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1 RESIST Trials - Grade 3 or 4 AST, ALT or Total Bilirubin: Actions and Outcomes Action Taken: TPV/r N=748 CPI/r N=737 Total Number of Grade 3 or 4 ALT, AST, or Bilirubin 74 (9.9)26 (3.5) Continued treatment57 (7.6%)26 (3.5%) No interruption47 (6.3%)23 (3.1%) Interrupted10 (1.3%)3 (0.4%) Discontinued treatment17 (22.7%)0 (0%) With Grade 37 (0.9%) With Grade 410 (1.3%)
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2 Lipid Lowering Agent Use Among RESIST Participants Note: agents included are statins, fibrates, and omega-3 fatty acids n=108n=102n=130n=79n=238n=181 Use of Lipid Lowering Drugs in RESIST Percentage
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3 Effect of LLD on triglycerides: RESIST 390 (259, 581) 355 (230, 538) 445 (298, 634) 367 (286, 568) N6363118118 # deter3463
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4 Risk Confirmed (3 times) Triglycerides Above 500 mg/dl for RESIST Patients 17.26 8.20 0 2 4 6 8 10 12 14 16 18 04812162024283236404448 Exposure (weeks) TPV/rCPI/r Probability of event (%) Note: Included are RESIST participants who had baseline triglycerides <500 and developed at least 3 determinations above 500 mg/dL
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5 RTV-boosted drug interaction assessments
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6 Reduced GSS as Key Mutations Increase 0 10 20 30 40 50 60 70 01234 Number of key mutations % baseline background RTI susceptibility scores <2
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7 Hypertriglyceridemia: Relative Contribution of TPV and RTV Median baseline and maximal increase in serum triglycerides according to dose among Trial 1182.52 participants Dosen Median (Q25, Q75) baseline (mg/dL) Median (Q25, Q75) maximum increase (mg/dL) 500/10073263 (168, 430)161 (58, 403) 500/20072221 (172, 332)271 (99, 558) 750/20071223 (173, 416)196 (72, 421)
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8 Analysis of Treatment Response at Week 48 n = Number of responders N = Number of evaluable patients Treatment difference and confidence interval weighted for the size of enfuvirtide and PI strata RESIST-1RESIST-2 Treatment Group TPV/rCPI/rTPV/rCPI/r n(%)Nn Nn Nn N Key analysis FAS (week 24) (NCF, as randomised) 130(41.8)31174(23.9)309177(40.7)43576(17.8)428 FAS (week 48) (NCF, as randomised) 103(33.1)31149(15.9)309148(34.0)43564(15.0)428 Sensitivity analysis PPS (week 48) (NCF, as randomised) 66(35.7)18538(19.7)193102(37.4)27341(16.1)254
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9 K-M Probabilities for Grade 3 or 4 ALT and/or AST Through 120 Weeks in 8 HIV+ Integrated Trials* 29256210 187014451019417148133 # At Risk- Events- * Includes TPV/r patients from 1182.2, 1182.4, 1182.6, 1182.17, 1182.51, 1182.52, and CPI/r patients who switched to TPV/r 500/200 from RESIST trials 1182.12 and 1182.48
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RESIST Studies Cox Regression Model for Risk of Grade 3 or 4 ALT/AST Baseline risk factors for Grade 3 4 ALT/AST are similar in TPV/r and CPI/r Independent variables: age, gender, race, ΔCD4, baseline triglycerides, NRTI, NNRTI, viral load, CDC HIV stage, duration of HIV infection Factor/Comparison Risk Ratio 95% CI Treatment Group: TPV/r vs CPI/r2.41.5 – 3.8 Baseline ALT,AST Total Bilirubin: (Grade > 1 vs Grade < 1)2.51.3 – 4.8 CD4+ Cell Count at Baseline: >200 vs ≤200 cells/mm 3 2.01.3 – 2.5 HBV or HCV Co-infection: Co-infected vs not co-infected2.31.4 – 3.7 10
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11 Predictors of TPV/r Antiviral Response Multiple Regression Model P ValueEstimate <0.010.17 TPV Score (per mutation) <0.01-0.24 Per Available Drug in OBR <0.01-0.91Enfuvirtide Use <0.01-1.25Tipranavir/r 24 Weeks Parameter
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12 Tipranavir trough concentrations with proton pump inhibitors
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13 Trial 1182.52 Impact of IQ on 14-Day Viral Load Response Change from baseline at 2 weeks (log 10 ) Inhibitory quotient Observed dataFold Change = 301 log 10 decline 30 -3 -2 0 1 0.1110100100010,000
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14 1182.52 Impact of IQ on 14-Day Viral Load Response 0.05 -0.13 -1.03 -1.16 -0.98 -1.25 -1.4 -1.2 -0.8 -0.6 -0.4 -0.2 0 ≤5≤5>5–30>30–50>50–100>100–150>150 Inhibitory quotient HIV RNA log 10 change from baseline 7 2714342558 0.2
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15 RESIST Trials 24 Week VL Change according to IQ in Patients not using Enfuvirtide
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16 RESIST Trials 24 Week VL Change according to IQ in Patients using Enfuvirtide
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17 Antiviral activity of tipranavir (ViroLogic) Non-clade B isolates Mean EC 50 (nM) 102 74 116 38 124 Ref. NL4-3 (B virus) EC 50 = 62 nM EC 50 values measured at ViroLogic Inc (South San Francisco) using the PhenoSense assay No evidence that other HIV-1 clades and circulating recombinant forms have lower susceptibility to TPV than HIV-1 clade B Clade B biological cutoff value for TPV not yet determined (1.6X LPV or 99nM)* * Parkin et al, AAC, 2004, 48, 437-443 (three isolates each except two for clade H)
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18 VIRCO / ViroLogic in Tipranavir Phenotype
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19 Mutations Which Increase Susceptibility to TPV Amino acid Median FC IC 50 N Parameter Estimate P-value Wild typeMutated 18L1.000.505-0.550.035 30N1.200.5026-0.54<0.001 50V1.100.7019-0.310.021 54L1.100.7021-0.310.018 77I1.201.00102-0.180.011 88D1.100.6026-0.380.001
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