Boosted protease inhibitor monotherapy in HIV-infected patients: results of a study in a real life setting

Autores de IIS La Fe

• Nicolas Di Benedetto

  Autor

• Marta Montero Alonso

  Autor

• Marino Blanes Juliá

  Autor

• Jose Lacruz Rodrigo

  Autor

• Sandra Cuéllar Tovar

  Autor

• Eva Calabuig Muñoz

  Autor

• José López Aldeguer

  Autor

• Miguel Salavert Lletí

  Autor

Grupos

• Infección Grave

  

  Investigador Principal

  María Ángeles Tormo Mas

• Investigacion clínica en enfermedades crónicas e Infección por el VIH

  Investigador establecido

  Marta Montero Alonso

Abstract

Background. Boosted protease inhibitor monotherapy may offer antiviral efficacy while reducing drug interactions, costs and toxicity. The aim of this study was to assess the efficacy of darunavir/ritonavir (DRV/r) and lopinavir/ritonavir (LPV/r) monotherapy in a real life setting. Methods. A retrospective analysis of all HIV infected patients, who had initiated DRV/r or LPV/r monotherapy, was performed. Patients whose HIV viral load had remained undetectable for at least two consecutive follow-up visits and who had no neurocognitive disorder or hepatitis B co-infection, were included. Results. Sixty patients were included. The median (IQR) time to follow-up was 66 (33-118) weeks. The proportions (CI95%) of patients with virological failure were 6.3% (1.7-20.2) and 25.0% (12.7-43.4), respectively, in the DRV/r and LPV/r groups (p= 0.0424). The proportions (CI95%) of patients with therapeutic success were 90.6% (80.5-100) in the DRV/r group and 60.7% (42.6-78.8) in the LPV/r group (p= 0.0063). No protease inhibitor mutations were detected. During the follow-up, 6 patients with dyslipidemia normalized their lipid values. The median monthly cost was 410 (IQR 242-416) euros per person lower for the monotherapy than for the combined antiretroviral therapy. Conclusions. Boosted protease inhibitor monotherapy was effective in a real life setting. This study showed differences in favour of DRV/r as compared with LPV/r in terms of therapeutic success; however prospective studies are needed to confirm these results. Finally, although this study was not specifically designed to detect benefits in terms of costs and lipid profile, it shows evidence of a positive impact of monotherapy in these fields.

Keywords

• lopinavir; darunavir; HIV protease inhibitors; HIV Highly Active; Antiretroviral Therapy