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July 18, 2011

IAS 2011: Disappointing results from Raltegravir intensification study for immune failure.


Disappointing results from Raltegravir intensification study for immune failure.

A recent article (Zoufaly, JID 2011) revealed that HIV-1 infected patients with persistently low CD4+ counts despite sustained viral suppression were at higher risk for HIV-related clinical events, especially in the first 6 months of complete viral suppression. For clinicians there have been no options to address immune discordancy. Carina Cesar from Fundación Huésped, Buenos Aires presented results on a study evaluating intensification with raltegravir for 48 weeks in these clients. Subjects with undetectable plasma viral loads (<5 copies/ml) at baseline but slow CD4 recovery (<200 cells/uL at baseline and <100 cells/uL increase in the last year) were randomized to intensify or not their regimen using a double blind placebo controlled study design. The average time on HAART was 36 months, most (75%) were on protease based regimens. Immune activation was assessed in CD4 and CD8 cells. No difference in gain in CD4 counts was noted between the arms nor a change noted in the proportion with an increase >50 cells. Unfortunately this disappointing news means that so far no intensification strategy has shown efficacy in increasing CD4 counts in immune discordant patients.

References:
A. Zoufaly et al. Clinical Outcome of HIV-Infected Patients with Discordant Virological and Immunological Response to Antiretroviral Therapy. J Infect Dis. 2011:203(3);364-371.

Cesar C. Raltegravir intensification in HIV-infected patients with immune discordant response to HAART
[Abstract]. July 18, 2011 at the 6th IAS Conference on Pathogenesis, Treatment and Prevention, Rome, Italy. Abstract MOPE166.

Cesar C.. Immune activation in HIV-infected patients with immune discordant response to HAART [Abstract]. July 18, 2011 at the 6th IAS Conference on HIV Pathogenesis, Treatment and Prevention, Rome, Italy. Abstract MOPE167


Source: Reporting for PRN news from Rome, Italy: Anita Radix, MD