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Is Monotherapy possible in the future
Oct 29, 2007

Hi doctors, I recently read an article about the success of Kaletra monotherapy in a recent small study.

My question is, do you think that the practice of triple therapy that is currently the standard of HIV treatment will be less the 'norm' in the future if medications are developed that can control HIV on its own?

I would be interested on your thoughts regarding this.

Many Thanks

Larry

Response from Dr. Pierone

Yes I do think that boosted protease inhibitor monotherapy will be used more often in the future.

There was a recent modeling study in the journal Clinical Infectious Diseases which addressed this topic. The conclusion was " An HIV treatment simplification strategy involving use of a boosted PI alone may lead to longer survival overall at lower cost, compared with the standard of care combination therapy, because the simplification strategy potentially adds an additional line of therapy. The risk of emergence of PI resistance during treatment with a simplified regimen is a critical determinant of the viability of this strategy".

Our team has quite a few patients on various protease inhibitor monotherapy regimens and the results have been good. In the past when I presented cases of monotherapy it raised eyebrows, but not so much anymore.

However, triple therapy will not die out quickly because of the massive investment in this approach and the inertia which needs to be overcome. The pharmaceutical industry is certainly not eager to pursue this agenda for the obvious reasons. The slow uptake of these studies by federally funded HIV researchers reflects dysfunctional leadership from this group (with few exceptions).



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