Bithérapies à base de darunavir associé à un inhibiteur d’intégrase chez les patients vivant avec le VIH de la cohorte ANRS CO3 Aquitaine

Abstract : Introduction: the two-drug regimen based on darunavir/ritonavir (DRV/r) and integrase inhibitor (INI) has been studied several times but rarely "in real life". We aimed to describe the effectiveness of DRV/r + INI dual therapy and its tolerance in the ANRS CO3 Aquitaine cohort. Methods: we performed a observational study of patients in the ANRS CO3 Aquitaine cohort who received at least once the DRV/r + INI combination dual-therapy alone between 01/02/2007 and 30/06/2016. We analyzed the immunological and virological reponse and the renal, lipidic, hepatic and cardiovascular tolerances. Results: two hundred and sixty data were included : 106 in the naive arm of DRV and 154 in the one with history of DRV. Raltegravir (RAL) was predominantly prescribed (185/260 patients). 66.1% of patients had an initial viral load (CV) <50 copies/mL. At M36, the percentage of patients with a CV <50 copies/mL was 88% in ITT analysis and 87.8% in analysis under treatment. The median CD4 increased from 481 cells/mm3 [IIQ 310-661] at M0 to 611 cells/mm3 [IIQ 417-769] at M36. Twenty-six virological failures (10.7%) were observed. The median time to virological success was 20.8 months [IIQ 9.4-41.2]. Levels of LDL-cholesterol and total cholesterol tended to increase to M36. Sixteen patients (6.2%) presented a cardiovascular event: 5 myocardial infarction (MI), 3 cerebrovascular, 11 peripheral. Renal and hepatic tolerance was good. Conclusion: our study showed a sustained virologic response under DRV/r + INI with a generally good tolerance,. This dual-therapy remains interesting in a targeted prescription for some groups of at-risk PLHIV.
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Master Thesis
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Anne-Sophie Frèche. Bithérapies à base de darunavir associé à un inhibiteur d’intégrase chez les patients vivant avec le VIH de la cohorte ANRS CO3 Aquitaine. Médecine humaine et pathologie. 2018. ⟨dumas-02062396⟩

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