gms | German Medical Science

10. Kongress für Infektionskrankheiten und Tropenmedizin (KIT 2010)

Deutsche Gesellschaft für Infektiologie,
Deutsche AIDS-Gesellschaft,
Deutsche Gesellschaft für Tropenmedizin und Internationale Gesundheit,
Paul-Ehrlich-Gesellschaft für Chemotherapie

23.06. - 26.06.2010, Köln

Maraviroc in treatment-experienced patients with HIV-1 infection – experiences in routine clinical practice

Maraviroc in antiretroviral vorbehandelten Patienten mit einer HIV-1 Infektion – Erfahrungen aus der klinischen Routine

Meeting Abstract

  • S. Reuter - Universitätsklinik Düsseldorf, Klinik für Gastroenterologie, Hepatologie und Infektiologie, Düsseldorf, Germany
  • P. Braken - Universitätsklinik Düsseldorf, Klinik für Gastroenterologie, Hepatologie und Infektiologie, Düsseldorf, Germany
  • B. Jensen - Universitätsklinik Düsseldorf, Klinik für Gastroenterologie, Hepatologie und Infektiologie, Düsseldorf, Germany
  • S. Sierra-Aragon - Institut für Virologie, Uniklinik Köln, Germany
  • M. Oette - Krankenhaus der Augustinerinnen, Köln, Germany
  • M. Balduin - Institut für Virologie, Uniklinik Köln, Germany
  • R. Kaiser - Institut für Virologie, Uniklinik Köln, Germany
  • D. Häussinger - Universitätsklinik Düsseldorf, Klinik für Gastroenterologie, Hepatologie und Infektiologie, Düsseldorf, Germany

10. Kongress für Infektionskrankheiten und Tropenmedizin (KIT 2010). Köln, 23.-26.06.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocP124

DOI: 10.3205/10kit179, URN: urn:nbn:de:0183-10kit1799

Veröffentlicht: 2. Juni 2010

© 2010 Reuter et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objectives: Maraviroc (MVC) has become a valuable HIV treatment option, but few data are available about the efficacy of MVC in routine clinical use to date. It has to be determined when and how to use MVC beyond deep salvage situations.

Methods: In this prospective single-center observational study we analysed the characteristics of 32 patients treated with MVC at our institution between 2006 and 2009. Tropism analysis was performed with a genotypic (n=31) and a phenotypic (n=13) assay. We determined indications for MVC use, the most frequent antiretroviral combinations, the number of new combination partners and treatment outcome.

Results: A complete suppression of viral replication was achieved in 75% after 3 months and in 78% after month 6. The median time of observation was 16 months. Twelve patients (34%) showed treatment failure (2 x primary, 10 x secondary). A marked increase of CD4 cells with a median of 124 cells /µl after 6 months was observed. Concordance between phenotypic and genotypic tropism analyses was achieved in 75%. Indications for MVC treatment included treatment failure (n=15), intolerance to a previous antiretroviral regimen (n=6) and add-on MVC for intensification of the current effective regimen (n=11). Additional salvage drugs most frequently combined with MVC were darunavir (n=14) and raltegravir (n=14).

The genotypic assay had predicted X4 tropism in 5 patients, using a false-positive rate (FPR) of 20%. Lowering the FPR to 5% resulted in the prediction of R5 virus in 4 cases and MVC use resulted in sustained complete viral response in these patients.

Conclusions: MVC containing salvage regimens achieve relevant CD4 cell increases and high viral response rates. In patients with few remaining treatment options it may be justified to lower the cutoff for the false positive rate (FPR) used when predicting the coreceptor usage from 20% to 5%. Hereby, MVC can still be applied in selected patients with otherwise limited treatment options.