Although currently available data suffice to support the use of protease inhibitor monotherapy in selected patients, there is concern about the antiviral activity of this regimen in the long term and in viral sanctuaries, such as the central nervous system. We report a case of encephalitis related to viral escape while receiving darunavir/ritonavir monotherapy in a carefully selected patient for participation in a clinical trial.
References
1.
HeatonR.K., FranklinD.R., EllisR.J.HIV-associated neurocognitive disorders before and during the era of combination antiretroviral therapy: differences in rates, nature, and predictors.J Neurovirol2011; 17: 3–16.
2.
ArribasJ., GirardP.M., PatonN.Efficacy of PI monotherapy versus triple therapy for 1964 patients in 10 randomised trials.J Int AIDS Soc2014; 17: 19788.
ImazA., CayuelaN., NiubóJ.Short communication: focal encephalitis related to viral escape and resistance emergence in cerebrospinal fluid in a patient on lopinavir/ritonavir monotherapy with plasma HIV-1 RNA suppression.AIDS Res Hum Retroviruses2014; 30: 984–987.
6.
ValcourV., SithinamsuwanP., LetendreS., AncesB.Pathogenesis of HIV in the central nervous system.Curr HIV/AIDS Rep2011; 8: 54–61.
7.
GutmannC., CusiniA., GunthardH.F.Randomized controlled study demonstrating failure of LPV/r monotherapy in HIV: the role of compartment and CD4-nadir.AIDS2010; 24: 2347–2354.
8.
CapparelliE.V., HollandD., OkamotoC.Lopinavir concentrations in cerebrospinal fluid exceed the 50% inhibitory concentration for HIV.AIDS2005; 19: 949–952.
9.
YilmazA., IzadkhashtiA., PriceR.W.Darunavir concentrations in cerebrospinal fluid and blood in HIV-1-infected individuals.AIDS Res Hum Retroviruses2009; 25: 457–461.
10.
PatonN., StohrW., Arenas-PintoA., DunnD.The PIVOT Trial Group randomised controlled trial of a PI monotherapy switch strategy for long-term HIV management.Conference on Retroviruses and Opportunistic Infections. 3–6 March 2014, Boston, MA, USA. Abstract #550LB.
11.
Pérez-ValeroI., González-BaezaA., EstébanezM.A prospective cohort study of neurocognitive function in aviremic HIV-infected patients treated with 1 or 3 antiretrovirals.Clin Infect Dis2014; 59: 1627–1634.
12.
ClarkeA., JohanssenV., GerstoftJ.Analysis of neurocognitive function and CNS endpoints in the PROTEA trial: darunavir/ritonavir with or without nucleoside analogues.J Int AIDS Soc2014; 17: 19526.
13.
CurranA., MonteiroP., DomingoP.Effectiveness of ritonavir-boosted protease inhibitor monotherapy in the clinical setting: same results as in clinical trials? The PIMOCS Study Group.J Antimicrob Chemother2014; 69: 1390–1396.
14.
Expert Panel of GeSIDA and the National Aids Plan, BerenguerJ., PoloR.Executive summary of the GeSIDA/National AIDS Plan consensus document on antiretroviral therapy in adults infected by the human immunodeficiency virus.Enferm Infecc Microbiol Clin2014; 32: 447–458.
AntinoriA., MarcotullioS., AmmassariA.Italian Guidelines for the Use of Antiretroviral Agents and the Diagnostic-clinical Management of HIV-1 Infected Persons. (Accessed 23 November 2015.) Available from http://www.newmicrobiologica.org/pub/allegati_pdf/2011/2/109.pdf.
