Immunovirological Response to Triple Nucleotide Reverse-Transcriptase Inhibitors and Ritonavir-Boosted Protease Inhibitors in Treatment-Naïve HIV-2–Infected Patients: The ACHIEV2E Collaboration Study Group

Benard, Antoine; van Sighem, Ard; Taieb, Audrey; Valadas, Emilia; Ruelle, Jean; Soriano, Vicente; Calmy, Alexandra; Balotta, Claudia; Damond, Florence; Brun-Vezinet, Françoise; Chene, Geneviève; Matheron, Sophie
May 2011
Clinical Infectious Diseases;May2011, Vol. 52 Issue 10, p1257
Academic Journal
This European inter-cohort collaboration shows poorer immunological and virological responses with triple NRTI compared to PI/r-containing cART in treatment-naïve HIV-2-infected patients, regardless of baseline CD4 cell count. PI/r-containing cART should be recommended as first-line antiretroviral regimens in HIV-2 infection.Background. Triple nucleoside reverse-transcriptase inhibitors (NRTIs) are recommended by the World Health Organization as first-line regimen in treatment-naïve HIV-2–infected patients. However, ritonavir-boosted protease inhibitor (PI/r)–containing regimens are frequently prescribed. In the absence of previous randomized trials, we retrospectively compared these regimens in observational cohorts.Methods. HIV-2–infected patients from 7 European cohorts who started triple NRTI or PI/r since January 1998 were included. Piecewise linear models were used to estimate CD4 cell count and plasma HIV-2 RNA level slopes, differentiating an early phase (until end of month 3) and a second phase (months 4–12). On-treatment analyses censored data at major treatment modification and systematically at month 12.Results. Forty-four patients started triple NRTI therapy and 126 started PI/r therapy. Overall, the median CD4 cell count was 191 cells/mm3 and the median plasma HIV-2 RNA level was ≥2.7 log10 copies/ml in 61% of the patients at combination antiretroviral therapy (cART) initiation; the median duration of the first cART was 20 months, not differing between groups. PI/r regimens were associated with better CD4 cell count and HIV-2 RNA level outcomes, compared with NRTI regimens. Estimated CD4 cell count slopes were +6 and +12 cells/mm3/month during the early phase (P = .22), and −60 cells/mm3/year versus +76 cells/mm3/year during the second phase (P = .002), for triple NRTI and PI/r, respectively. Estimated mean HIV-2 RNA levels at month 12 in patients with detectable viremia at cART initiation were 4.0 and 2.2 log10 copies/ml, respectively (P = .005).Conclusions. In this observational study, PI/r-containing regimens showed superior efficacy over triple NRTI regimens as first-line therapy in HIV-2–infected patients.


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