Important note: Information in this article was accurate in September 2006. The state of the art may have changed since the publication date.
Antiretroviral effect of foscarnet in patients with multiple drug resistance in late stage HIV disease
HIV Treat Bull - Vol. 7, No. 7/8, September 2006
In Volume 11, issue 5 of Antiviral Therapy, Ana Canestri and colleagues reported the results of using foscarnet as additional therapy in 11 multi-drug resistant French patients with late stage HIV disease, failing their current treatment.
Inclusion criteria for this open-label, single-arm, add-on pilot study, included viral load >50,000 copies/mL and CD4 counts <100/mm3, and documented three-class resistance. Foscarnet induction therapy consisted of 5 g intravenously twice daily for 6 weeks, in addition to their antiretroviral combination, and the primary endpoint was virological response at week 6. Patients with at least 1 log decrease in viral load at week 6 (W6), were given foscarnet 5 g intravenously twice daily on two consecutive days each week.
Median baseline CD4 and viral load were 10 cells/mm3 and at 5.16 log copies/mL respectively, with a median of 9 (RTI), 2 (NNRTI) and 12 (PI) associated mutations.
In an intent-to-treat analysis, the median change in viral load was almost -2.0 logs at week 2 and -1.79 logs at week 6. 8/11 patients had at least 1 log reduction at week 6. One patient discontinued foscarnet at week 2 because of renal toxicity.
Six patients started maintenance therapy. Change from baseline after 12 weeks of maintenance therapy was -0.85 log in the four patients who reached W12, and the median increase of CD4+ T-cell count was 60 cells/mm3.
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The study noted that ‘foscarnet markedly reduced plasma HIV load and improved immunological status’. Given the toxicity associated with foscarnet, and the difficulty of administration (twice-daily IV administration, often requiring a Port-a-Cath or Hickman line for anything treatment lasting longer than a few days) this is clearly a treatment of last resort.
It may nevertheless be suitable for a limited number of patients, particularly part of a short-term strategy to maximize virological response, and particlular if they also have active CMV.
Ref:
Canestri A, Ghosn J, Wirden M et al. Foscarnet as salvage therapy for patients with late-stage HIV disease and multiple drug resistance. Antiviral Therapy 2006; 11: 561-566. (Volume11, Issue 5)
2006-09-10
IB060709-06
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