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British HIV Association guidelines for the treatment of HIV-1-positive adults with antiretroviral therapy 2015.2015年英国HIV协会关于使用抗逆转录病毒疗法治疗HIV-1阳性成人的指南。
HIV Med. 2016 Aug;17 Suppl 4:s2-s104. doi: 10.1111/hiv.12426.
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Immune Reconstitution in Severely Immunosuppressed Antiretroviral-Naive HIV-1-Infected Patients Starting Efavirenz, Lopinavir-Ritonavir, or Atazanavir-Ritonavir Plus Tenofovir/Emtricitabine: Final 48-Week Results (The Advanz-3 Trial).开始使用依非韦伦、洛匹那韦-利托那韦或阿扎那韦-利托那韦联合替诺福韦/恩曲他滨的初治严重免疫抑制的HIV-1感染患者的免疫重建：48周最终结果（Advanz-3试验）
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Ann Intern Med. 2014 Oct 7;161(7):461-71. doi: 10.7326/M14-1084.
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First-line antiretroviral therapy with nevirapine versus lopinavir-ritonavir based regimens in a resource-limited setting.在资源有限的环境中，基于奈韦拉平与洛匹那韦-利托那韦的一线抗逆转录病毒疗法。
AIDS. 2014 May 15;28(8):1143-53. doi: 10.1097/QAD.0000000000000214.
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PLoS One. 2014 May 15;9(5):e97482. doi: 10.1371/journal.pone.0097482. eCollection 2014.
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Once-daily dolutegravir versus darunavir plus ritonavir in antiretroviral-naive adults with HIV-1 infection (FLAMINGO): 48 week results from the randomised open-label phase 3b study.在初治 HIV-1 感染的成人中，每日一次多替拉韦与达芦那韦/利托那韦比较（FLAMINGO）：随机、开放标签、3b 期研究的 48 周结果。
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N Engl J Med. 2013 Nov 7;369(19):1807-18. doi: 10.1056/NEJMoa1215541.
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Nevirapine-based regimens in HIV-infected antiretroviral-naive patients: systematic review and meta-analysis of randomized controlled trials.基于奈韦拉平的方案在 HIV 感染的抗逆转录病毒初治患者中的应用：随机对照试验的系统评价和荟萃分析。
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9
Lopinavir/ritonavir, atazanavir/ritonavir, and efavirenz in antiretroviral-naïve HIV-1-infected individuals over 144 weeks: an open-label randomized controlled trial.洛匹那韦/利托那韦、阿扎那韦/利托那韦及依非韦伦用于初治HIV-1感染个体超过144周的开放标签随机对照试验。
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非核苷类逆转录酶抑制剂与利托那韦增强型蛋白酶抑制剂为基础的方案用于初始治疗HIV感染的随机试验的系统评价和荟萃分析

Nonnucleoside Reverse-transcriptase Inhibitor- vs Ritonavir-boosted Protease Inhibitor-based Regimens for Initial Treatment of HIV Infection: A Systematic Review and Metaanalysis of Randomized Trials.

作者信息

Borges Álvaro H, Lundh Andreas, Tendal Britta, Bartlett John A, Clumeck Nathan, Costagliola Dominique, Daar Eric S, Echeverría Patrícia, Gisslén Magnus, Huedo-Medina Tania B, Hughes Michael D, Huppler Hullsiek Katherine, Khabo Paul, Komati Stephanus, Kumar Princy, Lockman Shahin, MacArthur Rodger D, Maggiolo Franco, Matteelli Alberto, Miro Jose M, Oka Shinichi, Petoumenos Kathy, Puls Rebekah L, Riddler Sharon A, Sax Paul E, Sierra-Madero Juan, Torti Carlo, Lundgren Jens D

机构信息

Centre for Health & Infectious Diseases Research, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen.

Department of Internal Medicine, Zealand University Hospital, Roskilde The Nordic Cochrane Centre, Rigshospitalet.

出版信息

Clin Infect Dis. 2016 Jul 15;63(2):268-80. doi: 10.1093/cid/ciw236. Epub 2016 Apr 18.

DOI:10.1093/cid/ciw236
PMID:27090986
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6276924/
Abstract

BACKGROUND

Previous studies suggest that nonnucleoside reverse-transcriptase inhibitors (NNRTIs) cause faster virologic suppression, while ritonavir-boosted protease inhibitors (PI/r) recover more CD4 cells. However, individual trials have not been powered to compare clinical outcomes.

METHODS

We searched databases to identify randomized trials that compared NNRTI- vs PI/r-based initial therapy. A metaanalysis calculated risk ratios (RRs) or mean differences (MDs), as appropriate. Primary outcome was death or progression to AIDS. Secondary outcomes were death, progression to AIDS, and treatment discontinuation. We calculated RR of virologic suppression and MD for an increase in CD4 cells at week 48.

RESULTS

We included 29 trials with 9047 participants. Death or progression to AIDS occurred in 226 participants in the NNRTI arm and in 221 in the PI/r arm (RR, 1.03; 95% confidence interval, .87-1.22; 12 trials; n = 3825), death in 205 participants in the NNRTI arm vs 198 in the PI/r arm (1.04; 0.86-1.25; 22 trials; n = 8311), and progression to AIDS in 140 participants in the NNRTI arm vs 144 in the PI/r arm (1.00; 0.80-1.25; 13 trials; n = 4740). Overall treatment discontinuation (1.12; 0.93-1.35; 24 trials; n = 8249) and from toxicity (1.21; 0.87-1.68; 21 trials; n = 6195) were comparable, but discontinuation due to virologic failure was more common with NNRTI (1.58; 0.91-2.74; 17 trials; n = 5371). At week 48, there was no difference between NNRTI and PI/r in virologic suppression (RR, 1.03; 0.98-1.09) or CD4(+) recovery (MD, -4.7 cells; -14.2 to 4.8).

CONCLUSIONS

We found no difference in clinical and viro-immunologic outcomes between NNRTI- and PI/r-based therapy.

摘要

背景

既往研究表明，非核苷类逆转录酶抑制剂（NNRTIs）可使病毒学抑制速度更快，而利托那韦增强的蛋白酶抑制剂（PI/r）可使更多CD4细胞恢复。然而，个别试验尚无足够的效力来比较临床结局。

方法

我们检索数据库以识别比较基于NNRTI与基于PI/r的初始治疗的随机试验。根据情况进行荟萃分析计算风险比（RRs）或均值差（MDs）。主要结局为死亡或进展至艾滋病。次要结局为死亡、进展至艾滋病及治疗中断。我们计算了第48周时病毒学抑制的RR及CD4细胞增加的MD。

结果

我们纳入了29项试验，共9047名参与者。NNRTI组有226名参与者发生死亡或进展至艾滋病，PI/r组有221名（RR，1.03；95%置信区间，0.87 - 1.22；12项试验；n = 3825）；NNRTI组有205名参与者死亡，PI/r组有198名（1.04；0.86 - 1.25；22项试验；n = 8311）；NNRTI组有140名参与者进展至艾滋病，PI/r组有144名（1.00；0.80 - 1.25；13项试验；n = 4740）。总体治疗中断情况（1.12；0.93 - 1.35；24项试验；n = 8249）及因毒性导致的治疗中断情况（1.21；0.87 - 1.68；21项试验；n = 6195）具有可比性，但因病毒学失败导致的治疗中断在NNRTI组更常见（1.58；0.91 - 2.74；17项试验；n = 5371）。在第48周时，NNRTI与PI/r在病毒学抑制（RR，1.03；0.98 - 1.09）或CD4(+)细胞恢复（MD，-4.7个细胞；-14.2至4.8）方面无差异。

结论

我们发现基于NNRTI与基于PI/r的治疗在临床及病毒 - 免疫结局方面无差异。