Inibitori dell'integrasi colpiscono anche l' HIV 2

Gli Inibitori dell'integrasi sono in grado di bloccare anche l' HIV 2.
Lo studio presentato all' ICACC, dimostra che Isentress (inibitore dell'integrasi) e' in grado di controllare anche la carica virale di quei pazienti infetti dal ceppo di Hiv 2 (ceppo per lo piu presente in Africa e poco presente 3-5 % nei paesi dell'occidente).


ICAAC: HIV-2 May Yield to Integrase Inhibitor

This report is part of a 12-month Clinical Context series.By Michael Smith, North American Correspondent, MedPage Today
Published: September 22, 2011
Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner Earn CME/CE credit
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Action Points
Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.


Explain that in a small study from Portugal, the integrase inhibitor raltegravir, along with boosted darunavir and tenofovir/emtricitabine, suppressed viral load to undetectable and increased CD4 cells in treatment-experienced HIV-2 patients.


Note that HIV-1 is far more common than HIV-2, but the latter virus variant still causes AIDS.
CHICAGO -- A drug aimed at patients with the most common form of HIV also appears to be effective in those with a less widespread form, a researcher said here.


In a small observational cohort of patients with HIV-2, the integrase inhibitor raltegravir (Isentress) -- added to a standard three-drug regimen -- helped drive viral loads to undetectable levels, according to Nuno Marques, MD, of the University Hospital of Coimbra in Coimbra, Portugal.

The drug, indicated for patients with HIV-1, now appears to be another option for patients with the rarer virus, Marques reported at the Interscience Conference on Antimicrobial Agents and Chemotherapy.

In Portugal, Marques told MedPage Today, between 3% and 5% of AIDS cases are caused by HIV-2, most imported from the country's former African colonies, either by immigrants or returning soldiers.

The seven patients in this study had a slowly eroding immune system despite apparently potent antiretroviral therapy, Marques said. When they were diagnosed, they had an average count of CD4-positive T cells of just 163 per cubic millimeter of plasma.

They were treated with a regimen that -- in patients with HIV-1 -- would usually have resulted in stable or even increasing numbers of CD4 cells, he said: boosted darunavir (Prezista) combined with tenofovir and emtricitabine (Truvada).

But instead, by the time doctors decided to try raltegravir, their average CD4 count had fallen to 122 cells per cubic milliliter of plasma -- even though four of them still had undetectable virus.

"Despite a potent regime, they were declining," he said.

Marques also reported:
The four whose virus was undetectable when they started on raltegravir continued to suppress HIV-2.
After a median of 13 weeks, the remaining three had undetectable virus.
On average, the patients gained 95 CD4 cells per cubic millimeter of plasma.

HIV-1 was the first to be discovered and is the cause of most HIV infections around the world, largely because HIV-2 is less infective -- meaning that it has a relatively poor capacity for transmission.

But if left untreated, Marques noted, it still leads to AIDS.

The research is welcome because HIV-2 gets very little attention, said Joseph Eron, MD, of the University of North Carolina Chapel Hill, a member of the conference's program committee who was not part of the study.

It's good news, Eron told MedPage Today, that raltegravir is well-tolerated and appears to increase patients' ability to suppress the virus.

Increasing the number of drugs available to treat the virus is "useful and laudable," Eron added.

Marques did not report any external support for the analysis and said he had no disclosures.

Eron reported financial links with Merck, GlaxoSmithKline, ViiV, BMS, Tibotec, and Gilead.


Primary source: Interscience Conference on Antimicrobial Agents and Chemotherapy
Source reference:
Marques N, et al "Efficacy of raltegravir containing regimens in HIV-2 infection" ICAAC 2011; Abstract H2-1410.

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