HIV: A therapeutic advance for resource-limited settings
ANRS 12286 MOBIDIP(1), a clinical trial running in parallel in three countries in sub-Saharan Africa (Cameroon, Burkina Faso, and Senegal), shows that dual therapy with lamivudine and a
boosted protease inhibitor is effective as second-line treatment in patients infected by HIV with multiple mutations. Such treatment de-escalation will reduce costs, side effects, and the need for virological monitoring of patients. The results of this study, led by Laura Ciaffi (TransHIVMI; Inserm-IRD-Université de Montpellier) and Sinata Koulla-Shiro (ANRS site -Cameroon), is published in The Lancet HIV on May 28, 2017.Second-line treatments of HIV infection recommended by the WHO for resource-limited countries are highly effective. However, there is currently no reliable way of de-escalating these treatments, while maintaining an undetectable viral load. Two strategies may provide a solution. The first is monotherapy with a boosted protease inhibitor (BPI), which in several trials has already yielded encouraging results, albeit with a risk of increased viral load. Such an increase constitutes a risk in resource-limited countries because patients there do not have access to regular virological monitoring, which can identify treatment failure. The second strategy is to combine a BPI with lamivudine, which is inexpensive, well tolerated, often used first line, and effective. This combination, however, has never been evaluated in patients infected by HIV with mutations that confer drug resistance, notably to lamivudine (M184V). ANRS 12286 MOBIDIP is the first trial to compare these two treatment de-escalation strategies in resource-limited countries, in patients with viremia controlled by second-line treatment.
ANRS 12286 MOBIDIP: assessing the efficacy of a new therapeutic strategy
ANRS 12286 MOBIDIP was led from 2014 and 2016 by Laura Ciaffi of TransHIVMI (joint
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