Week 96 results of the randomized, multicentre Maraviroc Switch (MARCH) study.

Area of Science:

• Infectious Diseases
• Virology
• Immunology

Background:

• Antiretroviral therapy is crucial for managing HIV-1 infection.
• Ritonavir-boosted protease inhibitors (PI/r) are effective but can have metabolic side effects.
• Chemokine receptor-5 (CCR5) inhibitors offer an alternative treatment option.

Purpose of the Study:

• To evaluate the durability of switching from PI/r to maraviroc (MVC) in HIV-1 patients.
• To assess the long-term efficacy and safety of MVC as a switch strategy.
• To determine the impact of MVC on lipid profiles and other safety parameters.

Main Methods:

• The Maraviroc Switch (MARCH) study was a 96-week, international, randomized, open-label trial.
• HIV-1 infected adults with R5-tropic virus, stable and virologically suppressed, were randomized (1:2) to continue PI/r or switch to MVC plus two N(t)RTIs.
• Primary endpoint: proportion with plasma viral load (pVL) < 200 copies/mL at 96 weeks; safety and lipid profiles were secondary endpoints.

Main Results:

• At 96 weeks, 89.0% (PI/r) and 90.4% (MVC) maintained pVL < 50 copies/mL.
• The switch to MVC was noninferior to continuing PI/r.
• Significant reductions in total cholesterol and triglycerides were observed in the MVC arm compared to PI/r.

Conclusions:

• Maraviroc is a safe and effective switch option for the PI/r component in HIV-1 patients with R5-tropic virus.
• Switching to MVC maintains virological suppression and offers significant lipid benefits over 96 weeks.
• The MARCH study confirms the long-term durability of maraviroc as a switch therapy.