二聚体。酶活性测定结果表明，经纯化的重组ＲＴ具有很高的逆转录酶活性（比活力为１．４×１０４ｕｍｇ）。结论本文通过对ＲＴ反应条件的研究，优化了ＲＴ反应系统，并测定了磷甲酸钠（ＰＦＡ）对重组ＲＴ的抑制效应，结果表明ＰＦＡ对重组ＲＴ的抑制反应动力学机制与天然ＲＴ相同，从而进一步说明用此法纯化的重组ＲＴ可直接用于抗ＨＩＶ药物的筛选与评价。