Comparison of initial combination antiretroviral therapy with a single protease inhibitor, ritonavir and saquinavir, or efavirenz

Research output: Contribution to journalArticle

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 languageEnglish (US)
Pages (from-to)1679-1686
Number of pages8
JournalAIDS
Volume15
Issue number13
DOIs
StatePublished - Sep 7 2001

Fingerprint

efavirenz
Saquinavir
Ritonavir
Protease Inhibitors
HIV-1
CD4 Lymphocyte Count
Therapeutics
RNA
Reverse Transcriptase Inhibitors
Highly Active Antiretroviral Therapy
Nucleosides
Cohort Studies
Outcome Assessment (Health Care)
Clinical Trials
HIV

Keywords

  • Antiretroviral therapy
  • CD4 cell count
  • Efavirenz
  • HIV-1
  • HIV-1 RNA
  • Protease inhibitor

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology

Cite this

@article{7073af79fcf4486b8976087a305ac832,
title = "Comparison of initial combination antiretroviral therapy with a single protease inhibitor, ritonavir and saquinavir, or efavirenz",
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.",
keywords = "Antiretroviral therapy, CD4 cell count, Efavirenz, HIV-1, HIV-1 RNA, Protease inhibitor",
author = "Lucas, {Gregory M} and Chaisson, {Richard E} and Moore, {Richard D}",
year = "2001",
month = "9",
day = "7",
doi = "10.1097/00002030-200109070-00011",
language = "English (US)",
volume = "15",
pages = "1679--1686",
journal = "AIDS",
issn = "0269-9370",
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T1 - Comparison of initial combination antiretroviral therapy with a single protease inhibitor, ritonavir and saquinavir, or efavirenz

AU - Lucas, Gregory M

AU - Chaisson, Richard E

AU - Moore, Richard D

PY - 2001/9/7

Y1 - 2001/9/7

N2 - 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.

AB - 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.

KW - Antiretroviral therapy

KW - CD4 cell count

KW - Efavirenz

KW - HIV-1

KW - HIV-1 RNA

KW - Protease inhibitor

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U2 - 10.1097/00002030-200109070-00011

DO - 10.1097/00002030-200109070-00011

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JO - AIDS

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SN - 0269-9370

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