Switch from enfuvirtide to raltegravir in virologically suppressed HIV-1 infected patients: Effects on level of residual viremia and quality of life

Grant, Philip M.; Palmer, Sarah; Bendavid, Eran; Talbot, Annie; Slamowitz, Debbie C.; Cain, Pat; Kobayashi, Stacy S.; Balamane, Maya; Zolopa, Andrew R.

doi:10.1016/j.jcv.2009.09.025

« Previous Next »Journal of Clinical Virology
Volume 46, Issue 4 , Pages 305-308, December 2009

Switch from enfuvirtide to raltegravir in virologically suppressed HIV-1 infected patients: Effects on level of residual viremia and quality of life

Philip M. Grant
- Stanford University, Palo Alto, CA 94305, USA
- Corresponding author at: Stanford University, Division of Infectious Diseases; 300 Pasteur Drive, Rm. S-101; Stanford, CA 94305-5107, USA. Tel.: +1 650 354 8101; fax: +1 650 354 8102.
Sarah Palmer
- Swedish Institute for Infectious Disease Control, Karolinska Institute, SE-171 77 Stockholm, Sweden
Eran Bendavid
- Stanford University, Palo Alto, CA 94305, USA
Annie Talbot
- Stanford University, Palo Alto, CA 94305, USA
Debbie C. Slamowitz
- Stanford University, Palo Alto, CA 94305, USA
Pat Cain
- Stanford University, Palo Alto, CA 94305, USA
Stacy S. Kobayashi
- Stanford University, Palo Alto, CA 94305, USA
Maya Balamane
- Stanford University, Palo Alto, CA 94305, USA
Andrew R. Zolopa
- Stanford University, Palo Alto, CA 94305, USA

Received 20 July 2009; received in revised form 16 September 2009; accepted 19 September 2009. published online 12 October 2009.

Abstract

Background

Raltegravir is a potential treatment option for virologically suppressed HIV-1 infected patients on enfuvirtide with injection site reactions.

Objectives

To characterize safety and efficacy of an enfuvirtide to raltegravir switch including changes in T-cells, quality of life, and residual viremia.

Study design

In patients with viral load <50 copies/mL and injection site reactions, enfuvirtide was switched to raltegravir without additional changes to the antiretroviral regimen. Virologic failure was defined as a viral load >1000 copies/mL or two consecutive viral load measurements between 50 and 1000 copies/mL (low-level viremia). Over the 24 week study, we compared changes in T-cells, injection site reactions, quality of life, and residual viremia, as measured through the single-copy assay which can detect plasma virus down to a single copy, using paired t-tests.

Results

Fourteen patients with a median CD4+ T-cell count of 420 cells/μL were enrolled. After the switch, two patients experienced virologic failure due to confirmed low-level viremia. However, both patients subsequently were re-suppressed, one without any changes to his regimen. There was no change in CD4+ T-cell count. Injection site reactions resolved. However, there was little reported change in quality of life. The baseline median level of residual viremia was 6 copies/mL and did not change after the switch to raltegravir.

Conclusions

A switch to raltegravir in virologically suppressed patients on enfuvirtide is effective in maintaining immunologic and virologic control at 24 weeks but did not result in a change in residual viremia.

Keywords: HIV infections/virology, Enfuvirtide, Raltegravir, Patient satisfaction, Skin/drug effects