Abstract
Objective: To compare the effectiveness of initial highly active antiretroviral therapy with either: a single protease inhibitor (PI); ritonavir (RTV)/saquinavir (SQV); or efavirenz (EFV) plus nucleoside reverse transcriptase inhibitors. Design: Cohort study. Setting: Urban HIV clinic. Patients: Five-hundred and forty-five HIV-1-infected individuals with minimal antiretroviral exposure who started combination therapy with ≥ 3 antiretroviral drugs and ≥ 1 NRTI to which they had not previously been exposed (single PI, 416; RTV/SQV, 68; EFV, 61). Main outcome measures: HIV-1 RNA < 400 copies/mi within 8 months of starting therapy; time to HIV-1 RNA rebound to > 1000 copies/ml in the subset of patients achieving initial viral suppression; change in CD4 cell count from baseline within 12 months of starting therapy. Results: By intent-to-treat analysis, initial viral suppression was achieved by 72% of patients in the EFV group, compared to 49% in the single PI group (P= 0.001) and 51% in the RTV/SQV group (P = 0.019). Among patients who achieved initial viral suppression, time to viral rebound was similar in the three groups. Durable viral suppression (≥ 3 consecutive HIV-1 RNA levels < 400 copies/mi for > 6 months) was achieved by 53% of patients in the EFV group, 26% in the single PI group, and 29% in the RTV/SQV group (P< 0.05 for both comparisons with EFV). The median CD4 cell count increase was 139 × 106 cells/l, and was similar in the three groups. Conclusions: In agreement with a recent clinical trial, use of initial EFV-based combination antiretroviral therapy was associated with higher rates of viral suppression than PI-based therapy in a clinical cohort.
Original language | English (US) |
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Pages (from-to) | 1679-1686 |
Number of pages | 8 |
Journal | AIDS |
Volume | 15 |
Issue number | 13 |
DOIs | |
State | Published - Sep 7 2001 |
Keywords
- Antiretroviral therapy
- CD4 cell count
- Efavirenz
- HIV-1
- HIV-1 RNA
- Protease inhibitor
ASJC Scopus subject areas
- Immunology and Allergy
- Immunology
- Infectious Diseases