Durability of lopinavir/ritonavir dual-therapies in individuals with viral load <50 copies/mL in the observational setting.

INTRODUCTION:

We aimed at evaluating the efficacy and durability of a lopinavir/ritonavir-based dual regimen (LPV/r-DR) in virologically controlled HIV-infected individuals in current clinical practice.
METHODS:

Patients who have initiated for the first time a LPV/r-DR with HIV-RNA<50 copies/mL were included in this observational study. The main endpoints were: time to virological rebound [VR=time of first of two consecutive viral loads (VL)>50 copies/mL] and time to experience either a single VL>200 copies/mL or discontinuation/intensification (= treatment failure, TF). Individuals' follow-up accrued from the date of starting the LPV/r-DR to event or last available VL. Kaplan-Meier curves and Cox regression analysis were used. Covariates included in the multivariable analysis were gender, age, route of transmission, hepatitis co-infection, calendar year of starting the DR, nadir CD4+ count, VL at initiation of first cART, previous failures to protease inhibitors (PIs), time with undetectable VL before starting the DR and the type of DR [nucleoside reverse transcriptase (NRTI), non-NRTI (NNRTI), raltegravir or maraviroc, with NRTI as reference group]. RESULTS are presented as median (Q1, Q3) or frequency (%) as appropriate.
RESULTS:

108 individuals followed for 18 (7, 30) months were included; baseline (BL) characteristics are detailed in Table 1.
CONCLUSIONS:

A LPV/r-DR can be considered a valuable option in patients with HIV-RNA<50 copies/mL and ongoing toxicity from the third drug of the regimen, although up to 17% of patients showed viral rebound by 3 years. Older patients are at lower risk of failure with this strategy, but larger sample size is needed to identify who might benefit from this strategy instead of others.