Lopinavir/ritonavir Chez Le Patient Infecté Par Le VIH En Situation D'échec Virologique Prolongé: Évolution Immunovirologique Et Tolérance Chez 121 Patients De La Cohorte ANRS CO8 Aproco-Copilote

Objective. - This study was made to determine the immunovirological outcome and tolerance to lopinavir/ritonavir (LPV/r) in HIV-infected protease inhibitors-experienced patients with long-term virological failure.Design. - Prospective follow-up was implemented for the French cohort ANRS CO8 Aproco-Copilote of 121 patients starting an LPV/r-containing regimen after a median duration of virological failure of 30.6 months. At baseline the median HIV-RNA plasma level was 4.1 log(10) copies/ml and the median CD4 cell count was 273/mm(3).Results. - On initiation of LPV/r, these patients were heavily pre-treated: 62% had received at least 4 NRTI, 65% at least 1 NNRTI, and 33% at least 3 PI. On prescription of LPV/r, the associated antiretroviral regimen was: no drug to which patients were previously naive in 49 cases (40%), at least one new drug in 72 cases: 1 NRTI (n = 42), 2 NRTI (n = 22), 1 NNRTI (n = 10), at least one new PI (n = 6), enfuvirtide (n = 2). The median HIV-RNA level was 2 log(10) copies/ml at M4 and M12, 1.7 log(10) copies/ml at M24 with respectively 74, 71 and 85% of patients achieving plasma HIV-RNA below 2.7 log(10) copies/ml. The median CD4 cell count was 385 and 429/mm(3) at M12 and M24 respectively. Among patients with genotypic testing at the time of LPV/r initiation, Ninety-five percent had at the most 5 protease mutations known to reduce LPV/r susceptibility. Thirty serious adverse events were reported but only 6 were related to LPV/r.Conclusion. - The use of LPV/r in HIV-infected patients failing multiple antiretroviral regimens provided a potent and durable immunovirological response. (C) 2007 Elsevier Masson SAS. Tous droits reserves.