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