INCIDENCE TRENDS AND OUTCOME OF NON-AIDS-DEFINING MALIGNANCIES (NADM) IN A COHORT OF HIV-INFECTED PATIENTS DURING THE PERIOD 1985-2008

Objectives. Raltegravir (RAL) is the only licensed HIV integrase inhibitor. The determinants of virological response to RAL-containing regimens and the prevalence of integrase mutations associated to RAL failure deserve further investigation. Methods. From the Italian database ARCA, we selected 3-class experienced subjects failing their current treatment with complete treatment history available. Selection criteria included HIVRNA, CD4 count and HIV genotype within 3 months prior to RAL initiation. Predictors of 24- week response were analyzed and genotypic sensitivity scores (GSS) and weighted-GSS were evaluated. Results. Virological response was achieved in 74.3% of 105 subjects. Mutations associated to RAL failure were detected in 12/24 subjects with an IN genotype, with the prevalence of Q148H+G140S. Each extra unit of GSS (p=.039) and weighted-GSS (p=.034) predicted virological response. A significant increase in the probability of response appeared for GSS 1- 1.49 (p=.030), GSS>1.5 (p=.044) and weighted-GSS>=1.5 (p=.037). GSS>=1 showed the highest sensitivity, 82.6%. ROC curves depicted the widest AUC (0.663, p=.054) of GSS >=1. Conclusions. Unresponsiveness to RAL-containing regimens among 3-class experienced subjects was low. The activity of the background regimen was a major predictor of response. Although few IN genotypes were available at failure, half of these were without IN resistance mutations Finding IN mutations in approximately half of the successfully genotyped subjects has been very common in most RAL trials, both in naïve and experienced subjects.