4CPS-096 Non-conventional antiretroviral therapy regimens in the maintenance of highly pre-treated patients with HIV disease

Background In the context of HIV-infected patients it may be necessary to prescribe non-conventional antiretroviral treatment (ART) combinations to achieve and maintain virologic suppression. To optimise compliance and avoid future virological failures (VF) it is desirable to reduce pill burden and an easy schedule. Purpose To study the use in clinical practice of unusual antiretroviral combinations in heavily pre-treated HIV patients or patients with persistent low-level viraemia (LLV). Material and methods Patients with three classes of antiretroviral drugs combined in two or three QD tablets were included. Demographic characteristics, prior ART, VF and resistance mutations were collected. Laboratory data, adverse effects and adherence were reviewed (according to dispensing records of the hospital pharmacy). Results Fifteen patients were included between August 2016 to May 2018, 60% men, median age 53 years (IQR 50.5–55.5), 40% with a history of AIDS. Median time since diagnosis was 21 years and median previous ART combinations were nine. Ninety-three per cent had received TDF, 67% ABC. Eighty-seven per cent had been treated with other NRTIs. Sixty per cent had failed two previous ART combinations and 60% showed mutations against two antiretrovirals classes. Forty-seven per cent selected M184V mutation and 53% received a previous bid ART and an average of five tablets/day (3–7). Patients started: E/C/FTC/TAF plus DRV (seven), ABC/3TC/DTG plus DRVr (four), TDF/FTC/RPV plus DTG (two), ABC/3TC DTG plus RPV (one) and TDF/FTC/RPV plus DRVcobi (one). The reasons for starting were: to simplify a previous rescue treatment (73%) and to optimize a QD regimen with three active drugs and high genetic barrier in four patients (two patients with prior ART discontinuation, one VF and one persistent LLV). Mean time of follow-up was 84 weeks (45–150). At the end of the follow-up, the median of CD4 lymphocytes was 710 cells/ml. Seventy-three per cent presented viral load (VL) undetectable; three patients VL Conclusion Unusual ART combinations have simplified a suppressive rescue ART with three active drugs in an effective and safe way and design an easy schedule with a high genetic barrier regimen in patients with VF or persistent LLV. Reference and/or acknowledgements Int J STD & AIDS 2014;26 :831–4. No conflict of interest.