학술논문

Optimizing the virological success of tenofovir DF/FTC/rilpivirine in HIV-infected naive and virologically suppressed patients through strict clinical and virological selection*.
Document Type
Article
Source
Infectious Diseases. Oct2016, Vol. 48 Issue 10, p754-759. 6p. 1 Diagram, 3 Charts.
Subject
*DNA
*EXPERIENCE
*HIV
*HIV-positive persons
*LONGITUDINAL method
*GENETIC mutation
*SCIENTIFIC observation
*PATIENT compliance
*RNA
*SYSTEMATIC reviews
*PROTON pump inhibitors
*PATIENT refusal of treatment
*HIGHLY active antiretroviral therapy
*TREATMENT effectiveness
*NUCLEOSIDE reverse transcriptase inhibitors
*ADVERSE health care events
*DESCRIPTIVE statistics
*GENOTYPES
Language
ISSN
2374-4235
Abstract
Background: Tenofovir DF/FTC/rilpivirine (TDF/FTC/RPV) is a single tablet regimen considered as safe and efficacious in HIV population as long as food requirements, concomitant PPI administration, and compromised antiviral activity have been carefully reviewed. We evaluated TDF/FTC/RPV in a real-life setting with focus on clinical and virological outcomes. Methods: OCEAN II is a prospective, two-centre observational study. From September 2012 to December 2013, antiretroviral-naive patients with HIV RNA <100,000 copies/mL or wishing to switch for simplification were considered for TDF/FTC/RPV. A systematic review of potential obstacles to TDF/FTC/RPV administration was undertaken during a multidisciplinary meeting, including DNA genotyping to detect archived RPV and/or NRTI-associated resistance mutations if historical RNA resistance testing was lacking. Results: TDF/FTC/RPV was considered for 480 patients, however was not offered to 194 patients (40%), mainly because of risk of insufficient virological efficacy, issues on adherence, patient refusal, meal constraint, or PPI therapy. A total of 286 patients (269 in maintenance; 17 ART-naive) received TDF/FTC/RPV. After a median follow-up of 30 months, virological failure occurred in five patients (1.7%) without the emergence of resistance mutations. Discontinuation of TDF/FTC/RPV occurred in 98 patients, due to adverse events in 43 patients (44%) and non-safety reasons in 55 patients (56%). No grade three-fourth adverse events occurred. Conclusion: In this real-life experience, cohort consisting primarily of virologically suppressed patients, TDF/FTC/RPV usually maintained virologic suppression. Discontinuation of therapy because of intolerability was due to mild adverse events. Strict clinical and virological screening probably explained the low rate of virological failure. [ABSTRACT FROM AUTHOR]