Clinical study called ANRS 12286 MOBIDIP, conducted in parallel in three countries in sub-Saharan Africa (Cameroon, Burkina Faso and Senegal), shows that dual therapy with lamivudine and boosted protease inhibitor is effective for patients infected with HIV with multiple mutations. Such treatment will reduce the cost, side effects and the need for virological monitoring of patients. The study is published in the journal The Lancet HIV May 28, 2017.
Highly effective treatments for HIV WHO recommended second-line for countries with limited resources. Currently there are two methods. First - monotherapy with boosted protease inhibitor (BPI), which during the test already given encouraging results, although the risk of an increase in viral load. This increase represents a risk in countries with limited resources, because there is no access to regular virological monitoring which can detect treatment failure. The second strategy is to combine the BPI with lamivudine, while this therapy is well tolerated and inexpensive. Previously, the combination of these methods has not been evaluated in patients infected with HIV with mutations.
The study was conducted from 2014 to 2016. 265 patients with an initial viral load of less than 200 copies / ml 96 weeks were observed. The aim of ANRS 12286 MOBIDIP was to compare the performance inefficiencies two therapeutic strategies: monotherapy and dual therapy. Half of the subjects received the BPI therapy, and the other half - BPI and lamivudine. After 48 weeks of treatment, monotherapy was interrupted. Patients with dual therapy continued treatment until the 96th week.
Indicators of treatment failure, defined as a viral load above 500 copies / ml, was 3% (4/132 patients) with dual therapy and 24.8% in monotherapy (33/133 patients). CD4 cell counts increased in people with dual therapy (65 vs. 12 cells / mm3), which indicates a strengthening of the immune defense. In general, both methods of treatment were well tolerated by patients.
ANRS 12286 MOBIDIP provides the first evidence of the effectiveness of the double second-line therapy, which is less expensive and better tolerated. Therapy combining BPI and lamivudine may be appropriate for countries with limited resources and insufficient virological monitoring. In addition, the use of lamivudine, which is already used in first-line therapy, helps to avoid switching to another class of drugs.
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