RESUMO
BACKGROUND: The toxicities, cost and complexity of triple combinations warrant the search for other treatment options, such as boosted protease inhibitor (PI) monotherapy. MONotherapy AntiRetroviral Kaletra (MONARK) is the first randomized trial comparing lopinavir/ritonavir monotherapy to triple combination therapy with zidovudine/lamivudine and lopinavir/ritonavir in antiretroviral-naïve patients. METHODS: A total of 136 antiretroviral-naïve patients, with a CD4 cell count above 100 cells/microL and a plasma HIV RNA below 100,000 HIV-1 RNA copies/mL, were randomized and dosed with either lopinavir/ritonavir monotherapy (n = 83) or lopinavir/ritonavir + zidovudine/lamivudine (n = 53). We focus here on patients in the lopinavir/ritonavir monotherapy arm followed to week 96. The intent-to-treat (ITT) analysis initially involved all patients randomized to lopinavir/ritonavir monotherapy (n = 83), and then focused on patients who had an HIV RNA < 50 copies/mL at week 48 (n = 56). RESULTS: At week 96, 39 of 83 patients (47%) had HIV RNA < 50 copies/mL, five of 83 had HIV RNA between 50 and 400 copies/mL, and three of 83 had HIV RNA > 400 copies/mL. Focusing on the 56 patients with an HIV RNA < 50 copies/mL at week 48, 38 of 56 patients (68%) had a sustained HIV RNA < 50 copies/mL to week 96. To week 96, a total of 28 patients (34%) had discontinued the study treatment. In addition, the allocated treatment was changed for seven patients. PI-associated resistance mutations were evident in five of 83 patients in the monotherapy arm from baseline to week 96. CONCLUSION: By ITT analysis, 39 of the 83 patients initially randomized to lopinavir/ritonavir monotherapy had HIV RNA < 50 copies/mL at week 96. The occurrence in some patients of low-level viraemia (50-500 copies/mL) may increase the risk of drug resistance. First-line lopinavir/ritonavir monotherapy cannot be systematically recommended.
Assuntos
Infecções por HIV/tratamento farmacológico , Inibidores da Protease de HIV/uso terapêutico , HIV-1 , Pirimidinonas/uso terapêutico , Ritonavir/uso terapêutico , Terapia Antirretroviral de Alta Atividade/métodos , Esquema de Medicação , Farmacorresistência Viral/genética , Quimioterapia Combinada , Seguimentos , Infecções por HIV/virologia , HIV-1/efeitos dos fármacos , HIV-1/genética , Humanos , Análise de Intenção de Tratamento , Lamivudina/uso terapêutico , Lopinavir , Masculino , Adesão à Medicação , RNA Viral/sangue , RNA Viral/genética , Inibidores da Transcriptase Reversa/uso terapêutico , Resultado do Tratamento , Zidovudina/uso terapêuticoAssuntos
Aciclovir/análogos & derivados , Antivirais/uso terapêutico , Infecções por Citomegalovirus/tratamento farmacológico , Síndromes de Imunodeficiência/complicações , Compostos Organofosforados/uso terapêutico , Ácido Fosfonoacéticos/uso terapêutico , Síndrome da Imunodeficiência Adquirida/complicações , Aciclovir/uso terapêutico , Infecções por Citomegalovirus/etiologia , Foscarnet , Ganciclovir , Humanos , Ácido Fosfonoacéticos/análogos & derivadosRESUMO
Congenital cervical thymic cysts are a very rare cause of tumor of the neck in children. They can exceptionally induce a laryngeal compression. Actual identification of the tumor may sometimes be made only after surgery and histologic examination. Evolution is benign. Their existence seems to be related to the persistence of thymic remnants in the neck.
