In HIV, Are Nonnucleoside Reverse Transcriptase Inhibitors Equal?
(HealthDay News) — For treatment-naive patients infected with HIV-1, three nonnucleoside reverse transcriptase inhibitor-sparing initial antiretroviral regimens can attain similarly high rates of virologic control, according to a study published in the October 7 issue of the Annals of Internal Medicine.
Jeffrey L. Lennox, MD, from the Grady Memorial Hospital and Emory University School of Medicine in Atlanta, and colleagues examined three nonnucleoside reverse transcriptase inhibitor-sparing initial antiretroviral regimens in a phase 3 open-label trial. A total of 1,809 treatment-naive patients with HIV-1 RNA levels >1,000 copies/mL were randomized to atazanavir with ritonavir; raltegravir; or darunavir with ritonavir plus combination emtricitabine and tenofovir disoproxil fumarate.
The researchers found that the incidence of virologic failure over 96 weeks demonstrated equivalence in all pairwise comparisons, with the margin of equivalence defined as −10–10%. Equivalent tolerability was seen for raltegravir and ritonavir-boosted darunavir; ritonavir-boosted atazanavir had a 12.7 and 9.2% increased incidence of tolerability discontinuation compared with raltegravir and ritonavir-boosted darunavir, respectively, and this was mainly attributed to hyperbilirubinemia. Ritonavir-boosted darunavir was superior to ritonavir-boosted atazanavir for combined virologic efficacy and tolerability, while raltegravir was superior to both protease inhibitors. At the time of virologic failure, antiretroviral resistance was rare, but was seen more frequently with raltegravir.
"Over two years, all three regimens attained high and equivalent rates of virologic control," the authors write.
Several authors disclosed financial ties to the pharmaceutical and biotechnology industries.