Durability of lopinavir/ritonavir dual-therapies in individuals with viral load <50 copies/mL in the observational setting.
BACKGROUND
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.
Infectious Diseases, San Raffaele Scientific Institute, Milano, Italy.
Nicola
N
Gianotti
Infection and Population Health, UCL Medical School, London, UK.
Alessandro
A
Cozzi-Lepri
Infectious Diseases, National Institute for Infectious Diseases "L. Spallanzani", Roma, Italy.
Andrea
A
Antinori
Infectious Diseases Unit, University of Genoa, Genova, Italy.
Antonio
A
Di Biagio
Niguarda Ca' Granda Hospital, Institute of infectious Diseases, Milano, Italy.
Maria Cristina
MC
Moioli
Infectious Diseases, San Raffaele Scientific Institute, Milano, Italy.
Silvia
S
Nozza
Infectious Diseases, Department of Public Health, Catholic University, Roma, Italy.
Antonella
A
Cingolani
Infectious Diseases Unit, Siena University Hospital, Siena, Italy.
Andrea
A
De Luca
Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy.
Giordano
G
Madeddu
Infectious Diseases Unit, Department of Medical Sciences, University of Torino, Torino, Italy.
Stefano
S
Bonora
Department of Experimental Medicine, University of Rome Tor Vergata, Roma, Italy.
Francesca
F
Ceccherini-Silberstein
Clinic of Infectious and Tropical Diseases, San Paolo University Hospital Milan, Milano, Italy.
Antonella d'Arminio
Ad
Monforte