HIV Viral Dynamics of Lopinavir/Ritonavir Monotherapy as Second-Line Treatment: A Prospective, Single-Arm Trial
Date
2019Journal
Journal of the International Association of Providers of AIDS CarePublisher
NLM (Medline)Type
Article
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Background: Characterizing viral response to lopinavir/ritonavir (LPV/r) monotherapy as second-line treatment may guide recommendations for resource-limited settings (RLS). Methods: We conducted a 48-week prospective, single-arm study of LPV/r monotherapy in patients failing first-line therapy in Nigeria. The primary outcome was sustained HIV-1 viral load (VL) <400 copies/mL at 48 weeks. Results: Of 30 enrolled patients, 28 (93%) achieved viral suppression on LPV/r, while 29 (96%) experienced low-level viremia. At 48 weeks, 9 (30%) met the primary outcome of sustained viral suppression; 14 (47%) patients were suppressed on LPV/r in a snapshot analysis. Detectable VLs at 12 and 24 weeks were strongly associated with treatment failure at 48 weeks. New resistance mutations were not detected. The trial was stopped early due to treatment failure. Conclusion: In this study, the rate of virologic failure among patients on a second-line lopinavir monotherapy regimen was relatively high and predicted by early detectable viremia. However, no LPV/r-associated resistance mutations were detected despite fluctuating low-level viremia, demonstrating the high genetic barrier to resistance of the protease inhibitor class which could be useful in RLS.Keyword
boosted protease inhibitor monotherapyHIV
lopinavir/ritonavir monotherapy
resource-limited settings
second-line antiretroviral therapy
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https://www.scopus.com/inward/record.uri?eid=2-s2.0-85062070935&doi=10.1177%2f2325958218823209&partnerID=40&md5=979422f502a5dfb2008f5d9347647f2f; http://hdl.handle.net/10713/10655ae974a485f413a2113503eed53cd6c53
10.1177/2325958218823209
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