Minimizing resistance consequences after virologic failure on initial combination therapy: a systematic overview

JA Bartlett, JJ Buda, B von Scheele… - JAIDS Journal of …, 2006 - journals.lww.com
JA Bartlett, JJ Buda, B von Scheele, JA Mauskopf, EA Davis, R Elston, MS King, ER Lanier
JAIDS Journal of Acquired Immune Deficiency Syndromes, 2006journals.lww.com
Objective: 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. Design: Systematic overview of genotypic resistance mutations from clinical trials
of combination ART. Methods: 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 …
Abstract
Objective:
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.
Design:
Systematic overview of genotypic resistance mutations from clinical trials of combination ART.
Methods:
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 (RC reg) and number of active drug (AD) scores for each regimen and to rank the regimens.
Results:
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 RC reg (range: 0.12-0.21) and the highest AD (range: 19.80-20.18) scores. NNRTI failures had higher RC reg (range: 0.00-1.22) and lower AD (range: 16.83-21) scores.
Conclusions:
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.
Lippincott Williams & Wilkins