This article is more than 5 years old. Information may no longer be current.

No difference in clinical outcomes between NNRTI- and boosted PI-based ART

Issue: November 2014

Add topic to email alerts

Receive an email when new articles are posted on

Please provide your email address to receive an email when new articles are posted on .

Subscribe

Added to email alerts

You've successfully added to your alerts. You will receive an email when new content is published.

Click Here to Manage Email Alerts

You've successfully added to your alerts. You will receive an email when new content is published.

Click Here to Manage Email Alerts

Back to Healio

We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com.

Back to Healio

PHILADELPHIA — There was no difference in outcomes between patients assigned to non-nucleoside reverse-transcriptase inhibitor- or ritonavir-boosted protease inhibitor-based antiretroviral therapy, according to study results presented at IDWeek 2014.

“Patients with HIV initiating NNRTI- or ritonavir-boosted PI-based regimens had comparable immunological, virological and clinical outcomes, though treatment discontinuation due to virological failure was more common among those receiving NNRTIs,” Álvaro H. Borges, MD, MSc, of the Centre for Health and Infectious Diseases Research at Rigshospitalet/University of Copenhagen in Denmark, said during his presentation.

 

Álvaro H. Borges

Borges, Andreas Lundh, MD, MSc, PhD, of the Nordic Cochrane Group and Hvidovre Hospital in Copenhagen, and colleagues conducted a systematic review and meta-analysis of randomized controlled trials that compared NNRTI-based regimens with regimens based on protease inhibitors boosted with ritonavir (Norvir, AbbVie). The primary endpoint was death or progression to AIDS. The researchers used intention-to-treat analyses to calculate risk ratios of virological suppression and mean differences in CD4 counts at week 48 after treatment initiation.

The analysis included 27 trials and 9,515 patients. There were 4,848 patients assigned to an NNRTI: 3,636 received efavirenz (Sustiva, Bristol-Myers Squibb) and 1,212 received nevirapine. Among the 4,667 patients assigned to a protease inhibitor, 2,661 received lopinavir/ritonavir (Kaletra, AbbVie), 1,498 received atazanavir/ritonavir and 508 patients received another protease inhibitor with ritonavir.

There were 10 trials in which the composite outcome of death or progression to AIDS was reported. In the NNRTI arms, 305 patients died or progressed to AIDS, as did 294 patient in the protease inhibitor arms (RR=1.04; 95% CI, 0.90-1.20). In 21 trials where death as a separate outcome was reported, there were 255 deaths in the NNRTI arms and 249 in the protease inhibitor arms (RR=1.02; 95% CI, 0.87-1.21). Within the 11 trials where progression to AIDS was a secondary endpoint, 194 patients in the NNRTI arm and 185 in the protease inhibitor arm progressed (RR=1.06; 95% CI, 0.87-1.28).

The rates of overall treatment discontinuation were similar between the arms, but the risk of discontinuation because of protocol-defined virological failure was higher among the NNRTI-treated patients (RR=1.89; 95% CI, 1.02-3.51). At week 48, there was no difference in virological suppression or increase in CD4 counts between two groups.

“An individual patient data meta-analysis is warranted to further investigate the different adverse event profiles and the dynamics of CD4 cell response and virological suppression after the initiation of NNRTI- or protease inhibitor-based regimens,” Borges said. – by Emily Shafer

For more information:

Borges A. Abstract 536. Presented at: IDWeek 2014; Oct. 8-12; Philadelphia.

Disclosure: Borges reports no relevant financial disclosures.