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Author Topic: Monotherapy with ritonavir-boosted PI is a viable option  (Read 1012 times)

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Offline Grasshopper

  • Member
  • Posts: 451
Monotherapy with ritonavir-boosted PI is a viable option
« on: October 25, 2010, 09:37:34 AM »
Wouter Bierman is doing his dissertation tomorrow at the VU Amsterdam University with the results of this study.

The study: http://protectenews.com/doc/IIconvegnoLetturaMagistrale/Monotherapy-Review.pdf

"Objective: To assess the efficacy of ritonavir-boosted protease inhibitor monotherapy.
Design and methods: Systematic review of all protease inhibitor-monotherapy studies
published in peer-reviewed journals or presented at conferences to date. Data of
randomized controlled trials were pooled to yield common odds ratios.
Results: Twenty-two protease inhibitor-monotherapy studies were identified. In the
intent-to-treat analysis, 395 out of 582 (67.9%) patients had undetectable HIV-RNA at
the end of follow-up. In the six randomized controlled trials (all lopinavir/ritonavir
monotherapy), the risk of therapy failure was greater on monotherapy: 121 out of 364
(33.2%) patients on monotherapy against 64 out of 280 (22.9%) patients on HAART
[pooled odds ratio 1.48 (95% confidence interval 1.022.13, P0.037)]. Regarding
patients with successfully resuppressed HIV-RNA upon (re-)introducing nucleoside
reverse transcriptase inhibitors (NRTIs) as nonfailures, the risk of therapy failure was
comparable: 98 out of 364 (26.9%) against 64 out of 280 (22.9%) patients [odds ratio
1.05 (95% confidence interval 0.721.53, P0.81)].
Conclusion: The overall efficacy of ritonavir-boosted protease inhibitor monotherapy is
inferior to HAART. The efficacy improves in patients started on monotherapy after
suppressed HIV-RNA for at least 6 months. Ten percent of patients have viral rebound
with HIV-RNA levels between 50 and 500 copies/ml. Possible explanations are lack of
HIV suppression in particular cells or compartments, alternative resistance mechanisms,
and nonadherence. Once proven that reintroduction of NRTIs, in patients with
loss of viral suppression, is safe and effective, a broader use of simplification of HAART
to protease inhibitor monotherapy might be justified. This review supports that the
majority of patients with prolonged viral suppression on HAART can successfully be
treated with protease inhibitor monotherapy. Arguments for this strategy are NRTI/
NNRTI side effects, NRTI/NNRTI resistance, and costs."

Offline eric48

  • Member
  • Posts: 1,136
  • @HIVPharmaCure & tinyurl.com/HIVPharmaCure
Re: Monotherapy with ritonavir-boosted PI is a viable option
« Reply #1 on: October 25, 2010, 05:12:41 PM »
Hi,

I have seen quite a bit of research in this field especially in cost concious areas (india...)

Theoretically seems a viable project, and I would think, more as a maintenance therapy once you have been undetectable for a while

Also interesting for lipids/sugar disorder management

Cheers Eric
NVP/ABC/3TC/... UD; CD4 > 1000; CD4/CD8 ~ 2.0

Offline surf18

  • Member
  • Posts: 525
Re: Monotherapy with ritonavir-boosted PI is a viable option
« Reply #2 on: October 25, 2010, 07:19:20 PM »
I thought pi's were bad on lipid profile and bad lipo sideeffects?
If that's the case who would want this.

Offline Assurbanipal

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  • Posts: 2,173
  • Taking a forums break, still see PM's
Re: Monotherapy with ritonavir-boosted PI is a viable option
« Reply #3 on: October 26, 2010, 11:51:34 AM »
I thought pi's were bad on lipid profile and bad lipo sideeffects?
If that's the case who would want this.

People have different reactions to the drugs.  Some people have lipid profile problems with PI's; some do not

And NRTi's often have unfavorable long term side effects (bone health, kidneys, heart...)  So a study on monotherapy is interesting as a way of refining treatment to reduce side effects for a subset of people on medication as well as to reduce the cost of treatment.
5/06 VL 1M+, CD4 22, 5% , pneumonia, thrush -- O2 support 2 months, 6/06 +Kaletra/Truvada
9/06 VL 3959 CD4 297 13.5% 12/06 VL <400 CD4 350 15.2% +Pravachol
2007 VL<400, 70, 50 CD4 408-729 16.0% -19.7%
2008 VL UD CD4 468 - 538 16.7% - 24.6% Osteoporosis 11/08 doubled Pravachol, +Calcium/D
02/09 VL 100 CD4 616 23.7% 03/09 VL 130 5/09 VL 100 CD4 540 28.4% +Actonel (osteoporosis) 7/09 VL 130
8/09  new regimen Isentress/Epzicom 9/09 VL UD CD4 621 32.7% 11/09 VL UD CD4 607 26.4% swap Isentress for Prezista/Norvir 12/09 (liver and muscle issues) VL 50
2010 VL UD CD4 573-680 26.1% - 30.9% 12/10 VL 20
2011 VL UD-20 CD4 568-673 24.7%-30.6%
2012 VL UD swap Prezista/Norvir for Reyataz drop statin CD4 768-828 26.7%-30.7%

Offline surf18

  • Member
  • Posts: 525
Re: Monotherapy with ritonavir-boosted PI is a viable option
« Reply #4 on: October 26, 2010, 12:30:34 PM »
So confusuing!
So is selzenyry or truvada nrti's?

Offline Assurbanipal

  • Member
  • Posts: 2,173
  • Taking a forums break, still see PM's
Re: Monotherapy with ritonavir-boosted PI is a viable option
« Reply #5 on: October 26, 2010, 12:35:05 PM »
So confusuing!
So is selzenyry or truvada nrti's?


The site has some good tools to help navigate through all the different terms.  The handy drug list is a great one http://www.aidsmeds.com/list.shtml

Truvada, Combivir, Epzicom are all two-NRTI combinations.  Selzentry is in a different drug class.
5/06 VL 1M+, CD4 22, 5% , pneumonia, thrush -- O2 support 2 months, 6/06 +Kaletra/Truvada
9/06 VL 3959 CD4 297 13.5% 12/06 VL <400 CD4 350 15.2% +Pravachol
2007 VL<400, 70, 50 CD4 408-729 16.0% -19.7%
2008 VL UD CD4 468 - 538 16.7% - 24.6% Osteoporosis 11/08 doubled Pravachol, +Calcium/D
02/09 VL 100 CD4 616 23.7% 03/09 VL 130 5/09 VL 100 CD4 540 28.4% +Actonel (osteoporosis) 7/09 VL 130
8/09  new regimen Isentress/Epzicom 9/09 VL UD CD4 621 32.7% 11/09 VL UD CD4 607 26.4% swap Isentress for Prezista/Norvir 12/09 (liver and muscle issues) VL 50
2010 VL UD CD4 573-680 26.1% - 30.9% 12/10 VL 20
2011 VL UD-20 CD4 568-673 24.7%-30.6%
2012 VL UD swap Prezista/Norvir for Reyataz drop statin CD4 768-828 26.7%-30.7%

 


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