Differential effects of efavirenz, lopinavir/r, and atazanavir/r on the initial viral decay rate in treatment naïve HIV-1-infected patients.
Journal article, 2010
Initial viral decay rate may be useful when comparing the relative potency of antiretroviral regimens. Two hundred twenty-seven ART-naïve patients were randomized to receive efavirenz (EFV) (n = 74), lopinavir/ritonavir (LPV/r) (n = 77), or atazanavir/ritonavir (ATV/r) (n = 79) in combination with two NRTIs. The most frequently used NRTI combinations in the EFV and ATV/r groups were the nonthymidine analogues tenofovir and emtricitabine or lamivudine (70% and 68%, respectively) and, in the LPV/r group, lamivudine and the thymidine analogue zidovudine (89%). HIV-1 RNA was monitored during the first 28 days after treatment initiation. Phase 1 and 2 decay rate was estimated in a subset of 157 patients by RNA decrease from days 0 to 7, and days 14 to 28. One-way ANOVA and subsequent Tukey's post hoc tests were used for groupwise comparisons. Mean (95% CI) HIV-1 RNA reductions from days 0 to 28 were 2.59 (2.45-2.73), 2.42 (2.27-2.57), and 2.13 (2.01-2.25) log(10) copies/ml for the EFV-, LPV/r-, and ATV/r-based treatment groups, respectively, with a significantly larger decrease in the EFV-based group at all time points compared with ATV/r (p < 0.0001), and with LPV/r at days 7-21 (p < 0.0001-0.03). LPV/r gave a greater RNA decrease compared with ATV/r from day 14 (p = 0.02). Phase 1 decay rate was significantly higher in the EFV group compared with LPV/r (p = 0.003) or ATV/r (p < 0.0001). No difference was found in phase 2 decrease. EFV-based treatment gave a more rapid decline in HIV-1 RNA than did either of the boosted protease inhibitor-based regimens. The observed differences may reflect different inherent regimen potencies.
HIV Infections
pharmacology
therapeutic use
pharmacology
Middle Aged
RNA
blood
Humans
therapeutic use
Male
Viral
drug effects
pharmacology
virology
drug therapy
Treatment Outcome
HIV-1
Benzoxazines
pharmacology
drug effects
Pyridines
Pyrimidinones
Oligopeptides
pharmacology
Drug Therapy
Reverse Transcriptase Inhibitors
therapeutic use
Female
Aged
Combination
Anti-HIV Agents
therapeutic use
therapeutic use
Adult
pharmacology
therapeutic use
Author
Arvid Edén
University of Gothenburg
L. M. Andersson
University of Gothenburg
Orjan Andersson
Sundsvall Hospital
Leo Flamholc
Skåne University Hospital
Filip Josephson
Karolinska University Hospital
Staffan Nilsson
Chalmers, Mathematical Sciences, Mathematical Statistics
University of Gothenburg
Vidar Ormaasen
Oslo University Hospital
Veronica Svedhem
Karolinska University Hospital
Christer Säll
Södra Älvsborg Hospital (SÄS)
A. Sonnerborg
Karolinska University Hospital
Karolinska Institutet
Petra Tunbäck
University of Gothenburg
Magnus Gisslén
University of Gothenburg
AIDS research and human retroviruses
1931-8405 (ISSN)
Vol. 26 5 533-40Subject Categories
Infectious Medicine
Microbiology in the medical area
DOI
10.1089/aid.2009.0177
PubMed
20455766