BOSTON — Third-line regimens with darunavir/ritonavir and raltegravir are highly effective in certain patients with HIV in resource-limited settings, according to researchers.
Targeted real-time genotyping also helps direct more costly drugs to patients with greater resistance to treatment, they said at CROI.
“With an increasing number of individuals using antiretroviral therapy worldwide — first-line and second-line — not everyone does well with therapy, so we have an increasing number of people who are failing second-line therapy, and we still don’t have a public health approach for patients failing second line,” researcher Beatriz Grinsztejn, MD, PhD, of the Instituto Nacional de Infectologia Evandro Chagas in Rio de Janeiro, Brazil, said at a CROI press conference. “Our objective was to see if newer antiretrovirals plus real-time genotyping, plus viral load monitoring could be a way for these individuals to have a better virological response.”
In their study, Grinsztejn and colleagues assessed patients with a viral load of at least 1,000 copies/mL after more than 24 weeks of treatment with protease inhibitor-based, second-line ART. They included patients enrolled between 2013 and 2015 in Africa, Asia, the Caribbean and South America.
The researchers separated the patients into cohorts based on prior ART use and treatment resistance based on real-time genotyping. Each cohort then received a range of ART options. The researchers assessed which patients achieved viral suppression to 200 copies/mL or less at 48 weeks of follow-up.
One cohort comprised 287 patients without resistance to lopinavir/ritonavir (LPV/r). Because of the lack of resistance, those patients continued to receive second-line ART. Of those patients, 44% achieved viral suppression. Meanwhile, 51% had confirmed virologic failure.
Another cohort consisted of 154 patients who were resistant to LPV/r but susceptible to darunavir/ritonavir (DRV/r) and to etravirine. They received third-line regimens containing DRV/r and raltegravir (RAL). Of those, 88% achieved viral suppression.
A third cohort consisted of 70 patients with resistance to LPV/r and etravirine but who were susceptible to DRV/r and had no prior treatment with RAL. According to the researchers, 90% of those patients achieved viral suppression.
Grinsztejn said the data show that more novel treatment options are needed for people failing second-line therapy.
“Now we have some data to show the profile of people failing second-line therapy,” she concluded. “It’s really important for us to better understand what is the best [treatment] we can offer so that individuals can truly have better outcomes.” – by Joe Green
Editor’s note: In the United States, darunavir is marketed as Prezista (Janssen Pharmaceuticals), lopinavir/darunavir is marketed as Kaletra (Abbvie); etravirine is marketed as Intelence (Janssen Pharmaceuticals) and raltegravir is marketed as Istentress (Merck).
Grinsztejn B, et al. Abstract 30LB. Presented at: Conference on Retroviruses and Opportunistic Infections; March 4-7, 2018; Boston.