13th Annual Conference of the British HIV Association 29 March–1 April 2007, Brighton, UK

USE OF DOUBLE BOOSTED PROTEASE INHIBITORS (DBPI) IN SALVAGE PATIENTS: A REAL LIFE EXPERIENCE

HIV Med 2007; 8(Suppl. 1):11 (abstract no. P4)

Rachael Jones, Andrew Scourfield, R Nathavitharana, Mark Bower, Brian Gazzard and Mark Nelson
Chelsea and Westminster NHS Trust, London, UK

INTRODUCTION: DBPI therapy is a salvage option. There are few data to support or refute their use. Our study investigates DBPI-containing combinations in a large London cohort.

METHODS: Our clinical database was interrogated to reveal individuals exposed to DBPI-containing ARV therapy. If individuals had received more than one DBPI regimen, the most recent was noted. Individuals exposed to DBPIs for ≤1/12 were excluded. Demographics, prior treatment/resistance history, and CD4/ VL values were collected.

RESULTS: 119 individuals received treatment for ≥1/12. Patients had been exposed to a mean of 8 (1–18) regimens, with 77% (92) exposed to all three ARV classes. A mean of six (0–19) resistance tests/individual had been performed, showing 64% (76) to harbour ≥5 NRTI mutations, 68% (81) with ≥2 NNRTI and 56% (66) with ≥1 major PI mutation. Mean exposure time was 12 (1–33) months. Of 16 combinations, rit/lop/saq (37%) was used most frequently. At the start of therapy, mean CD4 count was 288 cells/mm³ and 37 individuals (31%) had VL <50. At 3/12 and 6/12, 38 (32%) and 41 (35%) had VL <50, 16 (13%) and 10 (8%) had VL <1000, respectively. At 12 months, 47 (39%) remained on the DBPI combination. The main reason for discontinuation was virological failure. Most recent results showed that 40 individuals had VL <50. By ITT (where missing=failure) 34% of the starting population had VL <50. Mean rise in CD4 count was 71 cells/mm³.

CONCLUSION: Less than 40% of individuals prescribed DBPIs were still taking the regimen at 12 months. From the latest results for each individual, only a third of the initial cohort had an undetectable viral load. In an era of novel therapies for Salvage patients, alternative options should be considered prior to the use of DBPIs.

2007-03-29
P4

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