NRTI-sparing approach highlighted by new data

In the first head-to-head comparison between two commonly-used HIV treatments, researchers from the Universirty of Pittsburgh found that one "side-effect light" triple-drug therapy was significantly more effective at reducing HIV viral load when used as a first-line treatment. Results of the clinical trial, which sought to determine the optimal therapy for early HIV patients, were reported at the 16th International AIDS Conference, held in Toronto, Canada.

Of the two triple-drug approaches evaluated in the randomized trial, the therapy consisting of two nucleoside reverse transcriptase inhibitors with efavirenz, a non-nucleoside reverse transcriptase inhibitor, suppressed the virus to undetectable levels in more participants than the three-drug combination of two NRTIs and a protease inhibitor called lopinavir/ritonavir. Moreover, a third regimen, efavirenz and lopinavir/ritonavir, performed nearly as well as the three-drug cocktail with efavirenz, suggesting initial therapy need not include NRTIs, a class of drugs that can produce intolerable side effects in some patients.

According to Sharon Riddler, assistant professor of medicine in the University of Pittsburgh School of Medicine's infectious diseases division, the findings from the 753-patient study "suggest that the efavirenz plus two-NRTI regimen was the best of the three approaches as initial therapy, even in patients with relatively advanced HIV disease."