OBJECTIVES: To describe the pattern of drug resistance at virological failure in the NEAT001/ANRS143 trial (first-line treatment with ritonavir-boosted darunavir plus either tenofovir/emtricitabine or raltegravir). METHODS: Genotypic testing was performed at baseline for reverse transcriptase (RT) and protease genes and for RT, protease and integrase (IN) genes for patients with a confirmed viral load (VL) >50 copies/mL or any single VL >500 copies/mL during or after week 32. RESULTS: A resistance test was obtained for 110/805 (13.7%) randomized participants qualifying for resistance analysis (61/401 of participants in the raltegravir arm and 49/404 of participants in the tenofovir/emtricitabine arm). No resistance-associated mutation (RAM) was observed in the tenofovir/emtricitabine plus darunavir/ritonavir arm, and all further analyses were limited to the raltegravir plus darunavir arm. In this group, 15/55 (27.3%) participants had viruses with IN RAMs (12 N155H alone, 1 N155H + Q148R, 1 F121Y and 1 Y143C), 2/53 (3.8%) with nucleotide analogue RT inhibitor RAMs (K65R, M41L) and 1/57 (1.8%) with primary protease RAM (L76V). The frequency of IN mutations at failure was significantly associated with baseline VL: 7.1% for a VL of <100,000 copies/mL, 25.0% for a VL of ≥100,000 copies/mL and <500,000 copies/mL and 53.8% for a VL of ≥500,000 copies/mL (PTREND = 0.007). Of note, 4/15 participants with IN RAM had a VL < 200 copies/mL at time of testing. CONCLUSIONS: In the NEAT001/ANRS143 trial, there was no RAM at virological failure in the standard tenofovir/emtricitabine plus darunavir/ritonavir regimen, contrasting with a rate of 29.5% (mostly IN mutations) in the raltegravir plus darunavir/ritonavir NRTI-sparing regimen. The cumulative risk of IN RAM after 96 weeks of follow-up in participants initiating ART with raltegravir plus darunavir/ritonavir was 3.9%.
Antiretroviral resistance at virological failure in the NEAT 001/ANRS 143 trial : Raltegravir plus darunavir/ritonavir or tenofovir/emtricitabine plus darunavir/ritonavir as first-line ART / S. Lambert-Niclot, E.C. George, A. Pozniak, E. White, C. Schwimmer, H. Jessen, M. Johnson, D. Dunn, C.F. Perno, B. Clotet, A. Plettenberg, A. Blaxhult, L. Palmisano, L. Wittkop, V. Calvez, A.G. Marcelin, F. Raffi, N. Dedes, G. Chěne, C. Allavena, B. Autran, A. Antinori, R. Bucciardini, S. Vella, A. Horban, J. Arribas, A.G. Babiker, M. Boffito, D. Pillay, A. Pozniak, X. Franquet, S. Schwarze, J. Grarup, A. Fischer, L. Richert, C. Wallet, F. Raffi, A. Diallo, J. Molina, J. Saillard, C. Moecklinghoff, H. Stellbrink, R. Van Leeuwen, J. Gatell, E. Sandstrom, M. Flepp, F. Ewings, E.C. George, F. Hudson, G. Pearce, R. Quercia, F. Rogatto, R. Leavitt, B. Nguyen, F. Goebel, S. Marcotullio, N. Kaur, P. Sasieni, C. Spencer-Drake, T. Peto, V. Miller, F. Arnault, C. Boucherie, D. Jean, V. Paniego, F. Paraina, E. Rouch, C. Schwimmer, M. Soussi, A. Taieb, M. Termote, G. Touzeau, A. Cursley, W. Dodds, A. Hoppe, I. Kummeling, F. Pacciarini, N. Paton, C. Russell, K. Taylor, D. Ward, B. Aagaard, M. Eid, D. Gey, B.G. Jensen, M. Jakobsen, P.O. Jansson, K. Jensen, Z.M. Joensen, E.M. Larsen, C. Pahl, M. Pearson, B.R. Nielsen, S.S. Reilev, I. Christ, D. Lathouwers, C. Manting, B.Y. Mendy, A. Metro, S. Couffin-Cadiergues, A. Knellwolf, L. Palmisiano, E. Aznar, C. Barea, M. Cotarelo, H. Esteban, I. Girbau, B. Moyano, M. Ramirez, C. Saiz, I. Sanchez, M. Yllescas, A. Binelli, V. Colasanti, M. Massella, O. Anagnostou, V. Gioukari, G. Touloumi, B. Schmied, A. Rieger, N. Vetter, S. De Wit, E. Florence, L. Vandekerckhove, J. Gerstoft, L. Mathiesen, C. Katlama, A. Cabie, A. Cheret, M. Dupon, J. Ghosn, P. Girard, C. Goujard, Y. Lévy, P. Morlat, D. Neau, M. Obadia, P. Perre, J. Reynes, P. Tattevin, J.M. Ragnaud, L. Weiss, Y. Yazdan, P. Yeni, D. Zucman, G. Behrens, S. Esser, G. Fätkenheuer, C. Hoffmann, H. Jessen, J. Rockstroh, R. Schmidt, C. Stephan, S. Unger, A. Hatzakis, G.L. Daikos, A. Papadopoulos, A. Skoutelis, D. Banhegyi, P. Mallon, F. Mulcahy, M. Andreoni, S. Bonora, F. Castelli, A.D. Monforte, G. Di Perri, M. Galli, A. Lazzarin, F. Mazzotta, T. Carlo, V. Vullo, J. Prins, C. Richter, D. Verhagen, A. Van Eeden, M. Doroana, F. Antunes, F. Maltez, R. Sarmento-Castro, J.G. Garcia, J.L. Aldeguer, B. Clotet, P. Domingo, J.M. Gatell, H. Knobel, M. Marquez, M.P. Miralles, J. Portilla, V. Soriano, M. Tellez, A. Thalme, A. Blaxhult, M. Gisslen, A. Winston, J. Fox, M. Gompels, E. Herieka, M. Johnson, C. Leen, A. Teague, I. Williams, M.A. Boyd, N.F. Møller, E.F.M. Larsen, L. Piroth, V. Le Moing, F.W.N.M. Wit, J. Kowalska, J. Berenguer, S. Moreno, N.J. Müller, E. Török, F. Post, B. Angus, V. Calvez, C. Boucher, S. Collins, D. Dunn, S. Lambert, A. Marcelin, E. White, A. Ammassari, W. Stoehr, R.E. Schmidt, M. Odermarsky, C. Smith, R. Thiébaut, J.I.B. De La Serna, A. Castagna, H. Furrer, A. Mocroft, P. Reiss, V. Fragola, M. Lauriola, R. Murri, P. Nieuwkerk, B. Spire, A. Volny-Anne, B. West, H. Amieva, J.M.L. Codina, M. Braggion, E. Focá. - In: JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY. - ISSN 0305-7453. - 71:4(2016), pp. 1056-1062.
Antiretroviral resistance at virological failure in the NEAT 001/ANRS 143 trial : Raltegravir plus darunavir/ritonavir or tenofovir/emtricitabine plus darunavir/ritonavir as first-line ART
C.F. Perno;F. Pacciarini;A. Binelli;M. Galli;A. Lazzarin;
2016
Abstract
OBJECTIVES: To describe the pattern of drug resistance at virological failure in the NEAT001/ANRS143 trial (first-line treatment with ritonavir-boosted darunavir plus either tenofovir/emtricitabine or raltegravir). METHODS: Genotypic testing was performed at baseline for reverse transcriptase (RT) and protease genes and for RT, protease and integrase (IN) genes for patients with a confirmed viral load (VL) >50 copies/mL or any single VL >500 copies/mL during or after week 32. RESULTS: A resistance test was obtained for 110/805 (13.7%) randomized participants qualifying for resistance analysis (61/401 of participants in the raltegravir arm and 49/404 of participants in the tenofovir/emtricitabine arm). No resistance-associated mutation (RAM) was observed in the tenofovir/emtricitabine plus darunavir/ritonavir arm, and all further analyses were limited to the raltegravir plus darunavir arm. In this group, 15/55 (27.3%) participants had viruses with IN RAMs (12 N155H alone, 1 N155H + Q148R, 1 F121Y and 1 Y143C), 2/53 (3.8%) with nucleotide analogue RT inhibitor RAMs (K65R, M41L) and 1/57 (1.8%) with primary protease RAM (L76V). The frequency of IN mutations at failure was significantly associated with baseline VL: 7.1% for a VL of <100,000 copies/mL, 25.0% for a VL of ≥100,000 copies/mL and <500,000 copies/mL and 53.8% for a VL of ≥500,000 copies/mL (PTREND = 0.007). Of note, 4/15 participants with IN RAM had a VL < 200 copies/mL at time of testing. CONCLUSIONS: In the NEAT001/ANRS143 trial, there was no RAM at virological failure in the standard tenofovir/emtricitabine plus darunavir/ritonavir regimen, contrasting with a rate of 29.5% (mostly IN mutations) in the raltegravir plus darunavir/ritonavir NRTI-sparing regimen. The cumulative risk of IN RAM after 96 weeks of follow-up in participants initiating ART with raltegravir plus darunavir/ritonavir was 3.9%.
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