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Factors Associated With Virological Failure in HIV-1–Infected Patients Receiving Darunavir/Ritonavir Monotherapy

2011; Oxford University Press; Volume: 204; Issue: 8 Linguagem: Inglês

10.1093/infdis/jir518

1537-6613

Sidonie Lambert-Niclot, Philippe Flandre, Marc‐Antoine Valantin, Gilles Peytavin, Claudine Duvivier, Stéphanie Haïm‐Boukobza, Michèle Algarté-Génin, Yazdan Yazdanpanah, Pierre‐Marie Girard, Christine Katlama, Vincent Cálvez, Anne‐Geneviève Marcelin,

HIV Research and Treatment

Our objective was to determine virological and clinical characteristics associated with virological failure in human immunodeficiency virus (HIV)-infected patients switching to darunavir/ritonavir (DRV/r) monotherapy.The main outcome was virologic rebound, defined as 2 consecutive measurements of HIV-1 plasma RNA viral load (VL) >50 copies/mL. A logistic model was used to investigate which variables were predictive of a virologic rebound at weeks 48 (W48) and 96 (W96).Receiving DRV/r monotherapy was associated with virologic rebound at W48 (P = .016) and W96 (P = .002), comparable to triple therapy. In the DRV/r monotherapy group, at W48, having a VL >50 copies/mL at day 0 and even a baseline ultrasensitive VL >1 copy/mL were predictive factors to virologic rebound (P = .042 and P = .025, respectively). At W96, shorter time of prior antiretrovial therapy (ART) exposure (odds ratio [OR] = 2.93 per 5 years decrease; P = .006), higher HIV-1 DNA at day 0 (OR = 2.66 per 1 log(10) copies/10(6) cells increase; P = .04) and adherence <100% (OR = 3.84 vs 100%; P = .02) were associated with an increased risk of rebound.Factors associated with virological failure in patients receiving DRV/r monotherapy were having an initial blip, shorter time of antiretroviral treatment before monotherapy, and an adherence <100% during monotherapy. The importance of prior duration exposure to ART was in agreement with the impact of HIV-1 blood reservoir and VL level at baseline.