(Isentress), Etravirine (Intelence), and Ritonavir-boosted Darunavir (Prezista)
Is a Safe and Successful Salvage Regimen
treatment-experienced HIV patients -- especially those who started therapy when
regimens were less potent -- may have developed resistance to multiple antiretroviral
drugs, leading to treatment failure. Previous research has demonstrated that boosted
darunavir plus etravirine in the DUET
trials and raltegravir in the BENCHMRK
trials produced high rates of virological response in patients with multidrug-resistant
HIV, particularly when used with 2 or more other fully active antiretroviral drugs.
The present study looked at these 3 drugs in a combination regimen without
other agents. The analysis included 32 consecutive heavily treated-experienced
participants with multidrug-resistant HIV who started a new salvage regimen consisting
of 400 mg twice-daily raltegravir, 200 mg twice-daily etravirine, and 600/100
mg twice-daily darunavir/ritonavir.
At baseline, the median age was
44 years, the median duration of ART was 13 years, and participants had used a
median 9 prior ART regimens. The median CD4 cell count was 261 cells/mm3 and the
median viral load was 4.2 log10 copies/mL.
All patients had HIV mutations
conferring resistance to 3 classes of antiretroviral drugs. Three patients (9%)
had HIV isolates with 3 etravirine resistance mutations. All participants were
darunavir-naive and had a median of 1 darunavir resistance mutation. Half the
patients had experience with enfuvirtide
(T-20, Fuzeon) and 44% had used tipranavir
of patients achieving HIV RNA less than 50 copies/mL were as follows:|
CD4 cell count increased by 30, 73, and 103 cells/mm3 at Weeks 4, 12, and 24,
adverse events were mild to moderate.|
patients experienced adverse events leading to discontinuation of the regimen.|
the study authors wrote, "Raltegravir, etravirine, and darunavir/ritonavir
is a well tolerated and highly effective antiretroviral combination in treatment-experienced
and multidrug-resistant HIV-1-infected patients with few specific etravirine and
darunavir resistance-related mutations."
Department and Microbiology Department, Hospital Universitari Vall d'Hebron, Universidad
Autónoma de Barcelona, Barcelona, Spain; Infectious Disease Unit and Microbiology
Department, Hospital Universitari Son Dureta, Palma de Mallorca, Spainn.
A Imaz, SV Del Saz,
MA Ribas, and others. Raltegravir, Etravirine, and Ritonavir-Boosted Darunavir:
A Safe and Successful Rescue Regimen for Multidrug-Resistant HIV-1Infection. Journal
of Acquired Immune Deficiency Syndromes. August 3, 2009 (Epub ahead of print).