Portal de Periódicos da CAPES

Impact of the M184V Resistance Mutation on Virological Efficacy and Durability of Lamivudine-Based Dual Antiretroviral Regimens as Maintenance Therapy in Individuals With Suppressed HIV-1 RNA: A Cohort Study

2018; Oxford University Press; Volume: 5; Issue: 6 Linguagem: Inglês

10.1093/ofid/ofy113

2328-8957

Roberta Gagliardini, Arturo Ciccullo, Alberto Borghetti, Franco Maggiolo, Dario Bartolozzi, Vanni Borghi, Monica Pecorari, Antonio Di Biagio, Anna Paola Callegaro, Bianca Bruzzone, Francesco Saladini, Stefania Paolucci, Renato Maserati, Maurizio Zazzi, Simona Di Giambenedetto, Andrea De Luca, Vincenzo Mellace, Amedeo Capetti, Maria Rita Gismondo, Maria Luisa Biondi, Cristina Mussini, Monica Pecorari, Nicola Gianotti, D. Sacchini, Giustino Parruti, Ennio Polilli, Franco Baldelli, Stefania Zanussi, Alessandro Nerli, Lucia Lenzi, Carlo Calzetti, A Vivarelli, Renato Maserati, Fausto Baldanti, Federica Poletti, Vincenzo Mondino, Marina Malena, Antonio Cascio, G. Filice, G. Magnani, Alessandro Zerbini, Francesca Lombardi, Simona Di Giambenedetto, Massimo Andreoni, Marco Aurélio Echart Montano, Vincenzo Vullo, Ombretta Turriziani, Maurizio Zazzi, Angela Gonnelli, Andrea De Luca, Enzo Boeri, Stefano Bonora, Valeria Ghisetti, Daniela Francisci, Paolo Grossi, Maria Carla Re, Luca Butini, Romana del Gobbo, Maria Carla Re, Danilo Tacconi, Laura Monno, Grazia Punzi, Annapaola Callegaro, Franco Maggiolo, Alessia Zoncada, Elisabetta Paolini, Laura Sighinolfi, G Colao, Paola Corsi, Pierluigi Blanc, Luisa Galli, Paola Meraviglia, Andrea Tosti, Bianca Bruzzone, Maurizio Setti, Giovanni Penco, Antonio Di Biagio, Cesira Nencioni, Riccardo Pardelli, Irene Arcidiacono, Alberto Degiuli, Michele De Gennaro, Alessandro Soria, Alfredo Focà, Latella Surace, Lucio Cosco, Sergio Maria Ivano Malandrin, P Milini, Paola Cicconi, Stefano Rusconi, Valeria Micheli,

HIV/AIDS Research and Interventions

Abstract Background Dual therapy (DT) with boosted protease inhibitors (bPIs) plus lamivudine has been shown to be superior to bPI monotherapy in virologically suppressed patients despite previous selection of the lamivudine resistance M184V mutation. We compared the virological efficacy of lamivudine-based DT in patients with and without a history of M184V detection. Methods We retrospectively analyzed patients with HIV-RNA ≤50 copies/mL switching to DT with at least 1 previous resistance genotype in the ARCA database. Time to virological failure (VF; HIV-RNA ≥200 copies/mL or 2 consecutive HIV-RNA >50 copies/mL) and to treatment discontinuation (TD) was analyzed by survival analysis. Results Four hundred thirty-six patients switching to lamivudine plus bPIs (70%) or integrase inhibitors (30%) were included. Patients with M184V (n = 87) were older, had lower nadir CD4+ cell count, longer duration of antiretroviral therapy and of virologic suppression, and higher rate of hepatitis C virus infection compared with patients without M184V. The 3-year probability of remaining free from VF was 91.9% (95% confidence interval [CI], 86.6–97.2) without M184V and 87.8% (95% CI, 78.4–97.2) with M184V (P = .323). The time to TD did not differ between groups. Multivariate analysis adjusting for baseline variables differing between groups also did not detect M184V as being associated with VF or TD; however, the 3-year probability of remaining free of viral blips (isolated HIV-RNA 51–199 copies/mL) was 79.8% (95% CI, 67.8%–91.8%) with M184V vs 90.1% (95% CI, 84.0%–96.2%) without M184V (P = .016). Conclusions Previous selection of M184V did not increase the risk of VF or TD with lamivudine-based DT but was associated with a higher probability of viral blips.