L\u2019essai fran\u00e7ais ANRS 170 QUATUOR, conduit dans le champ de la prise en charge du VIH, \u00e9value une strat\u00e9gie d\u2019all\u00e8gement th\u00e9rapeutique consistant \u00e0 prendre un traitement antir\u00e9troviral 4 jours sur 7, en comparaison avec un sch\u00e9ma continu 7 jours sur 7, chez des patients ayant une charge virale contr\u00f4l\u00e9e sous trith\u00e9rapie \u00e0 base majoritairement d\u2019inhibiteurs non nucl\u00e9osidiques de la transcriptase inverse ou d\u2019inhibiteurs d\u2019int\u00e9grase. L\u2019\u00e9tude, pr\u00e9sent\u00e9e par Lambert S et al. (abstract WEPEB102, actualis\u00e9), s\u2019int\u00e9resse ici \u00e0 l\u2019impact de cette strat\u00e9gie intermittente sur le r\u00e9servoir viral sanguin sur une p\u00e9riode de deux ans.<\/p>\n
Chez 112 participants, l\u2019ADN proviral du VIH a \u00e9t\u00e9 mesur\u00e9 au d\u00e9but de l\u2019essai (J0), puis \u00e0 48 semaines (S48) et \u00e0 96 semaines (S96). L\u2019\u00e9volution de l\u2019ADN proviral entre J0 et S48 ne diff\u00e9rait pas significativement entre le groupe 4 jours sur 7 et le groupe 7 jours sur 7 (p = 0,762). Sur l\u2019ensemble de la p\u00e9riode J0\u2013S96, la variation de l\u2019ADN proviral dans le groupe 4 jours sur 7 (-0,01 log10 copies\/10\u2076 cellules) n\u2019\u00e9tait pas significativement diff\u00e9rente de celle observ\u00e9e chez les patients sous traitement continu (-0,09 log10 copies\/10\u2076 cellules, p = 0,190). Aucun \u00e9cart significatif n\u2019a \u00e9t\u00e9 observ\u00e9 dans le pourcentage de patients avec ADN proviral d\u00e9tectable entre S48 et S96 (p = 0,506), ce qui sugg\u00e8re une stabilit\u00e9 du r\u00e9servoir viral \u00e0 moyen terme malgr\u00e9 l\u2019all\u00e8gement th\u00e9rapeutique.<\/p>\n
L\u2019\u00e9tude montre par ailleurs que le niveau d\u2019ADN proviral \u00e0 l\u2019inclusion \u00e9tait significativement plus \u00e9lev\u00e9 chez les patients pr\u00e9sentant un \u00e9chec virologique (2,6 contre 2,1 log10 copies\/PCR, p = 0,043), mais ce param\u00e8tre n\u2019\u00e9tait pas associ\u00e9 \u00e0 la survenue de \u00ab blips \u00bb virologiques (p = 0,3). Chez les patients pour lesquels les analyses de s\u00e9quences virales \u00e9taient possibles (ADN d\u00e9tectable, amplification suffisante), aucune diff\u00e9rence significative entre les deux groupes n\u2019a \u00e9t\u00e9 observ\u00e9e, de l\u2019inclusion \u00e0 la semaine 48, en termes de diversit\u00e9 des haplotypes (p = 0,943) et de diversit\u00e9 nucl\u00e9otidique (p = 0,134). Ainsi, la strat\u00e9gie 4 jours sur 7, d\u00e9j\u00e0 d\u00e9montr\u00e9e non inf\u00e9rieure au plan virologique \u00e0 48 semaines avec maintien de l\u2019efficacit\u00e9 jusqu\u2019\u00e0 96 semaines, ne semble pas favoriser, \u00e0 deux ans de suivi, ni l\u2019augmentation du r\u00e9servoir viral sanguin ni la diversification g\u00e9n\u00e9tique du virus.<\/p>\n
Ces r\u00e9sultats, issus d\u2019un essai fran\u00e7ais coordonn\u00e9 par l\u2019ANRS, sont pertinents pour le suivi des politiques de sant\u00e9 en mati\u00e8re de VIH, en particulier concernant les strat\u00e9gies d\u2019all\u00e8gement th\u00e9rapeutique et leur impact sur le contr\u00f4le virologique et la dynamique du r\u00e9servoir viral \u00e0 moyen terme. Les conclusions restent toutefois limit\u00e9es \u00e0 la population \u00e9tudi\u00e9e (patients d\u00e9j\u00e0 contr\u00f4l\u00e9s sous trith\u00e9rapie, profils th\u00e9rapeutiques sp\u00e9cifiques) et \u00e0 la dur\u00e9e de suivi de deux ans.\u00a0(contenu r\u00e9sum\u00e9 par l’IA)Lire la Suite<\/a>\u200b<\/p>","protected":false},"excerpt":{"rendered":" L\u2019essai fran\u00e7ais ANRS 170 QUATUOR, conduit dans le champ de la prise en charge du VIH, \u00e9value une strat\u00e9gie d\u2019all\u00e8gement th\u00e9rapeutique consistant \u00e0 prendre un traitement antir\u00e9troviral 4 jours sur 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