Cahn P. Lancet Infect Dis. 2014 Jul;14(7):572-80
Type of ARV Trial
Head-to-head comparative trials for first line ART since 2006
» 2 drugs vs 3 drugs
» LPV/r + 3TC vs LPV/r + 2 NRTI
Head-to-head comparative trials for first line ART since 2006
» 2 drugs vs 3 drugs
» LPV/r + 3TC vs LPV/r + 2 NRTI
Drugs
LPV/r, 2 NRTI, 3TC
LPV/r, 2 NRTI, 3TC
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- LPV/r + 3TC dual therapy was virologically non inferior to a standard therapy of LPV/r + 2 NRTI
- Similar virologic response of the 2 regimens in patients with HIV RNA > 100 000 c/mL at enrolment
- No resistance mutations to protease inhibitor at virologic failure in either group
- 2 patients with M184V in dual therapy group
- Incidence of adverse events higher in triple therapy group
- Discontinuation because of adverse events mainly related to NRTI in the LPV/r + NRTI arm
- Potential advantages of first-line LPV/r + 3TC
- Cost
- Less toxicity (might need less monitoring)
- Spares the other NRTIs
Design :
*Randomisation was stratified by HIV RNA (<or > 100,000 c/mL) at screening
** Investigator-selected NRTI : ZDV/3TC = 54%, TDF/FTC = 37%, ABC/3TC = 9%
Objective :
- Non inferiority of LPV/r + 3TC at W48: % HIV RNA < 50 c/mL by intention to treat, snapshot analysis (lower limit of the 95% CI for the difference = -12%, 85% power)
Baseline characteristics and patient disposition :
Response to treatment at week 48 :
HIV RNA < 50 c/mL
Median CD4/mm3 increase :
+ 227 (LPV/r + 3TC) vs
+ 217 (LPV/r + 2 NRTI)
Virologic failure definition
- 2 consecutive HIV-1 RNA > 400 c/mL at or after W24
- HIV-1 RNA ≥ 50 c/mL at W48
Resistance data at week 48
Adverse events
Selected grade 3-4 laboratory abnormalities occurred at the same frequency in both groups, except for hyperlipidemia (more frequent in dual therapy group)
