Tags

Type your tag names separated by a space and hit enter

An updated systematic overview of triple combination therapy in antiretroviral-naive HIV-infected adults.
AIDS. 2006 Oct 24; 20(16):2051-64.AIDS

Abstract

OBJECTIVE

To compare the effectiveness of three drug combination antiretroviral therapy (ART) in treatment-naive HIV-infected persons, and identify the predictors of responses.

DESIGN AND METHODS

Overview of trials identified by searching public domain publications and conference presentations. The three-drug combination therapy was defined as two nucleoside reverse transcriptase inhibitors (NRTI) or nucleotide and NRTI, and either: (1) a protease inhibitor (PI); (2) a non-nucleoside RTI (NNRTI); (3) a third NRTI; or (4) a ritonavir-boosted PI (BPI). Week 24 and 48 results for the proportions of patients with plasma HIV RNA levels < 400 and < 50 copies/ml, and change in CD4(+) cell counts were recorded.

RESULTS

Fifty-three trials met the entry criteria, and enrolled 14 264 patients into 90 treatment arms. Overall 55% of patients had plasma HIV RNA levels < 50 copies/ml at week 48 and this percentage increased with later publication dates. In unadjusted pairwise comparisons at week 48, significantly greater percentages of patients receiving NNRTI (64%) and BPI (64%) had RNA < 50 copies/ml than NRTI (54%) or PI (43%), and CD4(+) cell count increases were significantly greater in the BPI group (+200 cells/microl) than the PI (+179), NNRTI (+173), or NRTI (+161) groups. Pill count and percentage of patients with week 48 plasma HIV RNA levels < 50 copies/ml were correlated in the univariate analysis (P = 0.0053; r = -0.323), but pill count was not a significant predictor in the multivariate analyses. Drug class and baseline CD4(+) cell counts were significant predictors, but explained only a modest amount of the treatment effect, (R(2) = 0.355).

CONCLUSIONS

NNRTI and BPI-containing regimens offer superior virologic suppression over 48 weeks, supporting existing guidelines for the choice of initial ART. Pill count was not a consistent predictor of virologic suppression.

Authors+Show Affiliations

Duke University Medical Center, Durham, North Carolina 27710, USA. jab5@duke.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

17053351

Citation

Bartlett, John A., et al. "An Updated Systematic Overview of Triple Combination Therapy in Antiretroviral-naive HIV-infected Adults." AIDS (London, England), vol. 20, no. 16, 2006, pp. 2051-64.
Bartlett JA, Fath MJ, Demasi R, et al. An updated systematic overview of triple combination therapy in antiretroviral-naive HIV-infected adults. AIDS. 2006;20(16):2051-64.
Bartlett, J. A., Fath, M. J., Demasi, R., Hermes, A., Quinn, J., Mondou, E., & Rousseau, F. (2006). An updated systematic overview of triple combination therapy in antiretroviral-naive HIV-infected adults. AIDS (London, England), 20(16), 2051-64.
Bartlett JA, et al. An Updated Systematic Overview of Triple Combination Therapy in Antiretroviral-naive HIV-infected Adults. AIDS. 2006 Oct 24;20(16):2051-64. PubMed PMID: 17053351.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - An updated systematic overview of triple combination therapy in antiretroviral-naive HIV-infected adults. AU - Bartlett,John A, AU - Fath,Michael J, AU - Demasi,Ralph, AU - Hermes,Ashwaq, AU - Quinn,Joseph, AU - Mondou,Elsa, AU - Rousseau,Franck, PY - 2006/10/21/pubmed PY - 2007/1/20/medline PY - 2006/10/21/entrez SP - 2051 EP - 64 JF - AIDS (London, England) JO - AIDS VL - 20 IS - 16 N2 - OBJECTIVE: To compare the effectiveness of three drug combination antiretroviral therapy (ART) in treatment-naive HIV-infected persons, and identify the predictors of responses. DESIGN AND METHODS: Overview of trials identified by searching public domain publications and conference presentations. The three-drug combination therapy was defined as two nucleoside reverse transcriptase inhibitors (NRTI) or nucleotide and NRTI, and either: (1) a protease inhibitor (PI); (2) a non-nucleoside RTI (NNRTI); (3) a third NRTI; or (4) a ritonavir-boosted PI (BPI). Week 24 and 48 results for the proportions of patients with plasma HIV RNA levels < 400 and < 50 copies/ml, and change in CD4(+) cell counts were recorded. RESULTS: Fifty-three trials met the entry criteria, and enrolled 14 264 patients into 90 treatment arms. Overall 55% of patients had plasma HIV RNA levels < 50 copies/ml at week 48 and this percentage increased with later publication dates. In unadjusted pairwise comparisons at week 48, significantly greater percentages of patients receiving NNRTI (64%) and BPI (64%) had RNA < 50 copies/ml than NRTI (54%) or PI (43%), and CD4(+) cell count increases were significantly greater in the BPI group (+200 cells/microl) than the PI (+179), NNRTI (+173), or NRTI (+161) groups. Pill count and percentage of patients with week 48 plasma HIV RNA levels < 50 copies/ml were correlated in the univariate analysis (P = 0.0053; r = -0.323), but pill count was not a significant predictor in the multivariate analyses. Drug class and baseline CD4(+) cell counts were significant predictors, but explained only a modest amount of the treatment effect, (R(2) = 0.355). CONCLUSIONS: NNRTI and BPI-containing regimens offer superior virologic suppression over 48 weeks, supporting existing guidelines for the choice of initial ART. Pill count was not a consistent predictor of virologic suppression. SN - 0269-9370 UR - https://www.unboundmedicine.com/medline/citation/17053351/An_updated_systematic_overview_of_triple_combination_therapy_in_antiretroviral_naive_HIV_infected_adults_ L2 - https://doi.org/10.1097/01.aids.0000247578.08449.ff DB - PRIME DP - Unbound Medicine ER -