Minimizing resistance consequences after virologic failure on initial combination therapy: a systematic overview.
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 (RCreg) 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 RCreg (range: 0.12-0.21) and the highest AD (range: 19.80-20.18) scores. NNRTI failures had higher RCreg (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.
Duke Scholars
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Related Subject Headings
- Virology
- Reverse Transcriptase Inhibitors
- Meta-Analysis as Topic
- Humans
- HIV Protease Inhibitors
- HIV Infections
- HIV
- Genotype
- Drug Resistance, Viral
- Antiretroviral Therapy, Highly Active
Citation
Published In
DOI
ISSN
Publication Date
Volume
Issue
Start / End Page
Location
Related Subject Headings
- Virology
- Reverse Transcriptase Inhibitors
- Meta-Analysis as Topic
- Humans
- HIV Protease Inhibitors
- HIV Infections
- HIV
- Genotype
- Drug Resistance, Viral
- Antiretroviral Therapy, Highly Active