|
Darunavir/ritonavir once daily: a single centre cohort experience
C. Scott, J. Dunning, A. Teague, M. Bower, B. Gazzard, M. Nelson
Chelsea and Westminster Hospital, Dept of Sexual Health & HIV, London, United Kingdom
Background: Darunavir (DRV) is a novel non-peptidic protease inhibitor (PI) with activity against wild type and protease inhibitor resistant HIV-1 when boosted with low dose ritonavir. We describe our experience of using once daily darunavir/ritonavir (900/100mg) within the Chelsea & Westminster Hospital cohort.
Methods: This prospective observational study followed a cohort of patients who received DRV/r (900/100mg) od plus reverse transcriptase inhibitors (RTIs). CD4 count, viral load (VL) and routine safety bloods where measured at baseline, 0, 12, 24, 36 & 48 week intervals.
Results: 187 patients commenced RTI + DRVr (900/100). All patients underwent phenotypic resistance testing confirming no baseline resistance to DRV. 24/187 patients were anti-retroviral therapy naïve and 155/187 patients were anti-retroviral experienced. 108/155 patients switched with VL< 50 copies/mL. Data were available for 187, 187, 154 and 102 patients at weeks 12, 24, 36 and 48 respectively. The proportion of patients achieving HIV VL < 50 copies/mL (ITT) in the treatment naïve group was 54% at week 12, 79% at week 24, 83% at week 36 and 78% at week 48. In the treatment experienced group the proportion of patients with HIV RNA < 50 copies/mL (ITT) was 64% at week 12, 59% at week 24, 57% at week 36 and 58% at week 48. 108 individuals switched to DRVr with an undetectable HIV VL. The proportion maintaining HIV VL < 50 copies/mL was 72 % at week 48 (ITT). 4 virological failures were observed in this group due to poor adherence. No DRV resistance was identified. 32/187 patients discontinued therapy. Main reasons for discontinuation were diarrhoea and patient driven treatment interuption. 7/108 patients were lost to follow up.
Conclusions: In this cohort of treatment naïve and experienced patients with no background PI resistance, once daily darunavir/ritonavir (900/100mg) is both effective in terms of virological suppression and well tolerated.
|