Background Single-drug regimens (SDR) with ritonavir-boosted protease inhibitors (PI) could potentially be a regimen simplification to avoid nucleoside reverse transcriptase inhibitor (NRTI) toxicities in patients carrying human immunodeficiency virus (HIV) who fulfil several requirements: virological suppression, high level of medicines adherence, no previous IP virological failure and high CD4 count (>100 cell/mcL).
Purpose To evaluate the effectiveness and safety of SDR with ritonavir-boosted lopinavir (Lp/r) and ritonavir-boosted darunavir (Dr/r) in HIV-positive patients pre-treated with three-drug regimens (TDRs) including an NRTI.
Material and methods Retrospective observational study of HIV-positive patients with treatment switches from TDR to SDR in a second-level hospital.
Data were collected from the Farmatools-Dominion program and medical records. Variables included: sex, age, duration of previous TDR, plasma viral load (PVL) pre- and post-treatment switching, virological failure with PIs, CD4 cell count before switching and months of SDR to date (June’11–September’14).
Results Twenty-two patients were identified, 9 treated with Lp/r (5 men) and 13 with Dr/r (all men). Mean age at the time of the study: 48 + 6 years. 4 patients (2 with Lp/r and 2 with Dr/r) were co-infected with Hepatitis C virus and all subjects had been treated with TDR for a minimum of 12 months prior to treatment change. In all subjects basal PVL was undetected for at least 6 months before switching and remained undetectable during the entire study. One exception was a single patient with confirmed viral rebound which led to treatment re-intensification with two NRTIs included in the previous TDR.
No patients presented virological failure with the previous PI and the median CD4 counts at treatment switch were normal (825 ± 583 cell/mcL). All subjects were treated with SDR for a median period of 22 months and both adherence and tolerance were considered successful before and after switching.
Conclusion SDR with a ritonavir-boosted PI might be an alternative as effective as traditional combinations. It involves a clear benefit for HIV-positive patients because it simplifies treatment with minor toxicity and a small number of interactions.
References and/or acknowledgements No conflict of interest.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.