9TH EUROPEAN AIDS CONFERENCE (EACS)
1st EACS RESISTANCE & PHARMACOLOGY WORKSHOP

 October 25 - 29, 2003 Warsaw, Poland

7.4 Treatment Failure and Salvage Therapy

 F7/5 - TREATMENT INTERRUPTION (TI) IN PATIENTS WITH MULTIPLE FAILURES TO ARV THERAPY: CAN THE CONTROVERSY BE SOLVED?
* Costagliola D.1, Duvivier C. (1,2), Delaugerre C.3, Dominguez S. (1,2), Wirden M.3, Ghosn J.2, Calvez V.3, Peytavin G.4, Katlama C. (1,2)
 
(1) INSERM E 0214, Universite Pierre et Marie Curie,2 Département des Maladies Infectieuses et Tropicales, Hôpital Pitié-Salpétrière,3 Laboratoire de Virologie, Hôpital Pitié-Salpétrière,4 Département de pharmacologie, Hôpital Bichat-Claude Bernard, Paris, France
 

Background of Study: In very advanced treatment-failing patients (VL 5.3 log10, 27 CD4/mm3), the GigHAART study has shown the benefit of an 8-week TI with a median reduction in VL of #1.91 log10 versus #0.37 log10 cp/ml at W12 in patients with TI versus no TI (P= 0.008) and a benefit of +54 versus +7 CD4/mm3 respectively at W24. By contrast, the Reverse study has evaluated in 23 patients (VL 5.14 log10, 43 CD4/mm3) a longer duration of TI (median 170 days) with multitherapy started after reversion of resistance mutations (RM) in > 2 classes and showed no benefit (+0.06 log10 cp/ml in VL, -27 CD4/mm3) at W24.

Objectives: To explain this apparent discrepancy, we compared RM and number of sensitive ARV at baseline among those available and after TI among those prescribed.

Results: In GigHAART, median baseline RM were 5, 2 and 7 for NRTI, NNRTI, PI; 5 patients (17%) had virus sensitive to <2 drugs; after TI, there was no change in the median RM, 23 patients (68%) had virus sensitive to > 2 drugs. In Reverse, the RM were 6, 2 and 9; 17 patients (74%) had no more than one sensitive drug; TI induced a change in median RM with 0 major for PI, 0 NNRTI and 2 TAMs; 16 patients (70%) had virus sensitive to > 2 drugs

Conclusions: This suggests that the key issue in the efficacy of a salvage therapy depends highly on the number of drugs remaining potentially active before any intervention.

Presenting Author: PhD Dominique Costagliola, INSERM E 0214, 56, Boulevrad Vincent Auriol, BP335, 75625, Paris cedex 13, France, Phone: 33 (0)1 42 16 42 82

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