7th International AIDS Society Conference, Kuala Lumpur, June 2013:
United States antiretroviral treatment guidelines for adolescents and adults from the US Public Health Service apparently get it right in terms of the regimens the document deems preferred for first line therapy. Such regimens were more effective than others, based on an Australian meta-analysis of studies of initial HIV regimens.
Frederick Lee and colleagues from the Kirby Institute conducted a meta-analysis whereby they included any legitimate study where a first line regimen was studied in people living with HIV and they then looked at the likelihood of an undetectable viral load following treatment.
What Dr. Lee found was that an integrase inhibitor was significantly more likely to result an undetectable viral load and less chance for treatment failure than a NNRTI, notably efavirenz, or a protease inhibitor (unboosted or not). This confirms the Department of Health and Human Services (DHHS) guidelines recommendation of raltagrevir (Isentress) as a preferred first line regimen. Further, the Guidelines’ recommendation of tenofovir DF + emtricitabine (Truvada) as a backbone regimen was also superior to other regimens. Overall, however, average regimen efficacy was just over 60% when all studies were included and just 75% when more recently approved regimens were studied.
It should be noted that the study reached back in time to the late 1990s so a sub-analysis of more recent and more tolerable regimens may not have resulted in exactly the same results, especially if it was limited to randomized controlled trials. Nevertheless, it does appear to validate the expert consultation of the DHHS guidelines committee for preferred drugs in first line regimens .