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Logo of aidsrestherBioMed CentralBiomed Central Web Sitesearchsubmit a manuscriptregisterthis articleAIDS Research and Therapy
 
AIDS Res Ther. 2012; 9: 8.
Published online Mar 13, 2012. doi:  10.1186/1742-6405-9-8
PMCID: PMC3317876
Long-term treatment outcomes of ritonavir-boosted lopinavir monotherapy among HIV-infected patients who experienced NRTI and NNRTI failure
Weerawat Manosuthi,corresponding author1 Supeda Thongyen,1 Samruay Nilkamhang,1 Sukanya Manosuthi,1 and Somnuek Sungkanuparph2
1Bamrasnaradura Infectious Diseases Institute, Ministry of Public Health, Nonthaburi 11000, Thailand
2Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
corresponding authorCorresponding author.
Weerawat Manosuthi: drweerawat/at/hotmail.com; Supeda Thongyen: supeda_t/at/yahoo.com; Samruay Nilkamhang: samruay-nil/at/hotmail.com; Sukanya Manosuthi: skychimsuntorn/at/yahoo.com; Somnuek Sungkanuparph: ssungkanuparph/at/yahoo.com
Received December 21, 2011; Accepted March 13, 2012.
Abstract
Background
We continue the previously described prospective cohort study of ritonovir-boosted lopinavir (LPV/r) monotherapy for second-line therapy in HIV-infected patients with prior failure and extensive resistance to nucleoside reverse transcriptase inhibitors (NRTIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs), with the objective being to determine the three-year treatment responses.
Findings
There were 40 patients with a mean ± SD age of 37 ± 8 years. Median (IQR) baseline CD4 was 123 (37-245) cells/mm3 and median (IQR) HIV-1 RNA was 55,800 (9,670-100,000) copies/mL. All patients received twice daily LPV/r 400/100 mg and recycled lamivudine 150 mg. By intend-to-treat analysis at 144 weeks, 26 (65%) and 22 (56%) patients achieved HIV-1 RNA at < 400 and < 50 copies/mL, respectively. In as-treated analysis, the corresponding rates were 26 of 28 (93%) and 22 of 28 (78%), respectively. Low-level viral rebound (HIV-1 RNA 50-400 copies/mL) was found in 6 (15%), 6 (15%), and 4 (10%) patients at week 48, 96 and week 144, respectively. Medians CD4 at week 48, 96, and 144 were 351, 481, and 584 cells/mm3 and significantly changed from baseline (all, P < 0.05). There were increments of mean triglycerides at 48 weeks and 144 weeks from baseline (P < 0.05). No major protease resistance-associated mutations emerged after virologic failure.
Conclusion
LPV/r monotherapy with recycled lamivudine can maintain long-term virologic suppression in a relatively small proportion of patients failing NNRTI-based regimen and having limit option for active NRTI. More antiretroviral classes are needed be accessible in resource-limited countries.
Keywords: HIV, Lopinavir, Monotherapy, Lamivudine, Resistance, Thailand
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