ObjectiveWe evaluated the effectiveness of darunavir (DRV) treatment plus an optimized background regimen in 120 HIV-1 treatment-experienced patients.DesignRetrospective cohort, multicenter study.MethodsAdults >16 years with virological treatment failure starting therapy with a DRV-containing regimen were included. Effectiveness was evaluated as the percentage of patients with an undetectable HIV-1 RNA viral load (<50 and <200 copies/mL) after 48 weeks, and changes in CD4+ cell counts. We evaluated the risk factors associated with treatment failure.ResultsOf the cohort, 83 % were men with a median age of 45 years (interquartile range, IQR 40–51). They had experienced treatment for a median of 13 years (IQR 9–17) with a median of six previous regimens (IQR 4–7), all using protease inhibitors. After treatment, 82 % (95 % confidence interval, CI 74–88 %) of patients had an HIV-1 RNA viral load <200 copies/mL and 69 % (95 % CI 60–76 %) had <50 copies/mL. The CD4+ cell count increased by 378 cells/μL (IQR 252–559; P < 0.001 vs. baseline). Risk factors associated with poor outcome were age >40 years [odds ratio, OR 0.15 (95 % CI 0.10–0.78); P = 0.015], use of raltegravir in the regimen [OR 0.37 (95 % CI 0.10–0.97); P = 0.046], and baseline CD4+ cell count <200 cells/μL [OR 2.79 (95 % CI 1.11–6.97); P = 0.028].ConclusionIn this Mexican cohort Darunavir was metabolically safe, well tolerated and achieved high rates of virological suppression in highly treatment-experienced patients infected with HIV-1.

ObjectiveWe evaluated the effectiveness of a raltegravir (RAL)-containing regimen plus an optimized background regimen in HIV-1 highly treatment-experienced patients.DesignA retrospective cohort, multicentre study was conducted.MethodsAdult (>16 years old) HIV treatment-experience patients starting therapy with a RAL-containing regimen were included. Effectiveness was evaluated as the percentage of patients with an undetectable HIV-1 RNA viral load (<50 and <200 copies/mL) after 48 weeks, and changes in CD4+ cell counts. We evaluated the risk factors associated with treatment failure.ResultsOf the 107 patients in the cohort, 86% were men, the median age was 45 years [interquartile range (IQR) 40–52] and the median number of previous regimens was six (IQR 4–7). After 48 weeks of treatment, 73% (IQR 63–80%) of patients (n = 78) had a viral load of <50 copies/mL and 85% (IQR 77–90%) (n = 91) had <200 copies/mL. In a logistic regression model, risk factors associated with a virological outcome of HIV-1 RNA of <200 copies/mL were age >40 years [odds ratio (OR) 5.61; 95% confidence interval (CI) 1.61–18.84; P = 0.006] and use of tenofovir in the regimen (OR 0.16; 95% CI 0.03–0.80; P = 0.026).ConclusionsIn this Mexican cohort, RAL achieved high rates of virological suppression and an increase in CD4+ cell count in highly treatment-experienced patients infected with HIV-1. Age >40 years was associated with a good virological outcome, contrary to tenofovir use, which was associated with a poor virological outcome.

BackgroundTreatments in patients with multidrug resistance often involve the use of multiple agents with partial antiviral activity and overlapping metabolic toxicities. Enfuvirtide is therefore a welcome addition to the antiretroviral management of patients with multiclass resistant virus, given the low risk of systemic toxicities and novel mechanism of action relative to existing drug classes.The aim of this study was to evaluate the effectiveness of ENF plus optimized background regimen (OBR) in a Mexican cohort of highly HIV-1 ARV-experienced patients.MethodsProspective cohort of treatment-experienced HIV-1-infected adults with virological failure who started therapy with an ENF-containing regimen. The effectiveness of ENF treatment was evaluated with percentages of undetectable HIV-1 RNA viral load after 24 and 48 weeks of treatment, and changes in CD4+ cell counts.ResultsForty patients >18 years were included. After 24 weeks of treatment, 91% of patients had HIV-1 RNA viral load <400 copies/mL and 65.8% had <50 copies/mL. At week 48 of treatment, 81.4% of the patients had HIV-1 RNA <400 copies/mL and 55.5% had <50 copies/mL; in both cases p <0.0001 compared to baseline. Increase CD4+ cells were also statistically significant at weeks 24 and 48 with respect to the baseline. Pain at the site of injection was the main adverse event in 100% of patients.ConclusionOur study provides clinically important evidence of the effectiveness and safety of ENF in highly ARV-experienced HIV-1-infected patients. These findings strengthen the results of previous randomized controlled trials with this agent.

Introduction: Treatment options are limited for HIV-1-infected individuals who have received extensive previous antiretroviral therapy. ETV has shown significant clinical benefits in treatment-experienced HIV-1+ patients with antiretroviral resistance. The aim of this study was to evaluate the effectiveness of ETV plus optimized background regimen in real-life conditions in a cohort of highly HIV-1 antiretroviralexperienced patients. Methodology: Retrospective cohort of treatment-experienced HIV-1-infected adults with virological failure who started therapy with an ETVcontaining regimen. The effectiveness was evaluated using HIV-1 RNA viral load and changes in CD4+ cell count after 48 weeks of treatment. Results: Forty-two patients ≥ 16 years of age were included; 74% were men, and the median age was 45 years (IQR 41-53). All participants had prior non-nucleoside reverse transcriptase inhibitor use (55% nevirapine, 83%, efavirenz, and 28% both). Baseline median HIV-1 RNA viral load was 15,598 copies/mL (IQR 2651-84,175) and CD4+ cell count was 276 cells/L . After 48 weeks of treatment, 90.5% (95% CI 78-96) of patients had HIV-1 RNA viral load < 200 copies/mL and 76% (95% CI 61-86) had < 50 copies/mL. CD4+ cell counts increased from baseline to 48 weeks of treatment to a median of 407 cells/L (IQR 242-579); p < 0.001. Virological outcome was associated with virological failure at baseline HIV-1 RNA viral load ≥ 100,000 copies/mL (OR 7.6; 95% CI 1.2-44.80; p = 0.025). Conclusions: Our study provides clinically important evidence of the effectiveness and safety of ETV in highly antiretroviral-experienced HIV-1-infected patients.

Background: Human immunodeficiency virus (HIV) infection has become a disease in epidemiological transition since the introduction of antiretroviral therapy (ART); however, its control depends on adherence to therapy. There are some studies in Mexico regarding such adherence but they have had heterogeneous results. We aimed to determine the prevalence of ART adherence and risk factors associated with non-adherence among HIV-infected adults in a tertiary care hospital in Mexico. Methods: This was a cross-sectional study conducted at the Hospital de Infectología, "La Raza" National Medical Center, Mexico City. The subjects of the study were HIV-infected adults after at least 6 months on ART. They answered a questionnaire involving socio-demographics, biochemical, and clinical variables. Adherence was measured using the simplified medication adherence questionnaire Results: Three hundred seventy-six HIV-infected patients were included in the study. The median age was 35 years (interquartile range, IQR, 29-44) and most of them were men (79.3%). Among the participants, 73% (95% confidence interval, CI, 68.2-77.4%) adhered to the medications prescribed. Factors associated with good adherence were being male (odds ratio, OR, 0.43; 95% CI, 0.22-0.83) and the absence of alcohol use (OR, 0.27; 95% CI, 0.12-0.58); factors associated with non-adherence were a history of ≥2 ART regimens (OR, 1.95; 95% CI, 1.05-3.62), time spend attending medical care or receiving drugs (OR, 2.40; 95% CI, 1.22-4.70), and persistent viremia (OR, 2.72; 95% CI, 1.42-5.19; P<0.005). Conclusion: In the era of ART as prevention for transmission of HIV as well as treatment for HIV-positive individuals irrespective of CD4 cell counts, the importance of adherence has grown. Treatment failure reduces future treatment options and therefore long-term clinical success as well as increases the possibility of developing drug resistant mutations. Being male and a lack of alcohol use were factors associated with higher rates of adherence, whereas previous use of ART, more ARV regimens, and a longer time waiting for medical care or drugs, were associated with nonadherence in this HIV-infected population. Incomplete ART adherence is associated with persistent viremia. J o urnal o f A ID S & Cli n ic a l R es earc h