Data demonstrating non-inferiority of switching to ABC/DTG/3TC versus continuing current ART support ABC/DTG/3TC as an option when considering switch regimens in HIV-1-infected adults with stable viral suppression.
Virologic suppression was well maintained when HIV patients receiving 3TC/ABC with a boosted protease inhibitor were switched to emtricitabine/tenofovir disoproxil fumarate (FTC/TDF). Subjects randomized to FTC/TDF) had fewer virologic failures; in addition, improvements in lipids and Framingham risk scores were noted, while slight declines in estimated GFR were observed.
The findings of the KLEAN study extension (48 to 144 weeks) support durable viral suppression with both FPV/r and LPV/r treatment regimens when used in combination with ABC/3TC irrespective of viral load at baseline. Both regimens were well tolerated and had similar safety profiles.
The publisher would like to report an error that appeared in a recently published article [1]. The y-axis label in Figure 3A has been corrected as of 13 September 2017 and should read 'Median increase in CD4 + T-cell counts, cells/mm 3 '. The accompanying footnote has also been amended and the correct version is shown. The authors apologize for this error.
Because antiretroviral therapy (ART) is allowing people living with human immunodeficiency virus (PLWH) to survive longer, they are developing more age-related comorbidities. We evaluated the effects of age and gender on the burden of age-related comorbidities among PLWH.
In this retrospective real-world study, de-identified data were extracted from the medical charts of 2000 HIV-positive adults on ART across 10 sites in Canada. The prevalence of age-related comorbidities was determined in 6 age subgroups (<30, 30–39, 40–49, 50–59, 60–69, and ≥70 years). The effects of gender on these comorbidities were also examined. Risks of cardiovascular disease and chronic kidney disease (CKD) were calculated using the Framingham and D:A:D equations.
Most persons were White (68%), male (87%), and virologically suppressed (94%). The mean age was 50.3 years (57% aged ≥50 years), and mean CD4+ T-cell count was 616 cells/mm3. The most common comorbidities were neuropsychiatric symptoms (61%), overweight/obesity (43%), liver disease (37%), and dyslipidemia (37%). The mean number of comorbidities increased across age subgroups (P < .001). Across all age subgroups, the prevalence of hypertension (P = .04), dyslipidemia (P = .04), CKD (P = .03), bone fragility (P = .03), and depression (P = .02) differed between males and females. Both age (P < .001) and gender (P < .001) impacted cardiovascular disease and CKD risk.
Age and gender influenced the burden, types, and risks of age-related comorbidities in PLWH in this Canadian cohort. These comorbidities should be diagnosed and treated in routine clinical practice.
Purpose of the studyThe purpose of the study was to assess virologic and immunologic effectiveness of lopinavir/ritonavir in HIVinfected adults who are antiretroviral (ARV) naïve, protease inhibitor (PI) naïve or PI-experienced but naïve to lopinavir/ritonavir.
MethodsThis is an ongoing 96-week, observational, open-label, multicenter study. Patients were prescribed the standard dose of lopinavir/ritonavir (400 mg/100 mg) twice a day. Other ARV medications were prescribed at the discretion of the physician according to usual clinical practice.
Summary of resultsOf the 142 patients enrolled, 47.2% had not received any previous ARV treatment (ARV-naïve), 19.0% have not been treated with PI-based regimen (PI-naïve), and 31.7% have been exposed to PI-based regimen with the exception of lopinavir/ritonavir (PI-experienced). The mean (SD) age was 44.6 (9.5) years, 123 (86.6%) were male and 109 (76.8%) were Caucasian. The mean (SD) duration of HIV disease was 4.3 (0.7) years. Of the 35 (25.6%) patients discontinued, 13 withdrew due to adverse event (AE). The virologic results after 48 weeks of treatment are available for 106 patients (53 ARV-naive; 19 PI-naïve; 34 PI-non-naive). There were 34 (64.2%) ARV-naïve, 14 (73.7%) PI-naïve, and 22 (64.7%) PI-experienced patients with HIV-RNA viral load < 50 copies/mL after 48 weeks of treatment. There were 116 patients included in the immunologic analyses. Linear regression was performed to estimate the CD4 cell counts at 48 weeks of treatment. Mean (SD) change in absolute CD4 cell counts between baseline and 48 weeks of treatment was 196.9 (52.0) (p < 0.001) in ARV-naïve, 110.8 (52.8) (p < 0.001) in PI-naïve and 13.0 (78.0) (p = 0.513) in PI-experienced patients. Of the 142 patients enrolled, none developed >6 protease resistance mutations. At the time of the analysis, there were 171 AEs probably/possibly related to lopinavir/ritonavir reported by 70 out of 142 patients, 29 ARVnaïve, 16 PI-naïve and 25 PI-experienced patients. Hypercholesterolemia was reported by one ARV-naïve and one PI-experienced patient who were not receiving lipid-lowering agents. Of the 17 serious AEs reported by three ARVnaïve and four PI-experienced patients, 12 were probably not/not related to study drug and none led to discontinuation.
ConclusionAfter 48 weeks of treatment in a clinical setting, lopinavir/ ritonavir is effective in achieving virologic control and immunologic improvement in ARV-naïve, PI-naïve or PIexperienced patients, with more significant immunologic benefit in ARV and PI-naïve patients.
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