Therapeutic options in heavily pretreated HIV-1 patients based on the genotypic resistance patterns

Purpose of the study

To investigate the levels of resistance and therefore the number of available drugs in heavily pretreated HIV-1 patients in Greece.

Methods

The number of available drugs was estimated in 140 patients who had undergone >6 treatment failures (HIV-RNA>1000 copies/mL) by using the Rega V7.1.1 algorithm based on the results of the genotypic resistance testing.

Summary of results

Among 140 heavily experienced patients, the number of available drugs were as shown in Table 1.

Table 1

Inclusion of darunavir and etravirine significantly increased the percentage of patients having at least one fully-active drug from two or three different drug categories. Specifically, this percentage changed from 21% to 44% (two categories) and from 15% to 31% (three categories) (p < 0.001). Interestingly, in the study population, 81 (58%) individuals had no options in the N(t)RTI class. Concerning the other drug classes, 33 (41%) individuals had no available NNRTIs, while 58 (72%) of them had less than two options among the PIs.

Conclusion

Despite the approval of new active drugs (DRV, ETV), for a considerable percentage of heavily pretreated patients there are not any fully active drugs available among the N(t)RTIs which comprise the backbone of HAART.