Question

Can I move to darunavir monotherapy?

28 September 2009. Related: All topics, Changing treatment.

Hi

My doctor has suggested a trail to move from my current combination of atazanavir/Norvir/Truvada to darunavir monotherapy.

Is monotherapy safe? There seems to be conflicting messages on some websites.

Thanks.

Answer

Answer: Simon Collins

Hi

Your doctor is probably talking about the PIVOT study which is now running in the UK.

We posted information about this study on the i-Base website here. It is being run by the MRC (Medical Research Council) who also have information on their site here.

It looks like an interesting and safe study to enroll in. The advantages include the possibility that once your viral load is undetectable for six months (reduced to less than 50 copies/mL) you may not need to use the nucleoside drugs in your combination (tenovovir and FTC in Truvada).

Cutting back to just atazanavir/ritonavir (Reyataz/Norvir) does not seem potent enough, but there are several studies that show darunavir/ritonavir may be fine. Importantly, one recent study reported that darunavir will work in other important body compartments (like your brain) which has been a concern with some other boosted-PI combinations.

People are carefully monitored in PIVOT, so that if your viral load does blip up on the study, you could add back the nucleosides (ie Truvada) and it would drop back down again.

Two studies-Monet and MONOI-ANRS that looked into the efficacy of darunavir monotherapy.

Both they showed a fairly good result of darunavir monotherapy-at least non-inferior compared to triple combination, and that viral load was quickly re-suppressed in the few people where it ‘blipped’ higher.

There is a larger study that is ongoing and which results are expected in 2011. It will give us a way clearer idea.

Up till now though, from the current results, it looks like darunavir monotherapy is very promising. You may decide to discuss, however, with your doctor what is the reason behind his/her suggestion.