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Background: Enfuvirtide was shown to be highly effective in treatment- experienced patients. Data on discontinuation of enfuvirtide and switch to new antiretroviral drugs are scarce. We aimed to evaluate the efficacy and the impact of discontinuing and/or switching enfuvirtide on virologic and clinical parameters in clinical practice. Methods: All HIV-infected individuals participating in the Swiss HIV Cohort Study who were treated with enfuvirtide for at least 4 weeks in combination with an optimized background antiretroviral regimen were included in this study. Results: A total of 151 patients were analyzed. The median baseline CD4 cell count was 108 cells/μL (interquartile range [IQR] 50–206) and HIV RNA was 4.7 log10 copies/mL (IQR 4.1–5.2). Virologic suppression, defined as a viral load below 50 copies/mL at 12 months, was achieved by 57.6% of patients. Overall, a median CD4 cell increase of 121 cells/μL (IQR 50–189) from baseline was noted. Up to 50% of patients discontinued enfuvirtide within the first year of treatment, mainly because of the patient’s choice. After discontinuation of enfuvirtide, high rates of virologic failure and clinical progression were observed, notably when CD4 cell count at stopping enfuvirtide was below 100 cells/μL and no switch to new potent antiretroviral drugs such as darunavir, maraviroc, or raltegravir was performed. Conclusions: Enfuvirtide provides high virologic and immunologic response in treatment-experienced patients in the setting of clinical practice. Enfuvirtide should not be discontinued but should be replaced by new potent antiretrovirals, particularly in case of severe immunosuppression. [ABSTRACT FROM AUTHOR]

Purpose: Antiretroviral therapy (ART) may induce metabolic changes and increase the risk of coronary heart disease (CHD). Based on a health care system approach, we investigated predictors for normalization of dyslipidemia in HIV-infected individuals receiving ART. Method: Individuals included in the study were registered in the Swiss HIV Cohort Study (SHCS), had dyslipidemia but were not on lipidlowering medication, were on potent ART for ⩾3 months, and had ⩾2 follow-up visits. Dyslipidemia was defined as two consecutive total cholesterol (TC) values above recommended levels. Predictors of achieving treatment goals for TC were assessed using Cox models. Results: Analysis included 958 individuals with median followup of 2.3 years (IQR 1.2–4.0). 454 patients (47.4%) achieved TC treatment goals. In adjusted analyses, variables significantly associated with a lower hazard of reaching TC treatment goals were as follows: older age (compared to 18–37 year olds: hazard ratio [HR] 0.62 for 45–52 year olds, 95% CI 0.47–0.82; HR 0.40 for 53–85, 95% CI 0.29–0.54), diabetes (HR 0.39, 95% CI 0.26–0.59), history of coronary heart disease (HR 0.27, 95% CI 0.10–0.71), higher baseline TC (HR 0.78, 95% CI 0.71–0.85), baseline triple nucleoside regimen (HR 0.12 compared to PI-only regimen, 95% CI 0.07–0.21), longer time on PI-only regimen (HR 0.39, 95% CI 0.33–0.46), longer time on NNRTI only regimen (HR 0.35, 95% CI 0.29–0.43), and longer time on PI/NNRTI regimen (HR 0.34, 95% CI 0.26–0.43). Switching ART regimen when viral load was undetectable was associated with a higher hazard of reaching TC treatment goals (HR 1.48, 95% CI 1.14–1.91). Conclusion: In SHCS participants on ART, several ART-related and not ART-related epidemiological factors were associated with insufficient control of dyslipidemia. Control of dyslipidemia in ART recipients must be further improved. [ABSTRACT FROM AUTHOR]