Scherrer, A U; von Wyl, V; Fux, C A; Opravil, M; Bucher, H C; Fayet, A; Decosterd, L A; Hirschel, B; Khanlari, B; Yerly, S; Klimkait, T; Furrer, H; Ledergerber, B; Günthard, H F (2010). Implementation of Raltegravir in routine clinical practice: Selection criteria for choosing this drug, virologic response rates, and characteristics of failures. JAIDS Journal of Acquired Immune Deficiency Syndromes, 53(4):464-471.
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BACKGROUND:: Raltegravir (RAL) achieved remarkable virologic suppression rates in randomized-clinical trials, but today efficacy data and factors for treatment failures in a routine clinical care setting are limited. METHODS:: First, factors associated with a switch to RAL were identified with a logistic regression including patients from the Swiss HIV Cohort Study with a history of 3 class failure (n = 423). Second, predictors for virologic outcome were identified in an intent-to-treat analysis including all patients who received RAL. Last observation carried forward imputation was used to determine week 24 response rate (HIV-1 RNA < 50 copies/mL). RESULTS:: The predominant factor associated with a switch to RAL in patients with suppressed baseline RNA was a regimen containing enfuvirtide [odds ratio 41.9 (95% confidence interval: 11.6-151.6)]. Efficacy analysis showed an overall response rate of 80.9% (152/188), whereas 71.8% (84/117) and 95.8% (68/71) showed viral suppression when stratified for detectable and undetectable RNA at baseline, respectively. Overall CD4 cell counts increased significantly by 42 cells/muL (P < 0.001). Characteristics of failures were a genotypic sensitivity score of the background regimen </=1, very low RAL plasma concentrations, poor adherence, and high viral load at baseline. CONCLUSIONS:: Virologic suppression rates in our routine clinical care setting were promising and comparable with data from previously published randomized-controlled trials.
|Contributors:||Swiss HIV Cohort Study|
|Item Type:||Journal Article, refereed, original work|
|Communities & Collections:||04 Faculty of Medicine > University Hospital Zurich > Clinic for Infectious Diseases|
|DDC:||610 Medicine & health|
|Deposited On:||27 Jan 2010 07:58|
|Last Modified:||27 Nov 2013 19:54|
|Publisher:||Lippincott Wiliams & Wilkins|
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