The benefits of antiretroviral therapy (ART) are compromised by virologic failure and drug resistance. To maintain virologic suppression, these patients have traditionally required multitablet “salvage” regimens. We retrospectively analyzed data to assess virologic efficacy of a 2-tablet, once daily combination of Elvitegravir /Cobicistat /Emtricitabine /TAF plus Darunavir (G/D) in HIV infected adults with history of prior resistance and regimen failure.
Electronic Medical Records of HIV infected adults with history of prior resistance and regimen failure in our HIV-Clinic were analyzed to assess efficacy of a 2 tablet ART regimen of G/D. Efficacy was defined as percentage of participants with HIV-1 RNA <50 copies/mL. Statistical analysis included descriptive summary of all patients. Categorical variables (gender, mode of transmission, presence of undetected viral load, presence of viral load < 50, class resistance number, presence of M184V mutation) were compared between the 2 outcome groups (success vs failure) using the Fisher exact test. The 2 groups were also compared using Student 2-sample t-test for normally distributed numerical variables (age and number of years from diagnosis to regimen change) and the Wilcoxon rank sum test for non-normally distributed numerical variables (CD4 level at diagnosis and CD4 level at regimen change).
34 patients were included in the study, of which 70.6% were men, majority MSM: 64.7%. Patients had been diagnosed with HIV for a median of 13.8±7.3 years. More than 50% of patients at time of switch were on 4 pills and 53% were on a BID regimen. 61.7% patients were virologically suppressed with the regimen of G/D. There was no difference between virologic success vs failure group when following variables were compared: CD4 at the time of regimen change, undetectable HIV VL vs viremic patients at regimen change, number of drug class resistance, presence of M184 V mutation. Only statistically significant variable was age, virologic failure arm patients were younger; 35.8 vs 48.2 years.
Despite the small numbers of patients, our results demonstrate that in a clinical setting a 2 tablet regimen provides substantial efficacy in ART-experienced patients harboring resistant virus.
I. Brar, Gilead: Research Contractor and Speaker's Bureau , Research grant and Speaker honorarium . Janssen: Research Contractor and Speaker's Bureau , Research grant and Speaker honorarium . Viiv: Research Contractor , Research grant .