Hodder Sally, Jayaweera Dushyantha, Mrus Joseph, Ryan Robert, Witek James
Department of Medicine, University of Medicine and Dentistry of New Jersey, Newark, NJ 07101, USA.
AIDS Res Hum Retroviruses. 2012 Jun;28(6):544-51. doi: 10.1089/AID.2011.0118. Epub 2012 Apr 2.
The GRACE (Gender, Race and Clinical Experience) trial enrolled treatment-experienced, HIV-1-infected patients, mainly women, in North America, to assess outcomes with a darunavir/ritonavir-based regimen, which could include etravirine (ETR). We present outcomes at week 48 for men and women receiving ETR. Virologic response (HIV-1 RNA <50 copies/ml) and safety were assessed; descriptive statistics are reported. To evaluate the independent contribution of ETR treatment, a post hoc analysis including a multivariate model assessed factors predictive of virologic response for the entire GRACE population (429 patients). Of 207 patients who received ETR (women, 57.5%; black or Hispanic, 81.7%), 71.4% of women and 79.5% of men completed the study. Week 48 virologic response rates in women and men (intent-to-treat population) were 58.0% and 61.4%, respectively. After censoring patients who discontinued treatment for reasons other than virologic failure, response rates were 79.3% and 73.0%, respectively. Overall, ETR was well tolerated. Women experienced more nausea (24.4% vs. 11.4%) and rash-related events (21.0% vs. 15.9%), but less diarrhea (15.1% vs. 21.6%), compared with men. Grade 3-4 hypertriglyceridemia was more common in men (9.3%) than women (1.1%). In total, 11 (9.2%) women and 7 (8.0%) men discontinued ETR due to adverse events. In the multivariate model of the entire GRACE population, ETR use was independently associated with improved virologic response. ETR is effective and well tolerated in treatment-experienced patients with HIV-1, with similar outcomes among women and men.
GRACE(性别、种族与临床经验)试验纳入了北美地区有治疗史的HIV-1感染患者,主要为女性,以评估基于达芦那韦/利托那韦的治疗方案(可能包括依曲韦林[ETR])的疗效。我们展示了接受ETR治疗的男性和女性在第48周时的疗效。评估了病毒学应答(HIV-1 RNA<50拷贝/毫升)和安全性;报告了描述性统计数据。为评估ETR治疗的独立作用,一项包括多变量模型的事后分析评估了整个GRACE人群(429例患者)中预测病毒学应答的因素。在207例接受ETR治疗的患者中(女性占57.5%;黑人或西班牙裔占81.7%),71.4%的女性和79.5%的男性完成了研究。女性和男性(意向性治疗人群)在第48周时的病毒学应答率分别为58.0%和61.4%。在剔除因病毒学失败以外原因中断治疗的患者后,应答率分别为79.3%和73.0%。总体而言,ETR耐受性良好。与男性相比,女性出现恶心(24.4%对11.4%)和皮疹相关事件(21.0%对15.9%)的情况更多,但腹泻(15.1%对21.6%)较少。3-4级高甘油三酯血症在男性中(9.3%)比女性中(1.1%)更常见。共有11例(9.2%)女性和7例(8.0%)男性因不良事件停用ETR。在整个GRACE人群的多变量模型中,使用ETR与改善病毒学应答独立相关。ETR在有治疗史的HIV-1患者中有效且耐受性良好,男女疗效相似。