Failure on First-Line Lopinavir/r Monotherapy: High Rates of PI Resistance

Results from the MONARK trial do not support lopinavir/r monotherapy as first-line treatment for HIV infection, because it was both less effective and more likely to cause major PI resistance than triple therapy with lopinavir/r, AZT, and 3TC.

One of the advantages of boosted PI–based antiretroviral therapy is the high barrier to resistance. Comparing boosted PI monotherapy with combination therapy for initial treatment of HIV-infected patients can elucidate the potential contribution of additional antiretroviral drugs to the resistance barrier.

In the MONARK trial (JW AIDS Clin Care Mar 24 2008), treatment-naive patients with viral loads <100,000 copies/mL and CD4 counts >100 cells/mm³ were randomized to receive lopinavir/ritonavir alone (83 participants) or in combination with AZT/3TC (53 participants). The primary endpoint — viral load <400 copies/mL at week 24 and <50 copies/mL at week 48 — was achieved by 64% of the monotherapy group and by 75% of the triple-therapy group, a …

Reviewing Author

Keith Henry, MD

Disclosures

Consultant/Advisory BoardViiV Advisory Board

Editorial BoardsJAIDS: Journal of Acquired Immune Deficiency Syndromes

Keith Henry, MD

Disclosures

Consultant/Advisory BoardViiV Advisory Board

Editorial BoardsJAIDS: Journal of Acquired Immune Deficiency Syndromes

Failure on First-Line Lopinavir/r Monotherapy: High Rates of PI Resistance

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Reviewing Author