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Peer advisory-based antiretroviral salvage regimens effective in resistant HIV
In HIV patients with significant history of ART, an optimized salvage regimen recommended by a peer advisory committee appears to yield a long-term virologic response and immune regeneration, according to recent findings.
In a nationwide cohort study, researchers evaluated 611 patients with HIV at a clinic in Mexico. All patients had an extensive background of ART, had previous occurrences of virologic failure with at least two antiretrovirals, and had current identifiable viremia. The selected patients had a median antiretroviral treatment duration of 10.5 years and a median of four previous failed regimens.
The patients underwent treatment by a physician who reviewed and adhered to the therapeutic recommendations of the salvage regimen formulated by a Mexican advisory board developed for rational antiretroviral usage. These recommendations were developed based on comprehensive data collection for each patient, including viral load and CD4+ T-cell counts, HIV genotyping, infection history, and complete antiretroviral treatment history. The patients also were evaluated by 10 senior physicians with antiretroviral expertise.
Patients were followed for a median of 33 months. The researchers used an observed failure competing risks regression analysis to determine the incidence of the study’s primary endpoint, defined as loss of virologic response (plasma HIV-RNA levels <200 copies/mL, with subsequent measurements above this level) during follow-up.
The researchers calculated the probabilities of virologic failure for multiple time points as follows: 11.9% at 12-month follow-up; 14.4% at 24-month follow-up; 16.9% at 36-month follow-up; 19.4% at 48-month follow-up. Of 531 patients who attained the primary endpoint, there was a median increase in blood CD4+ T-cell count of 162/mL (interquartile range, 45-304 cells/mL).
According to the researchers, the committee-based approach used in this study could guide the selection of future antiretroviral regimens in cases of multiclass drug-resistant HIV.
“The current paper describes the success of a strategy aimed at the prudent use of [antiretrovirals] based on a collaborative alliance between medical academic settings and the governmental offices in charge of programs seeking to control the HIV/AIDS epidemic,” the researchers wrote. “Our experience is unique in the literature and can serve as an example to other countries.”
Disclosure: Please see the full study for a list of relevant financial disclosures.