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Darunavir/ritonavir & lamivudine matches triple-drug therapy
Keith Alcorn, 2016-10-31 15:00:00

Simplifying antiretroviral therapy to a two-drug combination of lamivudine plus the protease inhibitor darunavir (Prezista) boosted by ritonavir is just as effective as a three-drug regimen in people with suppressed viral load, Spanish investigators reported at the International Congress on Drug Therapy in HIV infection last week in Glasgow.

Simplifying antiretroviral therapy so that a boosted protease inhibitor or an integrase inhibitor is taken with lamivudine holds several attractions:

  • The simplified regimen may reduce the risk of toxicities potentially associated with use of a second nucleoside or nucleotide analogue: cardiovascular disease in the case of abacavir, and kidney injury or bone loss in the case of tenofovir. Lamivudine has few side-effects and is well tolerated by the vast majority of people.

  • Lamivudine does not interact with drugs used to treat other conditions, reducing the potential for problematic drug interactions between an antiretroviral regimen and other medications, which is especially important in older people with HIV.

  • The simplified regimen is less costly because lamivudine is available in a cheap generic formulation.

  • Virologic rebound after failure of the simplified regimen will not result in cross-resistance to tenofovir, so preserving this drug as a future option. Rebounding virus may also remain sensitive to abacavir, although this depends on previous treatment history.

Pilot studies presented at previous conferences have shown that regimens combining a boosted protease inhibitor (lopinavir/ritonavir) or an integrase inhibitor (dolutegravir) with lamivudine are just as effective as three-drug regimens in previously untreated people.

Studies presented earlier in the week at the International Congress on Drug Therapy in HIV Infection showed that simplified maintenance regimens in virally suppressed patients were non-inferior to three-drug treatment, both in those without any history of virologic failure and in those already taking second-line treatment.

Previous attempts to simplify therapy using monotherapy with a single boosted protease inhibitor have shown that approach to be less durable than three-drug treatment.