{"id":7778,"date":"2015-10-29T22:31:02","date_gmt":"2015-10-30T02:31:02","guid":{"rendered":"http:\/\/blogs.nejm.org\/hiv-id-observations\/?p=7778"},"modified":"2015-10-30T04:46:43","modified_gmt":"2015-10-30T08:46:43","slug":"the-most-important-hiv-study-at-idweek-2015","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/the-most-important-hiv-study-at-idweek-2015\/2015\/10\/29\/","title":{"rendered":"The Most Important HIV Study at IDWeek 2015"},"content":{"rendered":"

After reporting\u00a0my choice for the most important HIV study at ICAAC<\/a>, I received this email from a colleague:<\/p>\n

If that’s the most important study, I really didn’t miss much …<\/p><\/blockquote>\n

Now she has notoriously high standards — hard to impress her — but her\u00a0opinion notwithstanding, I still\u00a0<\/em>think the STRIIVING study has some important messages we can apply to clinical practice today. So I stick by my choice.<\/p>\n

Now let me see if I can meet her approval\u00a0with an IDWeek 2015 (which took place earlier this month) selection. It’s another HIV switch study<\/a>, although this time with a twist. Instead of the usual switch-study population (first regimens, or only those with no\u00a0history of virologic failure or resistance), it looked at a very different group — patients who were virologically suppressed but highly treatment-experienced, all with 2-class (or more)\u00a0resistance, and taking multiple pills a day\u00a0with a darunavir-based regimen.<\/p>\n

Subjects were then randomized to continue their current therapy or switch to the\u00a0two-pill treatment of elvitegravir-cobicistat-FTC-TAF (ECF-TAF) plus darunavir 800 mg, both once daily. (Thanks to Greg Huhn, the presenting author, for sharing the slides.)<\/p>\n

\"ss<\/a><\/p>\n

At baseline,\u00a0the regimens included a median of 5 pills, and around 60% were taking at least 6 or more pills a day. Most had a history of M184V, and a significant minority had K65R and\/or PI resistance.<\/p>\n

At week 24, 97% vs 91% of the ECF-TAF + DRV vs continued baseline regimen groups\u00a0had HIV RNA < 50 cop\/mL; at week 48, it was 94% and 76%, a significant advantage of ECF-TAF + DRV.<\/p>\n

\"ss<\/a><\/p>\n

No new resistance was observed in those with virologic failure on the 2-pill arm; one subject developed resistance in the baseline regimen group, but not integrase resistance. A PK substudy demonstrated acceptable\u00a0levels of both EVG and DRV, greatly exceeding IC95 and IC50 respectively.<\/p>\n

Some comments on this study:<\/p>\n