Data challenge value of adding maraviroc to combination ART in advanced HIV

  • Lévy Y & al.
  • Ann Intern Med
  • 11 Feb 2020

  • curated by Liz Scherer
  • Clinical Essentials
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Takeaway

  • Adding maraviroc to standard combined antiretroviral therapy (c-ART) does not improve clinical outcomes among patients presenting with advanced HIV.
  • Studies are needed to determine potential value of short-term (6 months) maraviroc use.

Why this matters

  • Late diagnosis continues to challenge EU/EE efforts to reduce overall HIV transmission rates. 
  • Consult WHO consolidated guidelines for testing, including tips for generating demand from patients. 

Key results

  • Data for 409/416 patients analyzed (202 maraviroc; 207 placebo; 85% men; median age, 42 [range, 21-74] years).
  • Incidence of severe morbidity (new AIDS-defining event [ADE], serious infections, serious non-ADE):
    • Maraviroc: 11.1/100 person-years.
    • Placebo: 11.2/100 person-years.
    • Adjusted HR, 0.97 (P=.91).
  • More serious adverse events seen with maraviroc (11.8/100 person-years) vs placebo (2.9/100 person-years):
    • Incidence rate ratio (IRR), 4.00 (95% CI, 1.79-10.10).
  • Virologic success rate at week 72 (plasma viral load 
  • 72.8% with maraviroc vs 78.3% placebo.
  • Post-hoc: severe morbidity incidence was lower vs placebo at 0-24 weeks (IRR, 0.61), but higher at 24-72 weeks (IRR, 2.90).
    • P=.016 for interaction.
  • Study design

    • Randomized, placebo-controlled, multicenter study assessing benefit of adding maraviroc to standard, c-ART in persons with advanced HIV.
    • Funding: French National Agency for Research on AIDS; ViiV Healthcare.

    Limitations

    • No effect-modification analysis.
    • Inability to assess time-dependent outcomes.