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Relationship between Levels of Indinavir in Hair and Virologic Response to Highly Active Antiretroviral Therapy

Louis Bernard, MD; Albert Vuagnat, MD; Gilles Peytavin, MD; Marie-Charlotte Hallouin, MD; Damien Bouhour, MD; Thu Huyen Nguyen, MD; Jean Louis Vildé, MD; François Bricaire, MD; Gilles Raguin, MD; Pierre de Truchis, MD; David Ghez, MD; Michel Duong, MD; and Christian Perronne, MD, PhD
[+] Article, Author, and Disclosure Information

From Geneva University Hospital and Laboratoire de Virologie, Geneva, Switzerland; Hôpital Paul-Brousse, Villejuif, France; Hôpital de la Croix Rousse, Lyons, France; Hôpital Bichat, Hôpital Rothschild, Hôpital Pitié-Salpêtrière, and Hôpital de la Croix Saint-Simon, Paris, France; Hôpital Raymond-Poincaré, Garches, France; and Hôpital du Bocage, Dijon, France.

Acknowledgments: The authors thank Huguette Berthé for technical assistance and Sylvie Cotigny for HIV genotyping. They also thank Dr. Firouzé Bani-Sadr, Professor Dominique Peyramond, Professor Henri Portier, and Professor Willy Rozenbaum for the referral of patients, and Professor Bernard Hirschel, Professor Luc Perrin, and Dr. Laurent Kaiser for critical review of the manuscript.

Grant Support: By GIPIT (Groupe d'Investigation en Pathologie Infectieuse et Tropicale) and in part by an unrestricted grant from Merck Sharp & Dohme, Paris, France.

Requests for Single Reprints: Louis Bernard, MD, Division of Infectious Diseases, Geneva University Hospital, rue Micheli-du-Crest, CH 1211 Geneva, Switzerland; e-mail, louis.bernard@hcuge.ch.

Current Author Addresses: Dr. Bernard: Division of Infectious Diseases, Rue Micheli-du-Crest, CH 1211 Geneva, Switzerland.

Dr. Vuagnat: INSERM U472 Epidémiologie et Biostatistiques, Hôpital Paul-Brousse, 91400 Villejuif, France.

Dr. Peytavin: Service de Toxicologie et Pharmacologie, Hôpital Bichat, 75019 Paris, France.

Dr. Hallouin: Laboratoire de Virologie, Rue Micheli-du-Crest, Genève, Switzerland.

Dr. Bouhour: Service des Maladies Infectieuses, Hôpital de la Croix Rousse, 69000, Lyons, France.

Dr. Nguyen: Service des Maladies Infectieuses, Hôpital Rothschild, 75012 Paris, France.

Dr. Vildé: Service des Maladies Infectieuses, Hôpital Bichat, 75019 Paris, France.

Dr. Bricaire: Service des Maladies Infectieuses, Hôpital Pitié-Salpêtrière, 75013 Paris, France.

Dr. Raguin: Service des Maladies Infectieuses, Hôpital de la Croix Saint-Simon, 75020 Paris, France.

Drs. de Truchis, Ghez, and Perronne: Service des Maladies Infectieuses et Tropicales, Hôpital Raymond-Poincaré, Faculté de Médecine Paris-Ouest, 92380 Garches, France.

Dr. Duong: Service des Maladies Infectieuses, Hôpital du Bocage, Dijon, France.

Author Contributions: Conception and design: L. Bernard, M.-C. Hallouin.

Analysis and interpretation of the data: L. Bernard, A. Vuagnat, G. Peytavin, M.-C. Hallouin, D. Ghez.

Drafting of the article: L. Bernard, A. Vuagnat, D. Ghez, C. Perronne.

Critical revision of the article for important intellectual content: L. Bernard, M.-C. Hallouin, D. Ghez, C. Perronne.

Final approval of the article: L. Bernard, P. de Truchis, C. Perronne.

Provision of study materials or patients: L. Bernard, D. Bouhour, T.H. Nguyen, J.L. Vildé, F. Bricaire, G. Raguin, M. Duong.

Statistical expertise: A. Vuagnat.

Obtaining of funding: P. de Truchis, C. Perronne.

Administrative, technical, or logistic support: I. Peytavin, M.-C. Hallouin, D. Bouhour, T.H. Nguyen, J.L. Vildé, F. Bricaire, G. Raguin, P. de Truchis, M. Duong.

Collection and assembly of data: L. Bernard, G. Peytavin, M.-C. Hallouin.

Ann Intern Med. 2002;137(8):656-659. doi:10.7326/0003-4819-137-8-200210150-00009
Text Size: A A A

Background: Suboptimal levels of antiretroviral drugs result in virologic failure in HIV-infected patients treated with highly active antiretroviral therapy (HAART).

Objective: To assess the relationship between levels of indinavir in hair and virologic outcome.

Design: Cross-sectional study.

Setting: 7 AIDS clinics in France.

Patients: 89 HIV-infected patients who received HAART that included indinavir.

Measurements: Patients were classified as responders or nonresponders on the basis of viremia at the time of hair collection. In nonresponders, levels of indinavir in hair and resistance mutations in the protease gene were assessed at baseline and at the time of indinavir measurement.

Results: Mean indinavir levels (±SD) were significantly higher in the 65 responders than in the 24 nonresponders (24.4 ± 16 µg/g vs. 12.9 ± 8.6 µg/g) (P < 0.001). Nonresponders with intermediate levels of indinavir in hair had more mutations in the protease gene than did nonresponders with low levels of indinavir in hair.

Conclusion: Indinavir levels in hair are associated with virologic outcome in patients receiving HAART.


Grahic Jump Location
Figure 1.
Mean indinavir concentration in the first 2-cm segment of hair in patients who responded or did not respond to highly active antiretroviral therapy that included indinavir.
Grahic Jump Location
Grahic Jump Location
Figure 2.
Receiver-operating characteristic curve of indinavir concentrations in the first 2-cm segment of hair in nonresponders with HIV mutations and nonresponders without HIV mutations (area under the curve, 0).
Grahic Jump Location




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Summary for Patients

The Relationship between Levels of the Anti-HIV Drug Indinavir in Patients' Hair and Response to Treatment

The summary below is from the full report titled “Relationship between Levels of Indinavir in Hair and Virologic Response to Highly Active Antiretroviral Therapy.” It is in the 15 October 2002 issue of Annals of Internal Medicine (volume 137, pages 656-659). The authors are L Bernard, A Vuagnat, G Peytavin, MC Hallouin, D Bouhour, TH Nguyen, JL Vildé, F Bricaire, G Raguin, P de Truchis, D Ghez, M Duong, and C Perronne.


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