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Boosted protease inhibitor monotherapy as a maintenance strategy: an observational study
Marguerite Guiguet1, Jade Ghosn, Claudine Duvivier
1INSERM, U, Paris, France. marguerite.guiguet@inserm.fr
AIDS (London, England)
|June 15, 2012
Summary
Boosted protease inhibitor monotherapy (BPIMT) is effective for HIV treatment maintenance. Longer durations of viral suppression before switching to BPIMT reduce the risk of treatment failure.
Area of Science:
- Infectious Diseases
- Virology
- Clinical Pharmacology
Background:
- Antiretroviral therapy (ART) is crucial for managing HIV infection.
- Maintenance strategies aim to simplify treatment regimens while maintaining viral suppression.
- Boosted protease inhibitor monotherapy (BPIMT) is a potential simplification strategy.
Purpose of the Study:
- To evaluate the effectiveness of BPIMT as a maintenance strategy in routine HIV care.
- To identify factors predicting virological and treatment failure in patients on BPIMT.
Main Methods:
- Observational study of 529 virologically suppressed individuals switched to BPIMT (2006-2010).
- Analysis of virological failure (HIV-RNA > 50 copies/ml) and treatment failure (including reintensification or death).
- Assessment of baseline characteristics and duration of viral suppression as predictive factors.
Main Results:
- BPIMT effectiveness in routine care mirrored randomized clinical trial findings.
- A history of virological failure on previous regimens increased failure risk (aHR, 1.6).
- Longer duration of sustained viral suppression before switching to BPIMT significantly decreased subsequent failure risk (HR, 0.6 for ≥24 months).
- Failure rates were similar for lopinavir/ritonavir and darunavir/ritonavir but higher for atazanavir/ritonavir.
Conclusions:
- BPIMT is a safe and effective maintenance strategy in routine HIV care.
- Sustained virological suppression for at least 24 months prior to switching to BPIMT is associated with a lower risk of failure.
- Specific boosted protease inhibitors may have different failure rates.
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