Andreea Cristina Stoian 1, Florentina Dumitrescu 1, A. Cupşa 1, Cristina Iocu 2, Irina Niculescu 1, L. Giubelan 1, Liliana Marinescu 2
1 University of Medicine and Pharmacy from Craiova
2 Clinical Hospital Infectious Diseases “Victor Babeş” from Craiova
Abstract
Objectives: Analisys of clinical course after changing antiretroviral therapy (ART) in HIV infected patients (Px) with treatment failure (TF). Methods: A retrospective study in Craiova Regional Center for Monitoring and Evaluation of HIV/AIDS from 01/01/2009 to 12/31/2009, on two groups of Px in TF with at least 3 previous ARV scheme, Px in whom a new ART scheme was introduced: group A (16 Px) according to resistance test results and previous ART schemes and group B (23 Px) depending on previous ART schemes. Results: Clinical and immunological CDC staging- group A versus B was similar : B2 stage 1 Px (6.25%)/1 Px (4.34%), B3 stage 9 Px (56.25%)/7 Px (30.43%), C2 stage 1 Px (6.25%)/2 Px (8.69%), C3 stage 5 Px (31.25%)/13 Px (56.25%), median CD4=104 vs 181 cells/mm³, median HIV-RNA=4.49 vs 4.30 lg copies/ml. Darunavir (DRV), Etravirine (ETV), Raltegravir (RAL) were included in ART of 8 Px (50%) of group A vs. 9 Px (39.14%) in group B. Clinical outcome was good in 14 Px in group A and all Px in group B. In group A, 1 Px died with lymphoma and 1 Px had cerebral toxoplasmosis. HIV-RNA level, at 4 and 12 month, in group A vs group B, were: HIV-RNA <50 copii/ ml- 13 Px (81.25%) vs 18 Px (78.26%) (p> 0.05; 0.19 0.05; 0.12 0.05; 0.26 <OR = 1.53 <9.68). All Px with DRV, ETV, or RAL had HIVRNA <50 copies/ml and increasing CD4 value at 4 and 12 months. Conclusions: 1. Using DRV, ETV and RAL in HIV infected Px with TF was associated with favorable outcome independent of resistance testing, which is important in limited financial resources settings. 2. Control of viral replication and immunological success, unrelated to the immunodepression at the time of TF were similar in both groups. 3. Group size and duration of the study are relatively small and do not allow definitive conclusions, but the results urges for further monitoring.