Gisslén Magnus, Fuchs Dietmar, Hagberg Lars, Svennerholm Bo, Zetterberg Henrik
Department of Infectious Diseases, University of Gothenburg, Sweden.
Scand J Infect Dis. 2012 Dec;44(12):997-1000. doi: 10.3109/00365548.2012.690526. Epub 2012 Jul 9.
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.
在接受联合抗逆转录病毒治疗后病毒载量已无法检测到的大多数患者中，达芦那韦/利托那韦单药治疗可维持对HIV的抑制，并且在临床上的使用越来越多。然而，关于利托那韦增强型蛋白酶抑制剂（PI/r）单药治疗在预防中枢神经系统（CNS）中HIV复制方面的有效性，人们已提出担忧。在此，我们报告了2例接受达芦那韦/利托那韦维持单药治疗的患者，他们出现了脑脊液病毒突破，同时免疫激活增加以及神经元损伤的生物标志物迹象。这2例病例引发了对达芦那韦/利托那韦单药治疗在HIV中枢神经系统感染中有效性的担忧。因此，在获得临床研究的中枢神经系统结果之前，我们建议谨慎使用蛋白酶抑制剂单药治疗。
