No difference in the rate of change in telomere length or telomerase activity in HIV-infected patients after three years of darunavir/ritonavir with and without nucleoside analogues in the MONET trial.

Objective: To determine whether nucleos(t)ide reverse transcriptase inhibitors (NRTI) contribute to an accelerated loss in telomere length (TL) in HIV-infected patients on antiretroviral therapy (ART). Design: Substudy of randomised controlled trial. Methods: Patients with HIV RNA ,50 copies/mL on combination ART (n=256) were randomised to darunavir/ritonavir (DRV/r) 800/100 mg once daily, either as monotherapy (n=127) or with 2 NRTIs (n=129) for up to 144 weeks. TL and telomerase activity was quantified on stored peripheral blood mononuclear cells (PBMC; n=124) using quantitative real time PCR. Results: Patients in the sub-study had a mean age of 44 years and had received NRTI for a mean of 6.4 years (range 1–20 years). As expected, older patients have significantly shorter TL (p=0.006), while women had significantly longer TL (p=0.026). There was no significant association between TL and either the duration of prior NRTI treatment (p=0.894) or the use of a PI versus NNRTI (p=0.107). There was no significant difference between patients who continued or ceased NRTI in the mean change/year of TL or telomerase (p=0.580 and 0.280 respectively). Conclusion: Continuation versus cessation of NRTI treatment was not associated with an accelerated loss in TL or telomerase activity.