Durability of Boosted Atazanavir (ATV) or Darunavir (DRV) Plus Maraviroc (MVC) Dual rescue Therapy in Poorly Adherent Subjects in View of Long-Acting Drugs

Abstract

In poorly adherent HIV-infected subjects strategic approaches may avoid resistance to long-acting compounds. This study means to assess the safety of a strategy which was being carried out in our Division in several nonadherent subjects with general satisfaction.All subjects who had been switched to boosted protease inhibitors plus maraviroc for treatment failure between June 2014, and April 2015, were retrospectively evaluated. Eighteen were taking darunavir/ritonavir and 26 atazanavir/ritonavir plus maraviroc 300 mg once daily. All had a follow-up of 104 weeks and 27 exceeded 156 weeks. One patient, who was INSTI-experienced and still had >500 HIV-1 RNA copies/mL at week 60, switched to dolutegravir plus darunavir/ritonavir and rapidly failed, selecting for INSTI cross resistance-associated mutations (97A, 140S and 148H). At week 96 and 140, 81.8% and 85.2% had <50 HIV-1 RNA copies/mL, respectively. No one else selected resistance mutations nor switched co-receptor tropism. All remain eligible for long-acting therapy.