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NNRTI-based
HAART May Lead to More Stable Therapy
By
David Douglas
Initial use
of non-nucleoside
reverse transcriptase inhibitors (NNRTIs) rather than protease
inhibitor as the basis for highly active antiretroviral therapy
(HAART) for HIV infection may lead
to lasting treatment and less need for salvage
therapies, according to Canadian researchers.
"Our findings,"
lead investigator Dr. Marina B. Klein told Reuters Health, "support
the fact that the choice of therapy used in initial HIV treatment
is extremely important because it can affect all future treatment
responses if it fails."
Dr. Klein of
the Montreal Chest Institute and colleagues sought to determine
whether the initial use of protease inhibitors or NNRTIs influenced
subsequent therapy.
The researchers
studied data on 440 HIV-infected patients who were antiretroviral
naïve or nucleoside experienced. Of these, 291 had begun HAART
with a protease inhibitor and 149 with NNRTI. Median follow-up was
3.1 years in the protease inhibitor group and 2.3 years in the NNRTI
group.
Subjects who
started in the NNRTI group remained on their initial regimens for
a median of 2.1 years versus 1.6 years in the protease inhibitor
group (p = 0.03). Moreover, they were less likely to experience
virological failure.
In total, 15%
of the NNRTI group were exposed to three regimens or more versus
25% of the protease inhibitor group. Overall, only 7% of the initial
NNRTI group were exposed to all three antiretroviral classes versus
12% of protease inhibitor patients.
In addition,
new AIDS-defining illnesses were seen in 9% of NNRTI group patients
and 15% of the PI group. However, the difference was not significant.
"When
compared to the first generation of protease inhibitors," Dr.
Klein concluded, "NNRTIs appear to be superior when used as
initial HIV treatment with respect to tolerability, durability and
virologic responses and thus
may afford the best chance to avoid multiple salvage regimens."
10/15/04
AIDS 2004;18:1895-1904.
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