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Cerebrospinal fluid viral breakthrough in two HIV-infected subjects on darunavir/ritonavir monotherapy.

Journal article
Authors Magnus Gisslén
Dietmar Fuchs
Lars Hagberg
Bo Svennerholm
Henrik Zetterberg
Published in Scandinavian journal of infectious diseases
Volume 44
Issue 12
Pages 997-1000
ISSN 1651-1980
Publication year 2012
Published at Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry
Institute of Biomedicine, Department of Infectious Medicine
Pages 997-1000
Language en
Links dx.doi.org/10.3109/00365548.2012.69...
Keywords HIV, cerebrospinal fluid, darunavir, monotherapy, neuronal injury
Subject categories Infectious Medicine

Abstract

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.

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