The level of persistent HIV viremia does not increase after successful simplification of maintenance therapy to lopinavir/ritonavir alone

AIDS. 2006 Nov 28;20(18):2331-5. doi: 10.1097/QAD.0b013e32801189f6.

Abstract

Objective: To determine whether the level of persistent HIV-1 viremia is affected by simplifying standard antiretroviral therapy to lopinavir/ritonavir (LPV/r) alone.

Design: Measurement of HIV-1 RNA levels < 50 copies/ml in longitudinal plasma samples from 41 of 42 subjects enrolled in the 'Only Kaletra' study that compared maintenance therapy with LPV/r alone to standard of care (SOC) with two nucleoside reverse transcriptase inhibitors (NRTI) and LPV/r.

Methods: Plasma samples for each subject from study screening to week 48 were tested using a modified Roche Amplicor HIV-1 RNA assay with a quantification limit of 3 copies/ml.

Results: Median plasma HIV-1 RNA values at baseline and weeks 4, 8, 12, 24 and 48 were not significantly different between the LPV/r alone and the SOC arms, being 5.1 versus 3.0 (P = 0.29), 4.5 versus 2.9 (P = 0.44), 3.3 versus 2.9 (P = 0.99), 1.9 versus 1.0 (P = 0.68), 3.7 versus 3.6 (P = 0.49), and 2.8 versus 1.6 copies/ml (P = 0.78), respectively. In the 17 of 21 subjects who maintained virus suppression < 50 copies/ml on LPV/r alone, median HIV-1 RNA values did not increase significantly from baseline at any time point after discontinuing NRTI, in comparison to the three subjects with virologic failure whose median HIV-1 RNA levels began to rise at week 8.

Conclusions: The level of persistent viremia did not increase after stopping NRTI therapy among subjects who maintained virus suppression < 50 copies/ml on LPV/r alone through 48 weeks. This supports further studies of induction-simplification therapy for treatment of HIV-1 infection including the identification of factors predicting success or failure of simplified therapy.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Drug Resistance, Viral
  • Drug Therapy, Combination
  • HIV Infections / blood
  • HIV Infections / drug therapy*
  • HIV Protease Inhibitors / therapeutic use*
  • HIV-1*
  • Humans
  • Longitudinal Studies
  • Lopinavir
  • Pyrimidinones / therapeutic use*
  • RNA, Viral / blood
  • Reverse Transcriptase Inhibitors / therapeutic use
  • Ritonavir / therapeutic use*
  • Treatment Failure
  • Viral Load
  • Viremia / drug therapy

Substances

  • HIV Protease Inhibitors
  • Pyrimidinones
  • RNA, Viral
  • Reverse Transcriptase Inhibitors
  • Lopinavir
  • Ritonavir