Debating The Merits of Monotherapy For HIV José Arribas, MD Laurent Cotte, MD Réjean Thomas, MD

Mathis S, et al. Effectiveness of protease inhibitor monotherapy versus combination antiretroviral maintenance therapy: a meta-analysis. PLoS One. 2011;6(7):e Epub 2011 Jul 19. Risk ratios for maintaining viral suppression, intention to treat analysis, 48 week follow-up, viral suppression < 50 copies/ml

Monotherapy and Neurocognitive Impairment at CROI Positive Results Paper #479 –NCI Prevalence (wk48): 30% in mono-LPV/r vs 32% in TDF/3TC/LPV/r (p = 0.85). –NCI Incidence 6% in mono-LPV/r vs 7% in TDF/3TC/LPV/r (p = 0.85). –No significant differences in neuropsychological tests Paper #483 –Undetectable CSF Viral Load CSF for all but 3 MT patients and in 1 HAART patient (18% vs 6%, p = 0.601). –NCI observed in 7 patients on MT and 10 patients on HAART (41% vs 59%; p = 0.494). –Global Deficit Score showed differences between groups, indicating better rates in MT group (0.23 [±0.20] vs 0.46 [±0.30]; p = 0.025) Bunupuradah T. et al. Neurocognitive Impairments in Patients Using Lopinavir/ritonavir Monotherapy vs Lopinavir/ritonavir-based HAART. CROI 2012 Paper #479 Santos J., et al. Long-term Monotherapy with Lopinavir/ritonavir (>2 Years) Is Not Associated with Greater HIV-associated Neurocognitive Impairment. CROI 2012 Paper #483

Monotherapy and Neurocognitive Impairment at CROI 2012 – Negative Results Paper #480 –Higher CSF levels of S100-beta (570 ± 1132) & neopterin (2.5 ± 2.9) in monotherapy (MT) versus conventional therapy (CT) (0 ± 532, p = and 1.2 ± 2.5, p = 0.058, respectively) Du Pasquier R. et al. Rapid Increase of Astrocytic and Inflammatory Markers in the Cerebrospinal Fluid of HIV + Patients on Lopinavir/ritonavir Monotherapy. CROI 2012 Paper #480 MT CT MT CT S100-beta p=0.002 Neopterin p=0.058 MT CT MT CT S100-beta p=0.002 Neopterin p=0.058