Is It Better to Begin With a Nonnuke?

Initial anti-HIV treatment with regimens that include nonnucleoside reverse transcriptase inhibitors could have better results than regimens that instead include nucleoside analogs or protease inhibitors, according to a study published in the November 1 issue of the Journal of Acquired Immune Deficiency Syndromes. Beginning therapy with a class-sparing regimen might allow successful introduction of drugs from another class if treatment fails, according to the researchers. To compare class-sparing regimens they studied 291 treatment-naive patients who were given abacavir and lamivudine combined with either the nonnuke efavirenz or with ritonavir-boosted protease amprenavir or the nucleoside stavudine. Overall, 90% of the subjects completed 96 weeks of follow-up and 79% remained on study treatment. At the last follow-up there were no significant differences in outcomes between the two groups. More patients in the nonnuke group, though, did achieve viral loads at or below 50. In addition, only three nonnuke patients had treatment failure on their first regimen and switched therapy--compared with 13 protease patients and 16 patients on nuke-based therapy. Although there were no differences between arms in the primary outcome measures, the researchers conclude, the results of numerous secondary analyses favor a nonnucleoside-based approach.