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Abstract
Usefulness of the genotypic inhibitory quotient in HIV patients treated with tipranavir
Morello J.1, García-Gascó P.2, Rodríguez-Novoa S.1, de Mendoza C.2, Blanco F.2, González-Pardo G.1, Sanz B.1, Jiménez I.1, González-Lahoz J.2, Soriano V.2
Objectives: Tipranavir (TPV) is a potent PI approved for the treatment of ARV-experienced patients. Integration of pharmacokinetic parameters and baseline resistance mutations could improve the management of salvage therapy in HIV patients on TPV therapy.
Methods: All patients who started TPV/r as part of a salvage regimen at one HIV reference center were retrospectively analysed. TPV plasma levels were measured by HPLC at week 24. TPV associated-resistance mutations listed by the IAS-USA Panel (10V, 13V, 20M/R/V, 33F, 35G, 36I, 43T, 46L, 47V, 54A/M/V, 58E, 69K, 74P, V82L/T, 83D, 84V) were considered.
Results: A total of 66 patients were identified (88% men). Mean values: age 44±8 years, baseline CD4 count 292±229 cells/uL, plasma HIV-RNA 3.8±0.8 log copies/mL. Mean no. of protease and TPV-associated resistance mutations were 13±6 and 5±3, respectively. At 24 weeks, 65% of patients has plasma HIV-RNA <50 cop/ml. TPV plasma levels were available for 29 patients. Mean TPV plasma levels were 34.35±26.87 µg/ml. In patients with 1 to 5 baseline TPV resistance mutations (n=11) Cmin values did not predict viral response, as almost all patients responded. In contrast, in patients with 5 to 7 baseline TPV resistance mutations Cmin was significantly greater among responders (n=8) than non-responders (n=4) (36.64 vs 13.83 µg/mL; p=0.029). Finally, in patients with >8 TPV resistance mutations (n=6) the Cmin did not influence the virological response, as almost all failed virologically.
Conclusions: Monitoring TPV plasma levels may predict virological response particularly in the subset of HIV patients with an intermediate number of TPV resistance mutations. In patients with >8 TPV resistance mutations, high TPV plasma levels do not seem to overcome the loss of susceptibility to the drug.
4th IAS Conference on HIV Pathogenesis, Treatment and Prevention
Abstract no.
WEPEB011
Suggested Citation
"MorelloJ., et al.
Usefulness of the genotypic inhibitory quotient in HIV patients treated with tipranavir.
Poster exhibition:
4th IAS Conference on HIV Pathogenesis, Treatment and Prevention:
Abstract no.
WEPEB011"
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