Outcomes of Heavily Experienced HIV-infected Patients Receiving Salvage Raltegravir-based Therapy

Abstract

Background: New antiretrovirals improved the treatment success for heavily experienced HIV-infected patients as treatment failures or resistance to ART may limit the options for further therapy. Nonetheless, construction of ‘salvage’ regimens remains a complex and challenging issue worldwide. This study assessed real-life virologic success, long-term survival and adverse events in treatment experienced patients initiating either Raltegravir or other drugs for salvage regimens.Methods: we conducted a retrospective cohort study on adults with treatment failure (HIV-1 RNA viral load [PVL] >1000 copies/mL) who started either Raltegravir or other drugs (Darunavir/Ritonavir, Maraviroc or Etravirine). Propensity score (PS) matching methods were used to account for baseline clinical differences. We used Kaplan-Meier method and Generalized Wilcoxon tests for the matched subset to evaluate probability of virologic suppression (PVL<50 copies/mL) during follow up. Comparison of Mortality rates, cases of toxicity, treatment interruption, virologic failure and loss of follow-up, were ascertained using Poisson regression.Results: 168 patients (123 on Raltegravir; 45 on other drugs). Of these, 90 patients were matched by PS, 45 patients from each group, equivalent to 98 person-years of follow-up. During follow-up, virologic suppression was similar for both regimens (77.8% vs 82.2%, p=0.73). During a mean follow-up of 1.09 (SD = 0.32) years rates of mortality (4.04 vs 6.18 persons per 100 person-years; p=0.67), drug toxicity (0.00 vs 2.06 persons per 100 person-years; p=0.49), treatment interruption (8.07 vs 0.00 persons per 100 person-years; p=0.06), virologic failure (2.02 vs 4.12 persons per 100 person-years; p=0.61) and loss of follow-up (6.05 vs 4.12 persons per 100 person-years; p=0.70) did not differ between Raltegravir and other salvage regimens recipients.Conclusion: Similar survival and virologic success rates were found for Raltegravir and other drugs for salvage regimens, with similar rates of drug toxicity, treatment interruption, virologic failure and loss of follow-up.