Absence of HIV-1 shedding in male genital tract after 1 year of first-line lopinavir/ritonavir alone or in combination with zidovudine/lamivudine

• Published in: Journal of antimicrobial chemotherapy 2008-06, Vol.61 (6), p.1344-1347
• Main Authors: Ghosn, Jade, Chaix, Marie-Laure, Peytavin, Gilles, Bresson, Jean-Louis, Galimand, Julie, Girard, Pierre-Marie, Raffi, François, Cohen-Codar, Isabelle, Delfraissy, Jean-François, Rouzioux, Christine
• Format: Article
• Language: English
• Subjects: Anti-HIV Agents - therapeutic use; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antiretroviral drugs; Biological and medical sciences; Chromatography, High Pressure Liquid; compartmentalization; Drug Therapy, Combination; Effectiveness; Genitalia, Male - virology; HIV; HIV Infections - drug therapy; HIV Infections - virology; HIV-1 - isolation & purification; Human immunodeficiency virus; Human immunodeficiency virus 1; Human viral diseases; Humans; Immunodeficiencies; Immunodeficiencies. Immunoglobulinopathies; Immunopathology; Infectious diseases; Lamivudine - therapeutic use; Longitudinal Studies; Lopinavir; Male; Medical sciences; Mens health; Pharmacology. Drug treatments; Plasma - chemistry; Plasma - virology; protease inhibitor; Protease inhibitors; Pyrimidinones - pharmacokinetics; Pyrimidinones - therapeutic use; Reproductive system; Ritonavir - pharmacokinetics; Ritonavir - therapeutic use; RNA, Viral - isolation & purification; sanctuary site; semen; Semen - chemistry; Semen - virology; Time Factors; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Virology; Virus Shedding - drug effects; Zidovudine - therapeutic use
• ISSN: 0305-7453; 1460-2091
• DOI: 10.1093/jac/dkn098

Background New strategies such as boosted-protease inhibitor (PI) monotherapy are being investigated. However, a concern remains regarding the efficacy of this strategy in viral sanctuaries such as the male genital tract. More than 80% of untreated HIV-infected men have detectable HIV-RNA in semen and such a strategy could favour local selection of resistant variants, given the poor penetration of most PIs in semen. Objectives To evaluate the impact of a first-line lopinavir/ritonavir alone or standard triple combination on HIV-1 shedding in the genital tract. Methods HIV-1-infected men enrolled in the Monark randomized trial were eligible for the present study after 48 weeks of a first-line lopinavir/ritonavir alone or in combination with zidovudine and lamivudine. Single-paired samples of blood and semen were collected at week 48. Blood plasma HIV-RNA and seminal plasma HIV-RNA were measured at week 48. Lopinavir and ritonavir concentrations were measured in blood and in semen at week 48 by high-performance liquid chromatography. Results Ten patients were included: five of them received lopinavir/ritonavir monotherapy and five received a triple combination. At week 48, all patients had blood plasma HIV-RNA