Kaletra disappointing in people severely ill with COVID-19

• There is no approved treatment for COVID-19, but many clinical trials are underway
• Doctors are experimenting with drugs already approved to treat other conditions
• Kaletra, an older HIV treatment, has not been found effective in severe cases of COVID-19

A member of the coronavirus family called SARS-CoV-2 has spread around the world. This virus causes illness called coronavirus disease 2019 (COVID-19). Most people (80%) who become infected with SARS-CoV-2 will have symptoms similar to a mild cold or flu. However, some infected people can develop high fever, difficulty breathing, and pneumonia in both lungs. In severe cases infection can lead to death.

Currently there is no approved treatment for COVID-19. As a result, researchers are testing experimental drugs as well as drugs approved for other conditions in the hope that they can help people with COVID-19.

In Canada and other high-income countries, Kaletra is the brand name for two anti-HIV drugs in a pill or liquid formulation: lopinavir + ritonavir. This treatment is also sold under the name Aluvia and in generic forms in many countries. Lopinavir has antiviral activity against HIV. The purpose of ritonavir is to boost levels of lopinavir in the blood so that it can be taken once or twice daily.

In 2004, research suggested that Kaletra may have had a beneficial effect in people who were infected with another related coronavirus called SARS (severe acute respiratory syndrome). Studies have been launched with Kaletra to treat severe illness with SARS-CoV-2.

In China

Researchers in the Chinese city of Wuhan conducted a study comparing the following interventions in 199 HIV-negative people severely ill with COVID-19:

• 99 people were given Kaletra twice daily + supportive standard of care
• 100 people were given supportive standard of care

The interventions were given for 14 consecutive days and participants were monitored for a total of 28 days or until they left the hospital or died.

Results

The results of this Kaletra study were published in the New England Journal of Medicine. There was no significant difference between the two interventions regarding disease severity, death, or detectable virus. The researchers concluded: “[Kaletra] treatment did not significantly accelerate clinical improvement, reduce mortality or diminish [the detectability of SARS-CoV-2] in patients with serious COVID-19.”

The researchers also found that about 14% of participants who were given Kaletra were unable to complete the 14-day course of treatment because of side effects (including diarrhea and nausea).

For the future

Although the results of this study were disappointing, research is underway with other drugs and drug combinations that show promise against SARS-CoV-2. People living with HIV should not change their existing treatment regimen to try to prevent COVID 19.

Resources

Coronavirus disease (COVID-19), HIV and hepatitis C: What you need to know – CATIE News

Information about COVID-19 is changing rapidly. Please consult the resources below for the most current information:

• Canadian Updates about COVID-19
• Vulnerable populations and COVID-19
• How to isolate at home when you have COVID-19
• About coronavirus disease (COVID-19)
• Know the facts about coronavirus disease (COVID-19)
• Be prepared infographic (COVID-19)
• Be prepared factsheet

–Sean R. Hosein

REFERENCES:

1. Cao B, Wang Y, Wen D, et al. A trial of Lopinavir-ritonavir in adults hospitalized with severe Covid-19.  New England Journal of Medicine. 2020; in press.
2. Baden LR, Rubin  EJ. COVID-19 – The search for effective therapy. New England Journal of Medicine. 2020; in press.