Switching to Raltegravir From a Virologically Effec7ve Boosted...
Transcript of Switching to Raltegravir From a Virologically Effec7ve Boosted...
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SwitchingtoRaltegravirFromaVirologicallyEffec7veBoostedProteaseInhibitorRegimen:A
Compara7veEffec7venessAnalysisFromtheFrenchHospitalDatabaseonHIV(FHDH-ANRSCO4)
ValériePotard,AnneSimon,Jean-MarcLacombe,Jean-JacquesParien7,andDominiqueCostagliola;fortheFrenchHospitalDatabaseonHIV(FHDH-ANRSCO4)ComentadoporJavierDeLaTorreLimaPotardV,SimonA,LacombeJM,Parien=JJ,CostagliolaD;FrenchHospitalDatabaseonHIV(FHDH-ANRSCO4).SwitchingtoRaltegravirFromaVirologicallyEffec=veBoostedProteaseInhibitorRegimen:ACompara=veEffec=venessAnalysisFromtheFrenchHospitalDatabaseonHIV(FHDH-ANRSCO4).ClinInfect
Dis.2016Nov1;63(9):1254-1261.Epub2016Aug19.
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UpdatedDHHSGuidelines:SwitchingARTinVirologicallySuppressedPts
DHHSGuidelines.July2016.
SwitchStrategiesWithGoodSuppor7ngEvidence
SwitchStrategiesunderEvalua7on(NotYetRecommended)
SwitchStrategiesNotRecommended
Within-classswitch• EFVtoRPV• TDFtoTAF• RALtoDTGorEVG/COBI• PI/RTVtoPI/COBI
Between-classswitch,providednoresistancetootherregimencomponents• BoostedPItoRPV• NNRTItoINSTI• BoostedPItoINSTI
PI/RTV+3TC,ifnobaselineresistanceandpthashadsustainedvirologicsuppression
SwitchtoPI/RTV+INSTI
SwitchtoEVG/COBI/FTC/TDF+DRV
SwitchtoDTG+3TCorFTC
SwitchtoRTV-boostedPImonotherapy
Switching1componenttoMVC
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Obje7vo
Comparar la eficacia clínica y biológica en pacientes VIHvirológicamente suprimidos que cambiaron a RALTEGRAVIRfrente a los que conRnuaron con un régimen basado enINHIBIDORESDEPROTEASAS
PotardV,SimonA,LacombeJM,ParienRJJ,CostagliolaD;FrenchHospitalDatabaseonHIV(FHDH-ANRSCO4).SwitchingtoRaltegravirFromaVirologicallyEffecRveBoostedProteaseInhibitorRegimen:AComparaRveEffecRvenessAnalysisFromthe
FrenchHospitalDatabaseonHIV(FHDH-ANRSCO4).ClinInfectDis.2016Nov1;63(9):1254-1261.Epub2016Aug19.
![Page 4: Switching to Raltegravir From a Virologically Effec7ve Boosted …gesida-seimc.org/wp-content/uploads/club_bibliografico/Dr.Javierdel… · Valérie Potard, Anne Simon, Jean-Marc](https://reader034.fdocuments.us/reader034/viewer/2022042215/5ebd2616ecbfa81d5d672e6e/html5/thumbnails/4.jpg)
Método
• BasededatosdehospitalesfrancesessobreVIH• 1erTARconIPentre1997-2012y6mesesCV<50yposteriormenteseguir
conIPocambioaRAL• Criteriodevaloraciónprimariocompuestopor:
HospitalizaciónporeventonoSIDA AparicióndeunaenfermedaddefinitoriadeSIDA Muerte
PotardV,SimonA,LacombeJM,ParienRJJ,CostagliolaD;FrenchHospitalDatabaseonHIV(FHDH-ANRSCO4).SwitchingtoRaltegravirFromaVirologicallyEffecRveBoostedProteaseInhibitorRegimen:AComparaRveEffecRvenessAnalysisFromthe
FrenchHospitalDatabaseonHIV(FHDH-ANRSCO4).ClinInfectDis.2016Nov1;63(9):1254-1261.Epub2016Aug19.
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PotardV,SimonA,LacombeJM,ParienRJJ,CostagliolaD;FrenchHospitalDatabaseonHIV(FHDH-ANRSCO4).SwitchingtoRaltegravirFromaVirologicallyEffecRveBoostedProteaseInhibitorRegimen:AComparaRveEffecRvenessAnalysisFromthe
FrenchHospitalDatabaseonHIV(FHDH-ANRSCO4).ClinInfectDis.2016Nov1;63(9):1254-1261.Epub2016Aug19.
Resultados
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Resultados
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Resultados
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Resultados
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Resultados
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• DurabilidaddelRAL:41delos282individuosdelgrupodelcambiodisconRnuaronRAL.
• LatasaponderadaesRmadadelainterrupcióndelRALenelmes30fuedel22%.
• LatasadedesconRnuacióndeRALfuedel7%enel6ºmesydel11%enel12ºmes.
PotardV,SimonA,LacombeJM,ParienRJJ,CostagliolaD;FrenchHospitalDatabaseonHIV(FHDH-ANRSCO4).SwitchingtoRaltegravirFromaVirologicallyEffecRveBoostedProteaseInhibitorRegimen:AComparaRveEffecRvenessAnalysisFromthe
FrenchHospitalDatabaseonHIV(FHDH-ANRSCO4).ClinInfectDis.2016Nov1;63(9):1254-1261.Epub2016Aug19.
Resultados
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• En pacientes VIH con un régimen basado en IP potenciadovirológicamenteeficaz,elcambioaRAL,unadecisiónfrecuenteenla prácRca clínica, manRene la eficacia clínica, virológica einmunológica
• Amedida que la poblaciónVIH envejece y las comorbilidades sehacen cada vez más prevalentes, RAL, un anRrretroviral conmínimo riesgo de interacciones medicamentosas y buenatolerancia,seposicionacomounodelosfármacosdeelección.
PotardV,SimonA,LacombeJM,ParienRJJ,CostagliolaD;FrenchHospitalDatabaseonHIV(FHDH-ANRSCO4).SwitchingtoRaltegravirFromaVirologicallyEffecRveBoostedProteaseInhibitorRegimen:AComparaRveEffecRvenessAnalysisFromthe
FrenchHospitalDatabaseonHIV(FHDH-ANRSCO4).ClinInfectDis.2016Nov1;63(9):1254-1261.Epub2016Aug19.
Conclusiones
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• Fortalezas– Grantamañodelamuestra– PSsparacontrolarfactoresdeconfusión
• Debilidades– Noesunensayoclínico– Factoresdeconfusiónnomedidos,fundamentalmentelaadherenciaalTAR
PotardV,SimonA,LacombeJM,ParienRJJ,CostagliolaD;FrenchHospitalDatabaseonHIV(FHDH-ANRSCO4).SwitchingtoRaltegravirFromaVirologicallyEffecRveBoostedProteaseInhibitorRegimen:AComparaRveEffecRvenessAnalysisFromthe
FrenchHospitalDatabaseonHIV(FHDH-ANRSCO4).ClinInfectDis.2016Nov1;63(9):1254-1261.Epub2016Aug19.
Fortalezasydebilidades