12th Annual Conference of the British HIV Association 29 March–1 April 2006, Brighton, UK

TIPRANAVIR/T20-CONTAINING SALVAGE REGIMENS HIGHLY EFFECTIVE AND DURABLE IN HEAVILY PI-TREATMENT-EXPERIENCED HIV-1-INFECTED PATIENTS IN CLINICAL PRACTICE

HIV Med 2006; 7(Suppl. 1):13 (abstract no. P10)

Ravindra Gupta, Clive Loveday, Usha Kalidindi, Martin Lechelt, Celia Skinner, Maurice Murray, Guy Bailey and Chloe Orkin
Bart’s and the London NHS Trust, London, UK

AIMS: Highly antiretroviral-experienced individuals with failing HIV-1 therapy pose a challenge. Cross-class and triple-class resistance is resulting in reliance on new drugs. Tipranavir (TPV) has a resistance profile distinct from other PIs and although phase 3 trial data have shown boosted TPV to be superior to other PIs, there is little clinical practice data. This study evaluates the ongoing efficacy, durability, safety and tolerability of TPV-containing regimens in a clinical cohort.

METHODS: A retrospective clinical case review was undertaken of triple-class-experienced HIV-1-infected patients who had failed previous PI regimens and were receiving new optimised boosted TPV-containing regimens with up to 27 months follow-up. ART resistance was determined by RT and PR sequence analysis using IAS-USA scoring and TPV resistance score (TPV-RS) at baseline and failure.

RESULTS: 12 patients were commenced on TPV-containing therapy with median age 48 (IQR = 31–63) years, baseline CD4 count 46 (IQR = 12–276) cells/µl, VL 4.96 (IQR = 4.84–5.50) log₁₀ copies/ml, five previous PIs (range 3–7) and median exposure to TPV of 11 (range 3–27) months. 5/12 patients were <50 copies/ml after median 21 months (range 15–27), and 1/12 <700 copies/ml after 10 months. 6/12 patients failed after 9 (range 3–12) months and were more likely to have ≥3 TPV-RS mutations than non-failures (P=0.06). Presence of a major IAS-USA mutation at baseline was strongly associated with absence of a VL drop at 6 months (P=0.02).

CONCLUSION: TPV-containing regimens showed impressive efficacy and tolerability in this heavily experienced cohort, with 42% suppressed at 21 months. Baseline TPV-RS of three or greater appeared to be predictive of failure.

2006-03-29
P10

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