Early viral response in a cohort of heavily ARV-experienced patients receiving a salvage regimen recommended by a national advisory board in Mexico
Y. Vargas-Infante1, J. Andrade-Villanueva2, J. Sierra-Madero3, L. Soto-Ramirez3, J.A. Mata Marin4, J. Gaytan-Martinez4, J. Casillas-Rodriguez5, S. Treviño6, L. Pérez Saleme7, F. Ortiz Luna1, J.J. Calva1
1Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Clinical Epidemiology Unit, Mexico, Mexico, 2Antiguo Hospital Civil de Guadalajara, HIV Clinic, Guadalajara, Mexico, 3Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Infectious Diseases, Mexico, Mexico, 4Centro Medico Nacional La Raza, Infectious Diseases, Mexico, Mexico, 5Clinica Especializada Condesa, HIV Clinic, Mexico, Mexico, 6Hospital Regional no.1 del IMSS, Internal Medicine, Mexico, Mexico, 7Centro Médico Nacional Siglo XXI, Infectious Diseases, Mexico, Mexico
Background: A national committee was created by the Ministry of Health in 2008 to aid Mexican physicians in the prescription of an optimal ARV regimen in heavily treatment-experienced patients with virologic failure, based on history and resistance testing, and to optimize the use of the newest ARV drugs: darunavir, raltegravir and etravirine. Virologic response at 12 weeks and mortality were assessed.
Methods: Patients (pts) with a history of 2 or more ARV regimens, and viral failure , for whom his/her physician received a recommendation of a new optimized regimen and followed for at least 3 mo were included in the analysis. Surveillance of these pts was done through electronic registries and interviews with their clinicians.
Results: 235 evaluated pts had the following characteristics: 88% male, median age 41 yrs (IQR 33,47), median time of HIV- diagnosis 9 yrs (IQR 6,11), median time of ARV exposure 8 yrs (IQR 5,10) median number of previous regimens 4(IQR 3,6). Median CD4 T-cell count nadir 61 cells/ mm3 (IQR 23,152). 104(44%) pts achieved at least one VL below 400 cop/mL with previous regimens. At the time of this analysis 195(83%) pts started therapy as recommended by the committee, 143(73%) had at least one VL measurement during follow-up (FU) and 125/143(87%) of them reached a VL < 400 copies/mL after a median time of salvage therapy of 12 weeks (IQR 6,17). The median increase of CD4 count was 52 cel/mm3 (IQR -0.5,140), and viral rebound occurred in 6/143(4%) cases. 6/235(3%) pts were lost to FU and there were 10(4%) deaths.
Conclusions: Among these highly treatment-experienced patients a centralized committee to guide the use of salvage regimens, based mostly on the newer ARV drugs, led to a high short term virologic response rate. Longer FU will be needed to assess long term success of this strategy.
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