Substitution of raltegravir for ritonavir-boosted protease inhibitors in HIV-infected patients: the SPIRAL study

Abstract

In patients with sustained virological suppression on ritonavir-boosted protease inhibitor-based therapy, switching from ritonavir-boosted protease inhibitor to raltegravir demonstrated noninferior efficacy and resulted in a better lipid profile at 48 weeks than continuing ritonavir-boosted protease inhibitor.

Integrating Integrase Inhibitors Into an Antiretroviral Regimen

“…In SPIRAL, there was no significant difference in virologic failure at 48 weeks between the arms. The raltegravir-treated group had a favorable improvement in lipids, most notably a drop in total cholesterol and triglycerides [43]. The difference in virologic outcomes between the studies may be explained in part because subjects in the SPIRAL study had been suppressed on their PI-based regimen for longer periods of time, on average, compared to those enrolled in the SWITCHMRK studies.…”

Efficacy of Antiretroviral Therapy Switch in HIV-Infected Patients: A 10-Year Analysis of the EuResist Cohort

“…The growing efficacy of contemporary HAART makes modifications of combinations very safe while the VL is below the limit of detection. This important result must be described in several smaller studies applying defined treatment combinations [11,12,13,14]. However, it has to be kept in mind that each new combination has to be carefully selected to maintain sufficient potency [15], implying that treatment simplification might not be advisable for a patient with several previous courses of therapy.…”

Ce que le réanimateur doit connaître des antirétroviraux

“…En revanche, leur faible barrière génétique les expose plus facilement à l'émergence de mutations de résistance. Une association comprenant par exemple deux INNRT et le raltegravir peut représenter une alternative antirétrovirale transitoire efficace et avec peu de risque d'interaction médi-camenteuse [12,13]. Les nombreuses interactions médica-menteuses impliquant les antirétroviraux sont décrites dans les recommandations nationales sur la prise en charge médi-cale des personnes infectées par le VIH, et des adaptations posologiques sont proposées [5].…”