Predictors of loss of virologic response in subjects who simplified to lopinavir/ritonavir monotherapy from lopinavir/ritonavir plus zidovudine/lamivudine

Rafael E. Campo, Barbara A. Da Silva, Laurent Cotte, Joseph C. Gathe, Brian Gazzard, Charles B. Hicks, Cheri E. Klein, Yi Lin Chiu, Martin S. King, Barry M. Bernstein

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Abstract

Previous studies have demonstrated that lopinavir/ritonavir monotherapy maintained plasma HIV-1 RNA suppression in a large proportion of antiretroviral naive subjects. However, more subjects receiving lopinavir/ ritonavir monotherapy experienced confirmed virologie rebound >50 copies/ml compared to a standard three-drug HAART regimen. In this study, we sought to determine the factors associated with maintenance of virologie suppression in subjects receiving lopinavir/ritonavir monotherapy. Antiretroviral-naive HIV-1-infected volunteers were randomized 2:1 to initiate a lopinavir/ritonavir-based combination regimen followed by simplification to lopinavir/ritonavir monotherapy or an efavirenz-based triple combination therapy and followed for 96 weeks. Potential predictors of time to loss of virologic response included baseline demographics, baseline HIV-1 RNA levels, baseline CD4 + T cell counts, adherence as determined by 4-day subject recall, duration of HIV-1 RNA <50 copies/ml prior to simplification, and lopinavir concentrations. By the Cox proportional hazards model, higher reported adherence levels and higher baseline CD4 + T cell counts were associated with a greater likelihood of maintaining virologie suppression while receiving lopinavir/ritonavir monotherapy. Lopinavir concentrations, including trough concentrations, were not significantly associated with virologic outcomes. This analysis suggests that adherence and higher baseline CD4 + T cell counts may help to predict who will sustain virologic suppression with lopinavir/ritonavir monotherapy. The data also suggest that measuring lopinavir concentrations is not useful in predicting virologic response in these patients.

Original languageEnglish (US)
Pages (from-to)269-275
Number of pages7
JournalAIDS research and human retroviruses
Volume25
Issue number3
DOIs
StatePublished - Mar 1 2009

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ASJC Scopus subject areas

  • Immunology
  • Virology
  • Infectious Diseases

Cite this

Campo, R. E., Da Silva, B. A., Cotte, L., Gathe, J. C., Gazzard, B., Hicks, C. B., Klein, C. E., Chiu, Y. L., King, M. S., & Bernstein, B. M. (2009). Predictors of loss of virologic response in subjects who simplified to lopinavir/ritonavir monotherapy from lopinavir/ritonavir plus zidovudine/lamivudine. AIDS research and human retroviruses, 25(3), 269-275. https://doi.org/10.1089/aid.2008.0217