[Monotherapy in treatment-naïve patients]

Area of Science:

• Virology
• Pharmacology
• Immunology

Context:

• Current antiretroviral therapy (ART) for HIV has reduced mortality but has toxicity and cost concerns.
• Protease inhibitors (PI) like lopinavir/ritonavir (LPV/r) offer potential for less toxic, cost-effective monotherapy.
• Need for alternative ART strategies to improve universal access and reduce drug-related toxicities.

Purpose:

• To evaluate the efficacy and safety of lopinavir/ritonavir (LPV/r) monotherapy as an initial treatment for HIV.
• To assess the potential of LPV/r monotherapy to achieve undetectable viral loads and its impact on future treatment options.
• To explore the cost-effectiveness and feasibility of LPV/r monotherapy in the context of initial ART.

Summary:

• Studies suggest LPV/r monotherapy can achieve undetectable viral loads in a significant proportion of treatment-naïve HIV patients.
• Low likelihood of resistance mutations with LPV/r monotherapy preserves future treatment options, even if viral suppression is not achieved initially.
• Treatment intensification can suppress viral replication in patients not achieving undetectable viral loads with LPV/r monotherapy.

Impact:

• LPV/r monotherapy could offer a less toxic and more cost-effective initial ART option, improving access.
• Further large-scale, long-term studies are required to establish LPV/r monotherapy as a first-line treatment.
• Future research should focus on viral replication in PI-penetrated tissues to fully assess LPV/r monotherapy's effectiveness.