Lopinavir/ritonavir monotherapy after virologic failure of first-line antiretroviral therapy in resource-limited settings.
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2012-07-17
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OBJECTIVE: To evaluate virologic response rates of lopinavir/ritonavir (LPV/r) monotherapy as second-line antiretroviral treatment (ART) among adults in resource-limited settings (RLSs). DESIGN: An open-label pilot study of LPV/r monotherapy in participants on first-line nonnucleoside reverse transcriptase inhibitor three-drug combination ART with plasma HIV-1 RNA 1000-200 000 copies/ml. METHODS: Participants were recruited from five sites in Africa and Asia within the AIDS Clinical Trials Group (ACTG) network. All participants received LPV/r 400/100 mg twice daily. The primary endpoint was remaining on LPV/r monotherapy without virologic failure at week 24. Participants with virologic failure were offered addition of emtricitabine and tenofovir (FTC/TDF) to LPV/r. RESULTS: Mutations associated with drug resistance were encountered in nearly all individuals screened for the study. One hundred and twenty-three participants were enrolled, and 122 completed 24 weeks on study. A high proportion remained on LPV/r monotherapy without virologic failure at 24 weeks (87%). Archived samples with HIV-1 RNA levels less than 400 copies/ml at week 24 (n=102) underwent ultrasensitive assay. Of these individuals, 62 had levels less than 40 copies/ml and 30 had levels 40-200 copies/ml. Fifteen individuals experienced virologic failure, among whom 11 had resistance assessed and two had emergent protease inhibitor mutations. Thirteen individuals with virologic failure added FTC/TDF and one individual added FTC/TDF without virologic failure. At study week 48, 11 of 14 adding FTC/TDF had HIV-1 RNA levels less than 400 copies/ml. CONCLUSION: In this pilot study conducted in diverse RLS, LPV/r monotherapy as second-line ART demonstrated promising activity.
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Bartlett, John A, Heather J Ribaudo, Carole L Wallis, Evgenia Aga, David A Katzenstein, Wendy S Stevens, Michael R Norton, Karin L Klingman, et al. (2012). Lopinavir/ritonavir monotherapy after virologic failure of first-line antiretroviral therapy in resource-limited settings. AIDS, 26(11). pp. 1345–1354. 10.1097/QAD.0b013e328353b066 Retrieved from https://hdl.handle.net/10161/13791.
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John Alexander Bartlett
My clinical investigation is focused on the pathogenesis and treatment of HIV infection and its complications, especially in resource-limited settings.
Key Words: HIV infection, AIDS, treatment strategies, treatment failure, co-infections, resource-limited settings
John Andrew Crump
I am an Adjunct Professor of Medicine, Pathology, and Global Health. My work with Duke University is primarily based in northern Tanzania where I am former Site Leader and current Principal Investigator on projects linked to Duke University’s collaborative research program at Kilimanjaro Christian Medical Centre. I oversee the design and implementation of research studies on infectious diseases, particularly febrile illness, invasive bacterial disease, zoonotic infections, and infectious diseases diagnostics. In addition, I am Professor of Medicine, Pathology, and Global Health at the University of Otago and a medical epidemiologist with the US Centers for Disease Control and Prevention (CDC). My CDC work focuses on non-malaria febrile illness.
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