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Abstract



First report of raltegravir (RAL, MK-0518) use after virologic rebound on elvitegravir (EVT, GS 9137)

DeJesus E.1, Cohen C.2, Elion R.3, Ortiz R.1, Maroldo L.4, Franson S.4, Pesano R.4

Objectives: Data are limited about the clinical implications of resistance patterns and the possibility of sequencing integrase inhibitors (INI). We describe the clinical responses from 2 patients treated sequentially with INI.
Methods: After IRB approval and informed consent, 2 patients with virologic failure on elvitegravir were switched to raltegravir 400mg BID x7 days with the same background regimen (BR). At day-8, the regimen was re-optimized (OBR). Activity and safety labs, Phenosense-GT and samples for integrase sequence (IS) were collected at baseline(BL) and follow-up.
Results: Results are described for both patients 1 and 2; BL = transition from EVT to RAL, WK1 = RAL + BR, WK2 = RAL + OBR, WK4-24 = follow-up.


 12
 CD4VLARVCD4VLARV
BASELINE20410,700TVD/ENF/EVT459840TVD/EVT
WEEK 11947,254TVD/ENF/RAL499427TVD/RAL
WEEK 2 1,039TVD/ENF/RAL/DRV 189TVD/RAL/DRV
WEEK 4 808 457<50 
WEEK 82032,137 639<50 
WEEK 122472,893 592<50 
WEEK 24DISCONTINUED <50 

IS at BL and WK1 for patient 1 showed similar patterns including K7R, S17N, V31I, V72I, T124N, T125A, I151V, V201I, V234L, A265A/V, and other mutations suspected to be associated with resistance to one or both INI: E138E/K, G140G/C, S147S/G and Q148R. IS for patient 2 was nonamplifiable. Regimens were well tolerated; no grade >1 adverse events reported. Further enrollment was halted given the lack of significant virologic activity observed.
Conclusions: These data support the possibility that at least some cross-resistance occurs between elvitegravir and raltegravir. Data with drug levels were not available to assess the possibility of a negative drug-drug interaction.





4th IAS Conference on HIV Pathogenesis, Treatment and Prevention
Abstract no. TUPEB032


Suggested Citation
"DeJesusE., et al. First report of raltegravir (RAL, MK-0518) use after virologic rebound on elvitegravir (EVT, GS 9137). Poster exhibition: 4th IAS Conference on HIV Pathogenesis, Treatment and Prevention: Abstract no. TUPEB032"