Debating The Merits of Monotherapy For HIV, with Dr. José Arribas, Dr. Laurent Cotte and Dr....
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The need to switch patients from combination antiretroviral therapy (cART) to HIV monotherapy may become less urgent as newer, less toxic cART regimens are developed; however, there will likely continue to be concerns about toxicity from long term use of HIV medications. Following a formal presentation about HIV monotherapy from Dr. José Arribas, this panel brings in Drs. Laurent Cotte and Réjean Thomas to continue the discussion. They review concerns about the safety of returning to cART after a monotherapy regimens, the efficacy of monotherapy, and potential problems with resistance before transitioning into a discussion of some of the systemic barriers that work against switching patients to monotherapy – such as why multi-drug regimens are the clinical default. Finally, the doctors share their concerns about aging patients with HIV and, in particular, the potential for neurocognitive impairment with decades long use of cART.
Transcript of Debating The Merits of Monotherapy For HIV, with Dr. José Arribas, Dr. Laurent Cotte and Dr....
Debating The Merits of Monotherapy For HIV
José Arribas, MD Laurent Cotte, MD
Réjean Thomas, MD
Mathis S, et al. Effectiveness of protease inhibitor monotherapy versus combination antiretroviral maintenance therapy: a meta-analysis. PLoS One. 2011;6(7):e22003. Epub 2011 Jul 19.
Risk ratios for maintaining viral suppression, intention to treat analysis, 48 week follow-up, viral suppression < 50 copies/ml
Monotherapy and Neurocognitive Impairment at CROI 2012 - Positive Results
• Paper #479 – NCI Prevalence (wk48):
• 30% in mono-LPV/r vs 32% in TDF/3TC/LPV/r (p = 0.85).
– NCI Incidence • 6% in mono-LPV/r vs 7% in
TDF/3TC/LPV/r (p = 0.85). – No significant differences in
neuropsychological tests
• Paper #483 – Undetectable CSF Viral Load CSF
for all but 3 MT patients and in 1 HAART patient (18% vs 6%, p = 0.601).
– NCI observed in 7 patients on MT and 10 patients on HAART (41% vs 59%; p = 0.494).
– Global Deficit Score showed differences between groups, indicating better rates in MT group (0.23 [±0.20] vs 0.46 [±0.30]; p = 0.025)
Bunupuradah T. et al. Neurocognitive Impairments in Patients Using Lopinavir/ritonavir Monotherapy vs Lopinavir/ritonavir-based HAART. CROI 2012 Paper #479 Santos J., et al. Long-term Monotherapy with Lopinavir/ritonavir (>2 Years) Is Not Associated with Greater HIV-associated Neurocognitive Impairment. CROI 2012 Paper #483
Monotherapy and Neurocognitive Impairment at CROI 2012 – Negative Results
• Paper #480 – Higher CSF levels of S100-beta (570 ± 1132) & neopterin (2.5 ± 2.9)
in monotherapy (MT) versus conventional therapy (CT) (0 ± 532, p = 0.002 and 1.2 ± 2.5, p = 0.058, respectively)
Du Pasquier R. et al. Rapid Increase of Astrocytic and Inflammatory Markers in the Cerebrospinal Fluid of HIV+ Patients on Lopinavir/ritonavir Monotherapy. CROI 2012 Paper #480
MT CT MT CT
S100-‐beta p=0.002
Neopterin p=0.058
MT CT MT CT
S100-‐beta p=0.002
Neopterin p=0.058
