Dual antiretroviral therapy with tenofovir (TDF) and darunavir/ritonavir (DRV/RTV) in an HIV-1 positive patient: a case report, review, and meta-analysis of the literature on dual treatment strategies using protease inhibitors in combination with an NRTI
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Here, we report the case of an HIV positive patient under a dual antiretroviral drug regimen with tenofovir disoproxil and darunavir/ritonavir with stable clinical, virological, and immunological response over 126 weeks. Dual antiretroviral therapy has the advantage of reduced toxicity and lower health care costs, treatment failure and fostering drug resistance are perceived risks. Optimal drug combinations and indication criteria for dual treatment remain controversial. Nevertheless, first clinical trials indicate non-inferiority for combinations of nucleoside reverse transcriptase inhibitors and protease inhibitors. This case presents the combination of tenofovir disoproxil in combination with a protease inhibitor as a new potential dual treatment regimen.
We performed a systematic literature search and meta-analysis of trials comparing dual to triple ART.
Literature review revealed nine studies in which dual therapy with a protease inhibitor and an NRTI was compared to triple therapy. We performed a meta-analysis of six trials that reported a 48-week follow-up. In treatment-naïve patients as well when ART switch was assessed, there was no difference in the treatment success in patients with dual ART versus triple.
We conclude that dual therapy with a protease inhibitor and NRTI is safe and effective. The use of tenofovir in dual treatment as described in our case needs to be assessed in future clinical trials.
KeywordsDual therapy HIV Antiretroviral therapy Tenofovir Lamivudine Protease inhibitor
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. BTS and MWP were supported by grants from the German Federal Ministry of Education and Research (BMBF), Grant numbers 01KI1501 and 03ZZ0820D. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Compliance with ethical standards
Conflict of interest
SH, BL, SW, and MP declare no conflicts of interest. BS received research funding from Gilead, funding for attending congresses by MSD, Janssen-Cilag and Gilead, gave talks for MSD, Janssen-Cilag, Gilead, AIDS-Hilfe Potsdam and AIDS-Hilfe Dresden and worked as a consultant for Gilead, Janssen and ViiV. SR gave talks for Gilead and ViiV and received financial support for attending conferences from Gilead, ViiV, MSD, and Hexal.
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