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Abstract
Darunavir/ritonavir monotherapy maintains HIV suppression in most patients who have achieved an undetectable viral load on combination antiretroviral treatment, and is increasingly used in the clinic. However, concerns have been raised about the effectiveness of ritonavir-boosted protease inhibitor (PI/r) monotherapy in the prevention of HIV replication in the central nervous system (CNS). Here we report the cases of 2 patients on darunavir/r maintenance monotherapy with cerebrospinal fluid viral breakthrough together with increased immunoactivation and biomarker signs of neuronal injury. These 2 cases raise concerns about the effectiveness of darunavir/ritonavir monotherapy in HIV CNS infection. Thus, we recommend caution with protease inhibitor monotherapy until CNS results have been obtained from clinical studies.
Declaration of interest: This work was supported by the Swedish Research Council (K2008-58P-20930-04-1, K2008-58X-20931-01-1, K2010-63P-21562-01-4, and K2011-61X-20401-05-6) and the Sahlgrenska Academy at the University of Gothenburg (ALFGBG-141741 and ALFGBG-144341). MG has received lecture fees from and/or participated on scientific advisory boards for Abbott, Boehringer-Ingelheim, Bristol-Myers Squibb, Gilead Sciences, GlaxoSmithKline, Jansen/Tibotec, Merck, and Pfizer. LH has received lecture fees from Abbott and Roche and has participated on scientific advisory boards for Pfizer and Meda. BS has received research grants from Chrontech Pharma (former Tripep AB) and GlaxoSmithKline.
DF and HZ declare no competing interests.