Stratégies thérapeutiques antirétrovirales non conventionnelles en première ligne du traitement de l'infection par le VIH-1.

Abstract

The treatment of HIV-1 infection in untreated patients is based on a combination of antiretroviral drugs targeting key steps of the viral replication cycle. The highly active antiretroviral therapy combines two nucleosides reverse transcriptase inhibitors (NRTIs) with either a non-nucleoside inhibitor (NNRTI) or a protease inhibitor (PI). Second generation drugs (etravirine, rilpivirine) or drugs targeting new steps of the viral cycle (integrase inhibitors [INI] and CCR5 entry inhibitor) have appeared in the therapeutic arsenal. Rilpivirine has shown its effectiveness in patients with less than 100,000 copies/ml of viral load at initiation. Combinations of two NRTIs with INI (raltegravir, elvitegravir, dolutegravir) have proven their efficacy and tolerability compared to standard treatment options and have been included in treatment guidelines. In contrast, maraviroc has not demonstrated a similar efficacy to efavirenz, mainly due to the poor sensitivity at detecting non-R5 variants of assays to identify the viral tropism. Associations without NRTIs combining PI with raltegravir or maraviroc have not yet demonstrated their efficacy in large studies in patients initiating treatment.