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Open Access Review

Boosted protease inhibitor monotherapy in HIV-infected adults: outputs from a pan-European expert panel meeting

José R Arribas1*, Manuela Doroana2, Dan Turner3, Linos Vandekerckhove4, Adrian Streinu-Cercel5 and on behalf of the panel members

Author Affiliations

1 Consulta Medicina Interna 2, Hospital La Paz, IdiPAZ, Paseo de la Castellana 261, Madrid, 28046, Spain

2 Serviço de Doenças Infecciosas, Hospital de Santa Maria, Av Prof Egas Moniz, Lisbon, 1649-035, Portugal

3 Infectious Diseases Unit, Tel-Aviv Sourasky Medical Center, 6 Weizmann Street, Tel-Aviv, 64239, Israel

4 AIDS Reference Centre, Ghent University Hospital, De Pintelaan 185, Ghent, 9000, Belgium

5 HIV/AIDS Academy, Str Dr Calistrat Grozovici, Nr 1, Bucharest, 021105, Romania

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AIDS Research and Therapy 2013, 10:3  doi:10.1186/1742-6405-10-3

Published: 24 January 2013

Abstract

While the introduction of combination highly active antiretroviral therapy (HAART) regimens represents an important advance in the management of human immunodeficiency virus (HIV)-infected patients, tolerability can be an issue and the use of several different agents may produce problems. The switch of combination HAART to ritonavir-boosted protease inhibitor (PI) monotherapy may offer the opportunity to maintain antiviral efficacy while reducing treatment complexity and the risks of toxicity. Current European AIDS Clinical Society (EACS) guidelines recognise ritonavir-boosted PI monotherapy with twice-daily lopinavir/ritonavir or once-daily darunavir/ritonavir as a possible option in patients who have intolerance to nucleoside reverse transcriptase inhibitors, or for treatment simplification. Clinical trials data for PI boosted monotherapy are encouraging, showing substantial efficacy in the majority of patients; however, further data are required before this approach can be recommended as a routine treatment. Available data indicate that the most suitable candidates for the use of boosted PI monotherapy are long-term virologically suppressed patients who have demonstrated good adherence to antiretroviral therapy, who do not have chronic hepatitis B, have no history of treatment failure on PIs and are able to tolerate low-dose ritonavir.