Durability of lopinavir/ritonavir monotherapy in individuals with viral load ≤50 copies/ml in an observational setting
Articolo
Data di Pubblicazione:
2014
Citazione:
Durability of lopinavir/ritonavir monotherapy in individuals with viral load ≤50 copies/ml in an observational setting / A. d’Arminio Monforte, N. Gianotti, A. Cozzi-Lepri, C. Pinnetti, M. Andreoni, G.D. Perri, M. Galli, A. Poli, A. Costantini, G. Orofino, F. Maggiolo, G. Mazzarello, B.M. Celesia, F. Luciani, A. Lazzarin, L. Sighinolfi, G. Rizzardini, P. Bonfanti, C.F. Perno, A. Antinori, T.I.F. Cohort. - In: ANTIVIRAL THERAPY. - ISSN 1359-6535. - 19:3(2014), pp. 319-324. [10.3851/IMP2687]
Abstract:
Background: The main objective is to evaluate the efficacy and durability of lopinavir-ritonavir monotherapy (LPV/r-MT) in virologically controlled HIV-positive individuals switching from combination antiretroviral therapy (cART).
Methods: Criteria to be included in this observational study were to have initiated for the first time LPV/r-MT after >= 2 consecutive HIV RNA <= 50 copies/ml achieved on a >= 3-drug-including regimen. The main end points were time to virological rebound (VR; defined in two ways: time of first of two consecutive viral load [VL]>50 and >200 copies/ml), time to discontinuation/intensification and time to experience either a single VL>200 copies/ml or discontinuation/intensification (treatment failure [TF]). Individuals' follow-up accrued from the date of starting LPV/r-MT to event or last available VL. Kaplan-Meier curves and Cox regression analyses were used.
Results: A total of 228 individuals were included: median age 46 years (IQR 40-50), 36% females, 36% intravenous drug users and 25% HCV-coinfected. Median CD4(+) T-cell count at nadir was 215 cell/mm(3) (IQR 116-336) and at baseline was 615 cell/mm(3) (IQR 436-768). By 36 months after switching to LPV/r-MT, the proportion of individuals with VR (confirmed VL>200 copies/ml) was 11% and with TF was 35%. In the multivariable Cox model the factors associated with a lower risk of TF was the duration of viral suppression <50 copies/ml prior to baseline (ARH=0.92; 95% CI 0.85, 0.99; P=0.024, per 6 months longer) and having LPV/r as part of last cART (ARH=0.45; 95% CI 0.21, 0.95; P=0.037).
Conclusions: In daily clinical practice, we confirm a relatively safe approach of treatment simplification to LPV-MT in a selected population with long-lasting virological control.
Tipologia IRIS:
01 - Articolo su periodico
Keywords:
lopinavir-ritonavir monotherapy; HIV suppression; maintenance; therapy; risk
Elenco autori:
A. d’Arminio Monforte, N. Gianotti, A. Cozzi Lepri, C. Pinnetti, M. Andreoni, G.D. Perri, M. Galli, A. Poli, A. Costantini, G. Orofino, F. Maggiolo, G. Mazzarello, B.M. Celesia, F. Luciani, A. Lazzarin, L. Sighinolfi, G. Rizzardini, P. Bonfanti, C.F. Perno, A. Antinori, T.I.F. Cohort, A. Gori
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