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Response to raltegravir-based salvage therapy in HIV-infected patients with hepatitis C virus or hepatitis B virus coinfection

Weimer, Liliana Elena and Fragola, Vincenzo and Floridia, Marco and Guaraldi, Giovanni and Ladisa, Nicoletta and Francisci, Daniela and Bellagamba, Rita and Degli Antoni, Anna and Parruti, Giustino and Giacometti, Andrea and Manconi, Paolo Emilio and Vivarelli, Angela and D'Ettorre, Gabriella and Mura, Maria Stella Anna and Cicalini, Stefania and Preziosi, Roberta and Sighinolfi, Laura and Verucchi, Gabriella and Libertone, Raffaella and Tavio, Marcello and Sarmati, Loredana and Bucciardini, Raffaella (2012) Response to raltegravir-based salvage therapy in HIV-infected patients with hepatitis C virus or hepatitis B virus coinfection. Journal of Antimicrobial Chemotherapy, Vol. 68 (1), p. 193-199. eISSN 1460-2091. Article.

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DOI: 10.1093/jac/dks341

Abstract

Objectives To define the impact of coinfection with hepatitis B virus (HBV) or hepatitis C virus (HCV) on viroimmunological response to raltegravir-based salvage regimens that also include new HIV inhibitors such as maraviroc, darunavir and etravirine.
Methods We used data from a national observational study of patients starting raltegravir-based regimens to compare virological suppression and CD4 cell change from baseline in patients with and without concomitant HBV or HCV infection.
Results Overall, 275 patients (107 coinfected and 168 non-coinfected) were evaluated. Coinfected patients were more commonly former intravenous drug users and had a longer history of HIV infection and higher baseline aminotransferase levels. Both HIV-RNA and CD4 response were similar in the two groups. Mean time to first HIV-RNA copy number <50 copies/mL was 4.1 months (95% CI 3.5–4.6) in non-coinfected patients and 3.9 months (95% CI 3.3–4.5) in coinfected patients (hazard ratio 1.039, 95% CI 0.761–1.418, P = 0.766, log-rank test). The risk of developing new grade 3–4 hepatic adverse events was significantly higher in coinfected patients (hazard ratio 1.779, 95% CI 1.123–2.817, P = 0.009). The two groups of coinfected and non-coinfected patients had similar rates of interruption of any baseline drug (hazard ratio 1.075, 95% CI 0.649–1.781, P = 0.776) and of raltegravir (hazard ratio 1.520, 95% CI 0.671–3.447, P = 0.311). Few AIDS-defining events and deaths occurred.
Conclusions Viroimmunological response to regimens based on raltegravir and other recent anti-HIV inhibitors is not negatively affected by coinfection with HBV or HCV. Liver toxicity, either pre-existing or new, is more common in coinfected patients, but with no increased risk of treatment interruption.

Item Type:Article
ID Code:9000
Status:Published
Refereed:Yes
Uncontrolled Keywords:Antiretroviral therapy, HIV-1, HBV, HCV, integrase inhibitors, viral hepatitis, viral load, CD4 response, darunavir, maraviroc, etravirine, HIV resistance, liver disease
Subjects:Area 06 - Scienze mediche > MED/17 Malattie infettive
Divisions:001 Università di Sassari > 01-a Nuovi Dipartimenti dal 2012 > Medicina Clinica e Sperimentale
Publisher:Oxford University Press
eISSN:1460-2091
Copyright Holders:© The Author 2012
Deposited On:08 May 2013 13:55

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