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HIV/AIDS Research

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More convenient HIV treatment can be as effective as more complex regimens

HIV treatment regimens based on a non-nucleoside reverse transcriptase inhibitor (NNRTI) are at least as effective as treatment with a protease inhibitor, but require patients to take fewer pills each day, according to a new study supported in part by the Agency for Healthcare Research and Quality (290-02-0024).

Researchers found that disease progression was similar for both regimens, but NNRTI-based treatment appeared more effective at decreasing the amount of virus in the blood. The new study is the first to review all published research that directly compares the two classes of antiretroviral drugs used in highly active antiretroviral therapy (HAART). NNRTI-based regimens were found to be up to 60 percent more likely to suppress the amount of virus in patients' blood than protease inhibitor-based regimens. The percentages of patients who died or experienced disease progression were similar between the two treatments, and the number of patients who stopped taking the medications because of side effects or adverse events was also similar.

Roger Chou, M.D., and colleagues from the Oregon Health & Science University in Portland completed an analysis of 26 trials, including 12 head-to-head trials comparing NNRTI-based regimens with protease inhibitor-based regimens. Fourteen other trials compared two-drug regimens with either NNRTI-based or protease inhibitor-based, triple-drug regimens. Among 3,337 patients analyzed in the head-to-head trials, NNRTI-based regimens were 20 to 60 percent better than protease inhibitor-based regimens at achieving viral suppression.

Dramatic decreases in the rate of HIV-related illnesses and deaths have occurred since the introduction of HAART therapy using three or more antiretroviral agents. However, until now, comparisons of head-to-head trials were not available to support selection of a protease inhibitor or an NNRTI as part of that combination therapy. Researchers concluded that earlier analyses might be unreliable because their results differed dramatically from the analysis of head-to-head trials, even after excluding patients who had previously received HIV therapy and those who had received older NNRTIs, such as delaviridine, that are now used infrequently because they are less effective. Prior antiretroviral treatment can cause drug resistance and treatment failure.

See "Initial highly-active antiretroviral therapy with a protease inhibitor versus a non-nucleoside reverse transcriptase inhibitor: Discrepancies between direct and indirect meta-analyses," by Dr. Chou, Rongwei Fu, Ph.D., Laurie Hoyt Huffman, M.S., and P. Todd Korthius, M.D., in the October 28, 2006, Lancet 368, pp. 1503-1515.

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