Important note: Information in this article was accurate in June 2007. The state of the art may have changed since the publication date.
Higher risk of resistance using lopinavir/r monotherapy
HIV Treatment Bulletin - Vol. 8, No. 6/7, June-July 2007
Simon Collins, HIV i-Base
In the last presentation at the workshop, Constance Delaugerre presented an analysis of resistance results from the MONARK trial (Kaltera monotherapy).
In the study, 136 treatment naïve patients were randomised to either lopinavir/r monotherapy (n=83) or lopinavir/r + AZT/3TC (n-53). Baseline genotypes were available for 131 patients, 36% of which were non-B (CRF02 was most common).
As previously reported, low level viremia occured significantly more frequently in patients on lopinavir/r monotherapy arm. This was to a level that required genotyping in 32/83 and 7/53 of the monotherapy and triple therapy arms respectively.
18/32 monotherapy sequences showed protease changes compared to baseline, including 5/18 with major PI-associated mutations: 46I+63P at week 40, 76V at week 44. 13V+46I+76V at week 62, 10F+82A at week 76, and 76V at week 90.
These changes were detected at low levels of viremia, with latest median viral load (within 4 weeks of the test) of 2.9 logs (2.8-3.1). There was no relationship between baseline viral load and risk of viral rebound or of particular mutations. However, all patients who developed 76V had CRF02 virus.
Mean fold change in sensitivity to lopinavir in 4/5 samples available for phenotyping showed mean increase in IC50 of 1.64-fold (1.13 – 2.69).
4/7 patients in the triple therapy arm showed changes in protease but none of these included major PI mutations.
All patients who developed major PI mutations added AZT+3TC and resuppressed virus. It will be important to know whether these patients maintain suppression in the long-term.
2007-06-10
IB070806-10
©2007. I-BASE HIV Treatment Bulletin. Permission to reproduce courtesy of HIV i-Base, Third Floor East, Thrale House, 44-46 Southwark Street, London SE1 1UN - T: +44 (0) 20 7407 8488 F: +44 (0) 20 7407 8489
AEGiS is a 501(c)3, not-for-profit, tax-exempt, educational corporation. AEGiS is made possible through unrestricted grants from Boehringer Ingelheim, Bridgestone/Firestone Charitable Trust, Bristol-Myers Squibb Company, Elton John AIDS Foundation, the National Library of Medicine, and donations from users like you. Always watch for outdated information. This article first appeared in 2007. This material is designed to support, not replace, the relationship that exists between you and your doctor.
AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.
Copyright ©1980, 2007. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content.