Lopinavir/ritonavir as single-drug therapy for maintenance of HlV-1 viral suppression -: 48-week results of a randomized, controlled, open-label, proof-of-concept pilot clinical trial (OK study)

Objective: This study evaluated maintenance with lopinavir/ritonavir monotherapy vs. continuing topinavir/ritonavir and 2 nucleosides in HIV-infected patients with suppressed HIV replication. Design: Randomized, controlled, open-label, multicenter, pilot clinical trial. Methods: Adult patients were eligible if they had no history of virologic failure while receiving a protease inhibitor, were receiving 2 nucleosides + lopinavir/ritonavir (400/100 mg b.i.d.) for > 1 month and had maintained serum HIV RNA < 50 copies/mL for > 6 months prior to enrollment. Results: Forty-two patients were randomly assigned 1:1 to continue or stop the nucleosides. At baseline there were no significant differences between groups in median CD4 cells/mu L (baseline or nadir), pre-HAART (highly active antiretroviral therapy) HIV log(10) viremia, or time with HIV RNA < 50 copies/mL prior to enrollment. After 48 weeks of follow-up, percentage of patients remaining at < 50 HIV RNA copies/mL (intention to treat, M = F) was 81% for the monotherapy group (95% CI: 64% to 98%) vs. 95% for the triple-therapy group (95% CI: 86% to 100%); P = 0.34. Patients in whom monotherapy failed had significantly worse adherence than patients who remained vitally suppressed on monotherapy. Monotherapy failures did not show primary resistance mutations in the protease gene and were successfully reinduced with prerandomization nucleosides. Mean change in CD4 cells/mu L: +70 (monotherapy) and +8 (triple) (P = 0.27). Mean serum fasting lipids remained stable in both groups. No serious adverse events were observed. Conclusion: Most of the patients maintained with lopinavir/ritonavir monotherapy remain with undetectable viral load after 48 weeks. Failures of lopinavir/ritonavir monotherapy were not associated with the development of primary resistance mutations in the protease gene and could be successfully reinduced adding back prior nucteosides.