Letter to the Editor: Emergence of Protease Resistance During Simplification Therapy with Lopinavir/Ritonavir Alone

Sprinz, Eduardo; Jeffman, Marcelo Wainberg

doi:10.1310/hct0802-105

Cited by 1 publication

(1 citation statement)

References 14 publications

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“…There were two novel findings regarding LPV/RTV monotherapy in this study. Of the 10 failures, one patient developed full resistance to LPV, as described previously by our group [23]. The failure was first noted at 21 months on LPV/RTV monotherapy, with viral loads of 4300 and 10 000 copies/mL being measured in tests 2 months apart.…”

Section: Discussionmentioning

confidence: 71%

Lopinavir/ritonavir monotherapy as maintenance treatment in HIV‐infected individuals with virological suppression: results from a pilot study in Brazil

et al. 2008

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ObjectiveThe aim of the study was to evaluate the possibility of using lopinavir/ritonavir (LPV/RTV) alone as maintenance therapy in HIV-infected individuals with virological suppression. DesignThis was a single-armed single-centre pilot trial. MethodsAsymptomatic HIV-infected patients on highly active antiretroviral therapy (HAART) including LPV/RTV, and with plasma HIV RNA o40 copies/mL for at least 6 months, were enrolled in the study, during which they continued with LPV/RTV alone. The intention was to recruit 25 patients to be followed for 2 years. Viral failure was defined as two consecutive HIV RNA measurements 440 copies/mL. Nadir and baseline CD4 cell counts, highest ever HIV RNA load, time with undetectable viraemia before monotherapy, number of previous antiretroviral (ARV) regimens, and gene polymorphism at CYP3A4 and CYP3A5 were evaluated. ResultsAll patients (27) completed the study. Their median age was 43 years, and 66% were men. Ten patients (37%) failed to maintain virological suppression (the median time to HIV rebound was 10.5 months, with a range of 4-23 months). One patient developed full resistance to LPV and another developed neurocognitive impairment while on LPV/RTV which improved after HAART reintroduction. There were no differences between failures and nonfailures according to the analysed parameters. Patients with viral failure were successfully resuppressed. ConclusionsLPV/RTV maintenance therapy was associated with 37% failure, a higher than expected failure rate. In order to ensure that unnecessary risks are not being taken in patients on LPV/RTV, this finding should be further evaluated in large randomized trials for longer periods of follow-up.

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Section: Discussionmentioning

confidence: 71%