1396. Clinical outcomes associated with once daily ritonavir-boosted darunavir in HIV infected patients harboring single or multi-class resistant virus
Session: Poster Abstract Session: HIV: Antiretroviral Therapy
Friday, October 6, 2017
Room: Poster Hall CD
Posters
  • IDWeek Poster DRV (1).pdf (840.7 kB)
  • Abstract: Background: Limited data exist on the use of a potent boosted protease inhibitor plus <2 active nucleotide reverse transcriptase inhibitors without use of additional classes of ART in treatment experienced patients with background resistance. We evaluated the clinical outcomes in HIV-infected patients harboring single or multi-class resistant virus (NRTI +/- PI and/or NNRTI) treated with once daily darunavir/ritonavir (DRV/r) plus tenofovir/emtracitabine (TDF/FTC) Methods: This was a single-center, retrospective chart review of HIV-1 infected patients harboring single or multi-class resistant virus and receiving an ART regimen of TDF/FTC plus DRV/r administered as a once daily regimen > 24 weeks. The primary outcome was HIV viral load (VL) < 200 copies/ml (cp/ml) at last measurement. Additional endpoints included virologic rebound, re-suppression, and/or failure; VL < 40 cp/ml at last measurement; development of additional mutations. Virologic failure (VF) was defined as failure to achieve a VL < 200 cp/ml or achievement of VL < 200 cp/ml but with rebound to > 200 cp/ml on all successive VLs. Results: 34 of 387 patients meet criteria for inclusion in the study and were receiving DRV 800 mg daily/r 100 mg daily with fixed combination TDF/FTC. All patients had baseline resistance to FTC (M184V/I), 12 (35.3%) had resistance to TDF, and none had high level DRV resistance. 27 (79%) achieved a VL < 200 cp/ml and 25 (74%) had a VL < 200 cp/ml at the last reading. 23 (68%) achieved a VL of < 40 cp/ml. VF occurred in 8/34 patients (24%) with the following baseline parameters: TDF resistance (2/8), low/ intermediate DRV resistance (2/8), and VL > 100,000 cp/ml (3/8). Both patients with baseline DRV resistance and VF demonstrated high level resistance to DRV on repeat genotype testing. Adherence was considered a major contributor to VF. Conclusion: Use of once daily DRV/r plus TDF/FTC in treatment experienced patients with single/multi-class resistant virus resulted in virologic suppression in over two-thirds of patients. VF was seen in nearly 25% of patients including development of high level DRV resistance. This combination is a potentially viable option in a patient population seeking a once-daily option to improve adherence.
    Joan Duggan, MD, FIDSA, FACP, Department of Medicine, Division of Infectious Diseases, University of Toledo College of Medicine, Toledo, OH and Eric Sahloff, PharmD, AAHIVP, Pharmacy Practice, University of Toledo, Toledo, OH

    Disclosures:

    J. Duggan, None

    E. Sahloff, None

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