Objective
We
reviewed the current literature regarding antiretroviral (ARV)-sparing therapy
strategies to determine whether these novel regimens can be considered
appropriate alternatives to standard regimens for the initial treatment of
ARV-naive patients or as switch therapy for those patients with virologically
suppressed HIV infection.
Methods
A
search for studies related to HIV dual therapy published from January 2000
through April 2014 was performed using Biosis, Derwent Drug File, Embase, International
Pharmaceutical Abstracts, Medline, Pascal, SciSearch, and TOXNET databases;
seven major trial registries, and the abstracts of major conferences. Using
predetermined criteria for inclusion, an expert review committee critically
reviewed and qualitatively evaluated all identified trials for efficacy and
safety results and potential limitations.
Results
Sixteen
studies of dual therapy regimens were critiqued for the ARV-naive population.
Studies of a protease inhibitor/ritonavir in combination with the integrase
inhibitor raltegravir or the nucleoside reverse transcriptase inhibitor
lamivudine provided the most definitive evidence supporting a role for dual
therapy. In particular, lopinavir/ritonavir or darunavir/ritonavir combined
with raltegravir and lopinavir/ritonavir combined with lamivudine demonstrated
noninferiority to standard of care triple therapy after 48 weeks of treatment.
Thirteen trials were critiqued in ARV-experienced, virologically suppressed
patients. The virologic efficacy outcomes were mixed. Although overall data
regarding toxicity are limited, when compared with standard triple therapy,
certain dual therapy regimens may offer advantages in renal function, bone
mineral density, and limb fat changes; however, some dual combinations may
elevate lipid or bilirubin levels.
Conclusions
The potential benefits of dual therapy regimens include
reduced toxicity, improved tolerability and adherence, and reduced cost.
Although the data reviewed here provide valuable insights into the
effectiveness and tolerability of dual therapy regimens, it remains unclear
whether these potential benefits can be maintained long-term. Appropriately
powered studies with longer follow-up periods are needed to more definitively
assess potential toxicity reduction advantages with dual therapy.
Below: Efficacy of therapy by regimen in A) in ARV-naive, and B) ARV-experienced, virologically suppressed patients
Full article at: http://goo.gl/Lb7OlT
By:
Jean-Guy Baril
Clinique médicale du Quartier latin, Montreal, Quebec, Canada
Jonathan B. Angel
Division of Infectious Diseases, University of Ottawa and
the Ottawa Hospital, Ottawa, Ontario, Canada
M. John Gill
Department of Medicine, University of Calgary, Calgary,
Alberta, Canada
Joseph Gathe
Therapeutic Concepts, Houston, Texas, United States of
America
Pedro Cahn
Fundación Huesped, Buenos Aires, Argentina
Jean van Wyk
AbbVie Inc., North Chicago, Illinois, United States of
America
Sharon Walmsley
Toronto General Research Institute, University Health
Network, Toronto, Ontario, Canada
Sharon Walmsley
University of Toronto, Toronto, Ontario, Canada
More at: https://twitter.com/hiv insight
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