Tipranavir in highly antiretroviral treatment-experienced patients: Results from a French prospective cohort

Abstract

Background: In highly antiretroviral-experienced patients with a multidrug-resistant human immunodeficiency virus (HIV) infection, recommended regimens should preferentially contain 3 active components, including a ritonavir-boosted protease inhibitor (PI/r). Tipranavir/r (TPV/r), a non-peptidic PI, has been specifically developed for patients resistant to the usual antiretroviral classes including PIs. This paper discusses the role of TPV/r in patients experiencing multiple PI resistance. Methods: Virological, immunological, and safety outcomes were collected between 2003 and 2007 at 7 clinical units. Virus resistance assessment was based on 3 different genotypic tests. The 207 patients evaluated had previously received nucleoside reverse transcriptase inhibitors (NRTIs) and PIs. Results: The main drugs co-administered with TPV/r were 1 or 2 NRTIs associated, in half of the patients, with enfuvirtide. After 12 weeks, viral load was <50 copies/ml in 38% of the patients (44% with enfuvirtide), while median CD4 counts had increased from 150 to 250 cells/mm³. Genotypic testing suggested that most of the patients had viruses susceptible to TPV. Lipid and transaminase levels were slightly modified, and less than 10% of treatment discontinuations were due to gastrointestinal events. Conclusion: A regimen including TPV/r associated with at least 1 active component is a valuable option in highly ARV-experienced patients with multi-resistance to the usual ARV classes including PIs.

Keywords::

• Tipranavir
• HIV
• multidrug resistance
• protease inhibitors

Acknowledgements

The authors wish to thank Hervé Bismut for editorial assistance in the preparation of the manuscript, and the members of the Dat'Aids group: S. Brégigeon, P. Enel, O. Faucher, A. Menard, V. Obry-Roguet, I. Poizot-Martin (Marseille); M. Barone, L. Cuzin, B. Marchou (Toulouse); P. Dellamonica, J. Durant, V. Mondin, P. Pugliese, C. Pradier (Nice); C. Allavena, E. Billaud, C. Biron, B. Bonnet, S. Bouchez, D. Boutoille, C. Brunet-François, N. Feuillebois, T. Jovelin, O. Monoury, P. Morineau, F. Raffi, V. Reliquet (Nantes); F. Ajana, I. Alcaraz, V. Baclet, Ph. Choisy, S. Dassonneville, H. Gueroumi, M. Marien, H. Melliez, B. Riff, X. de la Tribonnière, M. Valette, N. Viguet, Y. Yazdanpanah (Tourcoing); R. Agher, C. Duvivier, C. Katlama, M.-A. Valantin (Paris). The study was conducted and supported by Boehringer-Ingelheim France.

Declaration of interest: C.A. has received travel sponsorships from Boehringer-Ingelheim, and honoraria from Janssen-Cilag, Gilead Sciences and Bristol-Myers Squibb. P.F. has received consulting fees from Tibotec, Bristol-Myers Squibb, GlaxoSmithKline and Abbott, and has received travel sponsorships from GlaxoSmithKline. M.A.V has received lecture fees, payment of travel expenses and registration fees from Roche, Tibotec, Gilead Sciences, GlaxoSmithKline, Bristol-Myers Squibb, Merck Sharp and Dohme and Boehringer-Ingelheim. C.D. has received travel grants from Abbott, Boehringer-Ingelheim, Bristol-Myers Squibb, Gilead Sciences, Merck Sharp and Dohme and Tibotec, and honoraria or study grants from Merck Sharp and Dohme, Tibotec and Roche. P.D. has received funds for speaking at symposia or being a member of advisory boards for Gilead Sciences, Roche, ViiV-Healthcare, GlaxoSmithKline, Bioalliance, Tibotec, Boehringer-Ingelheim and Abbot. F.R. has received research funding, honoraria or consultancy fees from Boehringer-Ingelheim and Janssen-Cilag.