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NNRTIs May Have Edge in HIV Therapy (Reuters Health)
An open-label study of current HIV regimens indicates that although all show excellent results, initial treatment with regimens that include non-nucleoside reverse transcriptase inhibitors (NNRTIs) may have certain advantages over those involving protease inhibitors (PIs) or nucleoside reverse transcriptase inhibitors (NRTIs), according to researchers.
In the November 1st issue of the Journal of Acquired Immune Deficiency Syndromes, Dr. John A. Bartlett of Duke University Medical Center, Durham, North Carolina and colleagues note that starting with a class-sparing therapeutic strategy may allow successful introduction of drugs from another class should treatment failure develop.
To compare class-sparing regimens, the researchers studied 291 treatment-naive subjects. They were randomized to abacavir and lamivudine combined with efavirenz (NNRTIs) or ritonavir-boosted amprenavir (PI) or stavudine (NRTI).
In all, 90% of the subjects completed 96 weeks of follow-up and 79% remained on study treatment. At the end of follow-up there were no significant between-group difference in outcomes.
However, more patients in the NNRTI group had HIV-1 RNA levels at or below 50 copies/mL at weeks 24 and 48, and they also had a greater overall duration of plasma RNA levels below 400 copies/mL.
In addition, only three NNRTI patients had treatment failure on their first regimen, and switched therapy, compared with 13 PI patients, and 16 NRTI patients. They also took fewer drugs and less of these patients used all three drug classes.
"Although there were no differences between arms in the primary outcome measures," the researchers conclude, "the results of numerous secondary analyses favor an NNRTI-based approach."
