12th Annual Conference of the British HIV Association 29 March–1 April 2006, Brighton, UK

KALETRA MONOTHERAPY – A REAL-LIFE EXPERIENCE

HIV Med 2006; 7(Suppl. 1):13 (abstract no. P9)

Laura Waters, Steve Balbeck, Brian Gazzard and Mark Nelson
Chelsea and Westminster Hospital, London, UK

AIMS: Despite limited evidence, dual and single protease-inhibitor (PI) regimens are used increasingly in experienced subjects. We present our experience of boosted lopinavir monotherapy (mLPV/r) outside a clinical trial setting.

METHODS: We identified all mLPV/r prescriptions up to September 2005 from a prospectively collected database. Baseline data including treatment history, resistance, CD4 count and viral load (VL) were collected. CD4 and VL changes over a 12-month period were analysed.

RESULTS: 35 patients prescribed mLPV/r were identified; mean CD4 count and VL at switch were 248 cells/µl and 54866 copies/ml, respectively and subjects had had a median of 5 previous drug regimens. Two switched for toxicity, five were lost to follow-up. 14/28 (50%) achieved VL <50 copies/ml and 73% a >1 log₁₀ reduction. Mean CD4 rise was 115 and 73 cells/µl in the undetectable and viraemic groups respectively. Five patients with major PI mutations at baseline were identified and three experienced satisfactory responses (CD4 increase; two undetectable, 1 <400 copies/ml). 10 had genotyping on mLPV/r; two exhibited new minor mutations. In total, 8/28 subjects switched therapy (three virological failure, two for blips, one immunological failure and two unclear reasons) and 20 remain on mLPV/r; 12/20, 60% are undetectable after a mean of 13.5 months (range 3–34).

CONCLUSION: In our series of drug-experienced individuals mLPV/r was associated with improved immunological parameters regardless of virological response. 50% achieved an undetectable (<50 copies/ml) VL and 73% a greater than 1 log₁₀ reduction. As most subjects switched to mLPV/r for poor compliance these data support this strategy for poorly adherent drug-experienced patients.

2006-03-29
P9

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