Abstract 387 / Session 50
Can Nelfinavir substitute for other protease inhibitor(s) in persons with plasma HIV- 1 RNA below 500 copies/ml before the substitution?
CJ COHEN*1, HELLINGER JA1, STEIN AJ2, GATHE J3, KEISER P4.ÿ 1-CRI New England, MA; 2-CRI So. Florida, FL., 3-Houston TX; 4-Dallas TX.
Background: While the goal of HIV combination therapy is maximal durable suppression, persons must be able to tolerate all components of that regimen.Nelfinavir (N), the most recently approved protease inhibitor in the US has a unique schedule, side effect profile, and resistance mutation pattern, persons may choose to switch to nelfinavir. The success when making this switch was the focus of this retrospective chart review.
Methodology: We reviewed records from three large clinical practices. Charts were from any individuals switched from a protease containing regimen on which the viral load (VL) was below the limit of quantification before switching to nelfinavir. Patients may have also switched other antivirals at the same time though this was not required. All VL measures after the switch were noted.
Results: Data from 39 charts were included: 13 on indinavir [I], median CD4+ÿÿÿ 222 (range 22-498); 26 on
ritonavir/saquinavir [IVS] combination, median CD4+ 368 (range 14-1059). After the I containing regimens, 8/12 (66%) were measured and still
below detection at week 6 (one had no measure in the window). Afterÿ the R/S regimens, 17/22 (77%) had VL measured and it was
below detection at week 6, 14/17 (82%) at week 12. Reasons for switching included: PI related side effect (36%), medication
preference (64%).
Conclusions: In persons with VL < 500 copies/ml on either I or R/S regimens,persons switching to nelfinavir had continued VL suppression 74% of the time atfirst follow up. These data support that persons switching to nelfinavir who haveVL suppression on another PI should have early VL measures in the first 6 weeksto monitor for the outcome of this switch. A prospective study is required to define the potential success for those switching to nelfinavir. |
