February 17, 2017
This week, a study finds that a switch in protease inhibitor-based regimens helps improve kidney function. Another study finds that viral load blips during early HIV treatment help predict post-treatment control. And a two-drug regimen containing dolutegravir (Tivicay) and rilpivirine (Edurant) worked well as maintenance therapy, according to a study at CROI 2017. To beat HIV, you have to follow the science!
Changing a protease inhibitor-based (PI) treatment regimen from lopinavir (Kaletra, LPV) or atazanavir (Reyataz, ATV) to darunavir (Prezista, DRV) improves kidney function, an analysis of data from the UK CHIC study that was published in AIDS showed.
Renal results, as measured by estimated glomerular filtration rates (eGFR), were somewhat better in all study participants who took tenofovir disproxil fumarate (Tenofovir) and switched their PI. Greater improvement in eGFR rates was observed among those whose eGFR slope had declined rapidly or who had suffered renal impairment prior to switching their PI.
Participants whose regimen did not include TDF saw no significant effect on renal function when they replaced lopinavir or atazanavir with darunavir. A small earlier study (47 participants) by the same authors had found no significant difference in renal results when their PI was switched to atazanavir. The current study examined data from 1,430 participants. Study authors theorize that the greater sample size may explain the difference in results.
Starting antiretroviral therapy soon after seroconversion and avoiding temporary increases in viral load (VL) predicted the likelihood that a person's VL remained undetectable even after stopping therapy, an observational study published in Journal of Acquired Immune Deficiency Syndrome found.
Researchers analyzed data on 778 participants in the CASCADE trial who started antiretroviral therapy within six months of seroconversion. A third stopped treatment at some point thereafter. Ten percent of those who ended treatment continued to show undetectable levels of HIV (post-treatment controllers, or PTC).
Participants whose VL temporarily increased by more than 400 copies/mL while on antiretroviral therapy (viral blip) were more likely to see their VL rebound after stopping treatment. Each such blip increased the likelihood of not controlling the virus without antiretrovirals by 71%. Similarly, the longer the interval between seroconversion and start of treatment, the less likely the person was to become a PTC. Study authors caution, however, that cofounding factors remain, including lower treatment adherence prior to viral blips.
An antiretroviral regimen consisting of only two drugs, the integrase inhibitor dolutegravir and the NNRTI rilpivirine, held up well as a maintenance approach in people with HIV who switched from more complex regimens, according to study findings presented on Feb. 14 at CROI 2017, in Seattle, Washington.
Warren Tong is the senior science editor for TheBody.com and TheBodyPRO.com. Follow Warren on Twitter: @WarrenAtTheBody.
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