Impact of 48 week lopinavir/ritonavir monotherapy on blood cell-associated HIV-1-DNA in the MONARK trial

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OBJECTIVES: To study the impact of protease inhibitor monotherapy on the HIV-1 blood reservoir in 72 antiretroviral-naive patients. PATIENTS AND METHODS: This was evaluated for 72 antiretroviral-naive patients included in the on-treatment analysis of the MONARK trial; 46 patients receiving lopinavir/ritonavir monotherapy and 26 patients receiving a triple therapy. HIV-DNA was quantified in whole blood, using real-time PCR. RESULTS: The decrease in HIV-DNA after 48 weeks of lopinavir/ritonavir monotherapy was similar to the decrease observed with triple therapy including lopinavir/ritonavir (-0.77 versus -0.69 log copies/10(6) leucocytes, respectively; P = 0.91). The HIV-DNA decrease was also similar in patients with a virological response in both arms (-0.69 versus -0.69 log copies/10(6) leucocytes, respectively). Interestingly, non-responders had a significantly higher baseline HIV-DNA load than responders in the monotherapy arm; 3.16 versus 2.86 log copies/10(6) leucocytes, respectively (P = 0.05). CONCLUSIONS: The MONARK data indicate that a lopinavir/ritonavir monotherapy regimen is potent against HIV blood reservoirs in antiretroviral-naive patients after 1 year of treatment, in comparison with a standard-of-care highly active antiretroviral therapy. This impact should be evaluated with other boosted protease inhibitor monotherapies.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.