Bartlett John A, Buda Jeffrey J, von Scheele Birgitta, Mauskopf Josephine A, Davis E Anne, Elston Robert, King Martin S, Lanier E Randall
AIDS Research and Treatment Center, Duke University Medical Center, Durham, NC, USA.
J Acquir Immune Defic Syndr. 2006 Mar;41(3):323-31. doi: 10.1097/01.qai.0000197070.69859.f3.
To identify optimal first-line therapies based on the rate of virologic success (VS) and the preservation of future treatment options in antiretroviral therapy (ART)-naive subjects.
Systematic overview of genotypic resistance mutations from clinical trials of combination ART.
Various sources were searched for studies in ART-naive subjects providing virologic response rates and genotypes from subjects with virologic failure. The International AIDS Society-USA genotypic resistance guidelines were used to calculate regimen resistance cost (RCreg) and number of active drug (AD) scores for each regimen and to rank the regimens.
Intra- and interstudy comparisons showed higher VS rates for nonnucleoside reverse transcriptase inhibitor (NNRTI) regimens (range: 51%-76%) and boosted protease inhibitor (boosted PI) regimens (range: 55%-79%). Boosted PI failures had the lowest RCreg (range: 0.12-0.21) and the highest AD (range: 19.80-20.18) scores. NNRTI failures had higher RCreg (range: 0.00-1.22) and lower AD (range: 16.83-21) scores.
NNRTI and boosted PI regimens provide the highest rates of VS in treatment-naive HIV-infected persons. Treatment option scores were higher in subjects who failed boosted PI- containing regimens versus NNRTI-containing regimens, however.
