Darunavir-ritonavir should be considered as a treatment option across the range of treatment-experienced patients with HIV infection, conclude Jose Madruga (Centro de Referência e Treinamento DST/AIDS, Sao Paulao, Brazil) and colleagues in an Article in this week's issue of The Lancet.
The results of this large randomised, phase III trial in lopinavir-naive, HIV-infected, treatment-experienced patients (TITAN), showed that at week 48, significantly more patients on darunavir-ritonavir than on lopinavir-ritonavir achieved a reduction of HIV RNA (genetic material marking the presence of the virus) in the blood plasma to below 400 copies per mL (77% vs 68%). Side effects were generally mild in both groups, and led to few discontinuations of treatment.
Darunavir, a protease inhibitor, has been shown to be efficacious in highly treatment-experienced patients with HIV infection, but has not previously been assessed in patients with a broader range of treatment experience, similar to that usually encountered in a clinical setting.
In an accompanying Comment, Bernard Hirschel and Thomas Perneger (Geneva Hospital, Geneva, Switzerland) point out that it is unlikely these results will generate a large-scale switch from lopinavir to darunavir because: "Darunavir's superior efficacy would be difficult to show in drug-naive patients, in whom pre-existing resistance to lopinavir is not the rule -- [and] darunavir-ritonavir is more expensive, particularly in the USA, than lopinavir-ritonavir."
The Lancet