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- Title
Durability of lopinavir/r monotherapy in people with viral load ≤50 copies/Ml.
- Authors
d'Arminio Monforte, A; Cozzi-Lepri, A; Andreoni, M; di Perri, G; Galli, M; Poli, A; Costantini, A; Maggiolo, F; Viscoli, C; Sighinolfi, L; Rizzardini, G; Bonfanti, P; Gianotti, N; Perno, C; Antinori, A
- Abstract
There is debate about whether lopinavir/r mono-therapy (LPV/r-MT) is a valid treatment option for HIV-infected patients who have shown perfect adherence to therapy. The objective was to evaluate the durability of LPV/r-MT in terms of time to virological rebound (VR), time to discontinuation/intensification or a composite endpoint considering both (=treatment failure). We also identified factors associated with faster progression to treatment failure and estimated the median CD4 count over time while people were still on LPV/r-MT. Patients enrolled in 10 clinical sites in Italy who ever started LPV/r-MT with a viral load ≤50 copies/mL (baseline) are included. Patients' follow-up accrued from baseline to the date of the event of interest (VR, defined using the thresholds of 50 and 200 copies/mL, or discontinuation/intensification) or at the date of last available visit/VL measurement. Standard survival analysis employing Kaplan-Meier curves was used. We studied 139 patients starting LPV/r-MT on average in 2010 (IQR: 2009-2011) with a VL≤50 copies/mL already for a median of 1 month (range: 1-17). Median age 45 years (IQR: 39-50), 35% females, 32% IDU. Median time from first initiation of ART was 33 months (16-58) with no history of virological failure. Median (IQR) marker values at baseline were 611 (432-741) CD4 count cells/mm3, 937 (655-1254) CD8 count and 28 (19-47) IU/L of ALT. Median CD4 count were 519 cells/mm3 at 3 months, 660 at 6 months, 603 at 9 months and 467 at 12 months. The table shows the Kaplan-Meier estimates by 1 year and 2 years for a number of endpoints examined. There was a wide range of estimates depending on the endpoint used. Of those stopping/intensifying, 6 people (4%) added Truvada (n=4), Kivexa (n=1) and darunavir (n=1), the remaining 8 restarted cART.
- Subjects
LOPINAVIR-ritonavir; HIV infections; THERAPEUTICS; HIV-positive persons; KAPLAN-Meier estimator; DISEASE progression
- Publication
Journal of the International AIDS Society, 2012, Vol 15, p1
- ISSN
1758-2652
- Publication type
Article
- DOI
10.7448/IAS.15.6.18378