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Clinical, virological and immunological responses in Danish HIV patients receiving raltegravir as part of a salvage regimen.

ABSTRACT: BACKGROUND:Raltegravir is the first integrase inhibitor approved for treatment of HIV-infected patients harboring multiresistant viruses. METHODS:From a Danish population-based nationwide cohort of HIV patients we identified the individuals who initiated a salvage regimen including raltegravir and a matched cohort of HIV-infected patients initiating HAART for the first time. We compared these two cohorts for virological suppression, gain in CD4 count, and time to first change of initial regimen. RESULTS:We identified 32 raltegravir patients and 64 HIV patients who initiated HAART for the first time in the period 1 January 2006 to 1 July 2009. The virological and immunological responses in the raltegravir patients were comparable to those seen in the control cohort. No patients in the two cohorts died and no patients terminated raltegravir treatment in the observation period. Time to first change of initial regimen was considerably shorter for HAART-naïve patients. CONCLUSION:We conclude that salvage regimens including raltegravir have high effectiveness in the everyday clinical setting. The effectiveness of the regimens is comparable to that observed for patients initiating HAART for the first time. The risk of change in the salvage regimens after initiation of raltegravir is low.

SUBMITTER: Engsig FN

PROVIDER: S-EPMC2943192 | biostudies-literature | 2010 Aug

REPOSITORIES: biostudies-literature

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Clinical, virological and immunological responses in Danish HIV patients receiving raltegravir as part of a salvage regimen.

Engsig Frederik N FN Gerstoft Jan J Kronborg Gitte G Larsen Carsten S CS Pedersen Gitte G Audelin Anne M AM Jørgensen Louise B LB Obel Niels N

Clinical epidemiology 20100809

<h4>Background</h4>Raltegravir is the first integrase inhibitor approved for treatment of HIV-infected patients harboring multiresistant viruses.<h4>Methods</h4>From a Danish population-based nationwide cohort of HIV patients we identified the individuals who initiated a salvage regimen including raltegravir and a matched cohort of HIV-infected patients initiating HAART for the first time. We compared these two cohorts for virological suppression, gain in CD4 count, and time to first change of i ...[more]

PMID: 20865112

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Project description:A rare phenotype of clinical non-progressors to AIDS is not well understood and the new protocol for universal treatment, may block the understanding of viral control thus it is crucial to define this controversial group.A cohort of 30 persons followed a criteria for viremia control groups 1 (VC1; n = 2) and 2 (VC2; n = 7) and non-viral controllers (NC; n = 21) including number of years of diagnosis, LTCD4+, LTCD8+ counts, plasma viral load and the absence of ART; 241 uninfected control persons were matched to age and sex. Infected persons were regularly examined and submitted to two or three annual laboratory measurements. Polymorphisms and allele frequencies of CCR5?32 and SDF1-3'A were detected in the genomic DNA. Plasma levels of cytokines (IL-2, IL-4, IL-5, IL-9, IL-10, IL-13, IL-17 and IFN-y) were measured.The group investigated is originated from a miscigenetic population and demographic and social characteristics were not significantly relevant. LTCD4+ median values were higher among VC than NC, but significantly lower than uninfected controls. Evolution of LTCD4+ and LTCD8+ counts, showed a slight increase of LTCD4+ among VC, but a significant decrease in the NC. The percentage of annual change in LTCD4+ was also significantly different between the groups. LTCD4+/LTCD8+ ratio was inverted but not significant among the VC, thus the ratio may be a useful biomarker for the VC. A clear signature indicated a change from Th1 to Th2 cytokine profiles from VC to NC, respectively.The knowledge of viral controllers characteristics in different population groups is important to define a strict universal definition for the sake of learning about the pathogenesis of HIV-1. Data on LTCD4+ seems to be stable and repetitive from published data, but the LTCD8+ response and the significance of LTCD4+/LTCD8+ ratio values are in need to further exploration as biomarkers. The change from Th1 to Th2 cytokine profile may help to design and adjust specific treatment protocols for the group.

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Dataset Information

Clinical, virological and immunological responses in Danish HIV patients receiving raltegravir as part of a salvage regimen.

Publications

Clinical, virological and immunological responses in Danish HIV patients receiving raltegravir as part of a salvage regimen.

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