Depression improves after Kaletra switch

People substituting Kaletra (lopinavir/ritonavir) for a PI or NNRTI to which they were moderately intolerant reported immediate, short-term improvement in symptoms of depression, as well as better overall tolerability, quality of life and maintenance of viral control, according the results of the PLATO (Performance of Lopinavir/ritonavir as an Alternative Treatment Option) study which were presented this week at the International AIDS Society 2nd Conference on Pathogenesis and Treatment in Paris.

Of 849 people enrolled in the PLATO study - an eight week randomised, open-label, international trial - 588 reporting Grade 2 side effects from their current PI- (nelfinavir, indinavir, or indinavir/ritonavir) or NNRTI- (efavirenz or nevirapine) based regimen were switched immediately to Kaletra. The remaining 261 deferred switching until week four.

Everyone in the study completed three different psychological assessment questionnaires; CES-D (a screening tool for depression) at baseline and week eight; ASDM (a side-effect symptoms assessment tool) and MOS-HIV (a quality of life assessment tool) at each study visit. The majority of patients were male (80%), white (78%) and had an average age of 41.7.

A statistically significant (p

Of interest, there was not necessarily a correlation between improvement of symptoms with relief of depression. Symptom assessment scores improved most in those on indinavir with or without ritonavir boosting, and least in the two NNRTIs, possibly indicating that depression improved imperceptibly in some of those changing from efavirenz, whereas depression improved in those changing from indinavir/ritonavir because of the noticeable gastrointestinal side-effects of either or both drugs. It could also have been because GI symptoms are more bothersome than sleep disorders, since results from a related PLATO cohort study, also reported here, found that although GI symptoms were alleviated greatly (46-92%) in those switching from boosted or unboosted indinavir and nelfinavir, new GI symptoms were seen in those previously on efavirenz.

Mean MOS-HIV mental health scores improved significantly, by 4.3 and 4.6 (both p

At baseline, 91% of patients had viral load measurements below 400 copies/mL. By week eight, depending on the analysis, this remained stable, 91% (on-study), or improved, 97% (intent-to-treat). Two patients (less than 1%) experienced possible Kaletra-related serious side-effects (diabetes and acute renal failure). Non-fasting triglycerides and cholesterol levels were elevated in 12.7% and 7.4% at eight weeks.

Depression is one of the most common HIV-associated disorders, affecting between one fifth and one third of people with HIV disease. It has also been linked to poor adherence and an increased likelihood of having unprotected sex. This study mostly shows that in the short term at least, if you switch from HAART that is giving you side-effects like diarrhoea, sleep disorder and nausea to one that generally doesn’t, you will feel better. However, the negative effects of Kaletra-based therapy may include lipid abnormalities, especially if the switch is from an NNRTI.

Another study presented here, however, does show that in antiretroviral naive patients, at least, Kaletra has staying power, with very little treatment failure (99% on treatment with viral load below 400 copies/mL), (82% with CD4s above 500 cells/mm³), a relatively low drop-out rate due to adverse events (7%) and no resistance mutations seen after more than four years.