Nevirapine-raltegravir combination, a NRTI and PI/r sparing regimen, as maintenance antiretroviral therapy in virologically suppressed HIV-1-infected patients.
Résumé
BACKGROUND: NRTI and PI/r sparing regimens may be useful to some HIV-infected patients. NVP and RAL are both potent ARVs with a good long-term safety profile. METHODS: We retrospectively identified from our electronic database all patients with HIV RNA < 50 copies/mL for > 6 months on a NVP-containing regimen and no prior exposure to INSTI who were switched to RAL plus NVP. Data was collected for 36 months or until discontinuation of RAL plus NVP for any reason. RESULTS: 39 patients (30 male) were included in this analysis. Median duration of prior antiretroviral therapy was 14 years (IQR 10-17) and median duration with plasma HIV-1 RNA < 50 copies/mL prior to switch was 50 months (IQR 22-96). Switched regimens included mainly a boosted PI (n=24) or TDF/FTC (n = 12). After switching, the percentages of patients with HIV-1 RNA < 50 copies/mL were 87.2% (95% CI: 76.7- 97.7%) and 82.1% (95% CI: 70.0- 94.1%) at 6 and 12 months, respectively in the ITT-e analysis, 97.1% (95% CI: 91.6- 100%) and 94.1% (95% CI: 86.2-100%), respectively, in the per-protocol analysis. All patients with follow-up to M24 (n=22) or M36 (n=14) had HIV-1 RNA < 50 c/mL. One virologic failure was observed (related to archived NNRTI resistance mutation). During follow-up, no patient experienced Grade 3-4 adverse events. Median values of serum creatinine and lipids significantly improved after switch. CONCLUSIONS: In patients with prolonged HIV-1 RNA < 50 copies/mL, switching to NVP-RAL combination maintained virologic suppression throughout 36 months. This combination deserves further evaluation in patients unable to tolerate NRTI or PI/r agents.