Clinical Care Options HIV http://clinicaloptions.com/hiv.aspx New treatment data and educational activities for HIV Clinicians en-us Clinical Care Options HIV http://images.clinicaloptions.com/img.asp?img=cco/CCO_hiv_RSS.gif http://clinicaloptions.com/hiv Maraviroc Failure in Treatment-Naive Patients in MERIT Trial: Role of Pretreatment Tropism Switches and Patient Nonadherence http://clinicaloptions.com/HIV/Conference%20Coverage/Retroviruses%202008/Tracks/Resistance/Capsules/40LB.aspx In antiretroviral-naive patients, switch in detected HIV tropism between screening and study baseline was significant predictor of treatment failure on maraviroc therapy. Increased Risk for Disease Progression With Longer Delay Until Regimen Modification in Patients Failing First-Line NNRTI-Based Treatmenthttp://clinicaloptions.com/HIV/Conference%20Coverage/Retroviruses%202008/Tracks/Experienced/Capsules/798.aspxNNRTI-based regimens were found to be less forgiving than PI-based regimens regarding risk of immunologic failure and mortality in patients experiencing virologic failure. Apricitabine Safe, Well Tolerated Through 24 Weeks in Treatment-Experienced Patients With M184Vhttp://clinicaloptions.com/HIV/Conference%20Coverage/Retroviruses%202008/Tracks/Experienced/Capsules/793.aspxIn phase IIb study, new NRTI appeared active, safe, well tolerated as part of OBR for treatment-experienced patients. Novel NRTI Amdoxovir Demonstrates Potent Synergistic Activity With Zidovudine, With No Notable Adverse Effectshttp://clinicaloptions.com/HIV/Conference%20Coverage/Retroviruses%202008/Tracks/Experienced/Capsules/794.aspxCombination treatment with amdoxovir/zidovudine produced 2 log10 copies/mL reduction in HIV-1 RNA after 10 days and appeared safe and generally well tolerated. 48-Week Pooled Data From MOTIVATE 1 and 2 Confirm Durable Efficacy, Safety of Maraviroc in Treatment-Experienced Patients With R5 HIV-1http://clinicaloptions.com/HIV/Conference%20Coverage/Retroviruses%202008/Tracks/Experienced/Capsules/792.aspxIn treatment-experienced patients infected with R5 HIV-1, maraviroc plus OBR provided greater virologic, immunologic efficacy over 48 weeks of follow-up vs OBR alone DUET-2: Etravirine Plus Darunavir/Ritonavir-Containing OBR Superior to OBR Alone at Week 48 in Treatment-Experienced Patients With Baseline NNRTI Resistancehttp://clinicaloptions.com/HIV/Conference%20Coverage/Retroviruses%202008/Tracks/Experienced/Capsules/791.aspxIn a pooled analysis of DUET-1 and DUET-2 studies, etravirine was also superior to placebo in virologic and immunologic outcomes DUET-1: Etravirine Plus Darunavir/Ritonavir-Containing OBR Superior to OBR Alone at Week 48 in Treatment-Experienced Patients With Baseline NNRTI Resistancehttp://clinicaloptions.com/HIV/Conference%20Coverage/Retroviruses%202008/Tracks/Experienced/Capsules/790.aspxIn a pooled analysis of DUET-1 and DUET-2 studies, etravirine was also superior to placebo in virologic and immunologic outcomes. BENCHMRK-2: Efficacy of Raltegravir Plus OBR in Multiclass-Resistant Patients Sustained Through Week 48http://clinicaloptions.com/HIV/Conference%20Coverage/Retroviruses%202008/Tracks/Experienced/Capsules/789.aspxIn pooled analysis of BENCHMRK-1 and -2, efficacy rates greatest in patients with OBR including multiple active agents. BENCHMRK-1: Raltegravir Plus OBR Provides Durable Virologic Efficacy Through 48 Weeks in Multiclass-Resistant Patientshttp://clinicaloptions.com/HIV/Conference%20Coverage/Retroviruses%202008/Tracks/Experienced/Capsules/788.aspxIn treatment-experienced patients with triple-class resistance, raltegravir plus OBR maintained significantly greater efficacy vs placebo plus OBR through Week 48. DELPHI: Darunavir/Ritonavir Safe, Well Tolerated, Effective in Treatment-Experienced Children and Adolescentshttp://clinicaloptions.com/HIV/Conference%20Coverage/Retroviruses%202008/Tracks/Experienced/Capsules/78LB.aspxThe DELPHI trial reports data supporting the use of darunavir/ritonavir in treatment-experienced children and adolescents. Lower Incidence of Failure on Second HAART Regimen, but Mortality Risk Remains Highhttp://clinicaloptions.com/HIV/Conference%20Coverage/Retroviruses%202008/Tracks/Experienced/Capsules/41.aspxIncidence of treatment failure in patients on second HAART regimens greatly decreased from 1996-2005, but mortality risk still a concern VICTOR-E1: Week 48 Virologic and Immunologic Responses to Vicriviroc Plus OBR in Antiretroviral-Experienced Patientshttp://clinicaloptions.com/HIV/Conference%20Coverage/Retroviruses%202008/Tracks/Experienced/Capsules/39LB.aspxVicriviroc plus boosted PI-containing OBR associated with superior virologic and immunologic responses vs OBR alone in treatment-experienced patients with only CCR5-tropic virus Improved Outcomes in SMART Study Patients Resuming ART but With Residual Effects of Treatment Interruptionhttp://clinicaloptions.com/HIV/Conference%20Coverage/Retroviruses%202008/Tracks/Experienced/Capsules/36.aspxDespite improved CD4+ cell counts and HIV-1 RNA levels, long-term effects of intermittent therapy persist in SMART study patients who resume therapy. No Virologic Benefit of Dose Escalation of PIs in Patients With Normalized Inhibitory Quotient = 1http://clinicaloptions.com/HIV/Conference%20Coverage/Retroviruses%202008/Tracks/Experienced/Capsules/35.aspxAlthough dose escalation led to increased NIQ, effect on HIV-1 RNA was not significantly different from standard of care arm in randomized trial. Multiple Study Design Factors Independently Influence Efficacy, Toxicity Outcomes of Antiretroviral Regimenshttp://clinicaloptions.com/HIV/Conference%20Coverage/Retroviruses%202008/Tracks/Firstline/Capsules/782.aspxMeta-analysis of 79 studies revealed new factors associated with variability in study regimen outcomes, including study length and antiretroviral inclusion criteria 2 Dual PI Regimens Associated With Insufficient Week 16 Virologic Success Rates in Treatment-Naive Patientshttp://clinicaloptions.com/HIV/Conference%20Coverage/Retroviruses%202008/Tracks/Firstline/Capsules/779.aspxDual PI regimens are unable to suppress viral replication in HIV-infected treatment-naive patients with the robustness of currently recommended regimens. Interrupted ART Noninferior to Continuous ART but Associated With NNRTI Resistance in West African Patientshttp://clinicaloptions.com/HIV/Conference%20Coverage/Retroviruses%202008/Tracks/Firstline/Capsules/778.aspxFixed-cycle scheduled treatment interruptions of ART associated with comparable outcomes but increased NNRTI resistance compared with continuous ART. Virologic Efficacy and Safety of Once-Daily Lopinavir/Ritonavir Tablet Noninferior to Twice-Daily Tablet in Treatment-Naive Patientshttp://clinicaloptions.com/HIV/Conference%20Coverage/Retroviruses%202008/Tracks/Firstline/Capsules/775.aspxWeek 48 results of M05-730 study demonstrate noninferiority of once-daily lopinavir/ritonavir tablet vs twice-daily tablet in antiretroviral-naive patients, independent of baseline HIV-1 RNA or CD4+ cell count Low CD4+ Cell Count, Black Race, Female Sex, Younger Age Associated With Virologic Failure in ACTG 5142http://clinicaloptions.com/HIV/Conference%20Coverage/Retroviruses%202008/Tracks/Firstline/Capsules/776.aspxAmong women, risk of virologic failure was lowest with lopinavir/ritonavir plus efavirenz vs NRTI-containing regimens, but risk of virologic failure was lowest with efavirenz plus 2 NRTIs among men. HEAT Trial: Abacavir/Lamivudine Noninferior to Tenofovir/Emtricitabine in Treatment-Naive Patients Receiving Once-Daily Lopinavir/Ritonavirhttp://clinicaloptions.com/HIV/Conference%20Coverage/Retroviruses%202008/Tracks/Firstline/Capsules/774.aspxAbacavir/lamivudine was associated with similar virologic efficacy and better CD4+ cell count increase when compared with tenofovir/emtricitabine.