{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T12:23:04Z","timestamp":1789820584768,"version":"4.0.1"},"reference-count":25,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2019,7,5]],"date-time":"2019-07-05T00:00:00Z","timestamp":1562284800000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,9,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>In a context of life-long therapy, we asked whether it could be possible to reduce the number of antiretroviral drugs without jeopardizing viral suppression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>ECOVIR was a prospective study aiming to assess whether in patients on combination ART with \u22654 antiretrovirals for \u226524\u2009weeks and virally suppressed for \u226548\u2009weeks, a drug-reduced (DR) regimen could be proposed. The intervention consisted of discontinuing genotypically less susceptible drugs to reach a DR regimen with \u22643 antiretrovirals. The primary endpoint was the proportion of patients maintaining viral suppression at week (W) 24.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>From 89 eligible individuals for the study, a DR regimen was proposed in 86 (97%) patients, of whom 71 were switched to a DR regimen. Baseline characteristics [median (IQR)] were: age 58 (53\u201365) years, duration of treatment 24 (21\u201326) years and viral suppression 8 (6\u201311) years. The cumulative resistance profile showed full resistance to lamivudine\/emtricitabine (91%), abacavir (74%), efavirenz\/nevirapine (70%), rilpivirine (56%), darunavir (q24h\/q12h) (42%\/29%), lopinavir (69%), atazanavir (71%) and raltegravir (24%). The final DR regimen consisted of a two-drug or three-drug regimen in 54 patients (76%) and in 17 patients (24%), respectively. The success rate of a DR regimen at W24 was 93.9% (95% CI 84.4\u201397.6, Kaplan\u2013Meier estimate). Four patients experienced virological failure (at W4, W8 and W12), all with plasma viral load (pVL) &lt;600 copies\/mL and no emergence of resistance mutations. The DR strategy allowed a monthly cost saving of 36%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In experienced patients with high-level resistance, individualized strategies based on expert advice can offer DR regimen options with fewer drug\u2013drug interactions and a significant economic impact while ensuring virological success.<\/jats:p><\/jats:sec>","DOI":"10.1093\/jac\/dkz255","type":"journal-article","created":{"date-parts":[[2019,5,26]],"date-time":"2019-05-26T11:07:40Z","timestamp":1558868860000},"page":"2716-2722","source":"Crossref","is-referenced-by-count":8,"title":["Antiretroviral drug reduction in highly experienced HIV-infected patients receiving a multidrug regimen: the ECOVIR study"],"prefix":"10.1093","volume":"74","author":[{"given":"Marc-Antoine","family":"Valantin","sequence":"first","affiliation":[{"name":"AP-HP, H\u00f4pitaux Universitaires Piti\u00e9 Salp\u00eatri\u00e8re - Charles Foix, Service des Maladies Infectieuses, 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