Nucleoside reverse transcriptase inhibitor-reducing strategies in HIV treatment: assessing the evidence.
Identifieur interne : 000945 ( PubMed/Corpus ); précédent : 000944; suivant : 000946Nucleoside reverse transcriptase inhibitor-reducing strategies in HIV treatment: assessing the evidence.
Auteurs : C. Orkin ; J M Llibre ; S. Gallien ; A. Antinori ; Gmn Behrens ; A. CarrSource :
- HIV medicine [ 1468-1293 ] ; 2017.
Abstract
Antiretroviral (ARV) therapy, comprising a backbone of two nucleos(t)ide reverse transcriptase inhibitors (NRTIs) plus another ARV, is the recognized standard of care (SOC), which has helped extend life expectancy in people living with HIV. In a quest to reduce lifelong drug exposure and minimize or avoid the toxicity of NRTIs, "NRTI-reducing" regimens have been investigated. This descriptive review assessing the results of NRTI-reducing strategies from the largest randomized trials focuses on virological efficacy, resistance, regimen safety (in terms of bone mineral density, renal function, lipids and central nervous system function) and simplicity. The review considers efficacy across various NRTI-sparing strategies, for example an integrase strand transfer inhibitor (INSTI) plus a ritonavir-boosted protease inhibitor (PI/r) or PI/r + lamivudine (3TC), in both naïve and switch regimes. Of 10 key studies in treatment-naïve adults assessing five NRTI-reducing strategies, only four studies demonstrated noninferiority vs. SOC [GARDEL, NEAT 001, AIDS Clinical Trials Group 5142 and PROGRESS]. In switch settings, 17 studies (10 randomized) were reviewed that used four strategies, including three studies assessing an INSTI plus a nonnucleoside reverse transcriptase inhibitor . Noninferiority of the NRTI-reducing arm was shown in six of 10 studies (ATLAS-M, SALT, DUAL, OLE, LATTE-2 and SWORD). In general, NRTI-reducing therapy did not always result in an improvement in short- or long-term adverse events; however, in many cases, these endpoints were not reported. Some of these studies reported higher virological failure rates with more frequent emergence of resistance mutations. None of these NRTI-reducing strategies has been compared against a single-pill regimen, including those containing tenofovir alafenamide. Only strategies demonstrating noninferior efficacy, a benefit in safety/tolerability, and a favourable cost-efficacy ratio, preferably in a single pill, will eventually match the current SOC of triple ARV therapy.
DOI: 10.1111/hiv.12534
PubMed: 28737291
Links to Exploration step
pubmed:28737291Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Nucleoside reverse transcriptase inhibitor-reducing strategies in HIV treatment: assessing the evidence.</title><author><name sortKey="Orkin, C" sort="Orkin, C" uniqKey="Orkin C" first="C" last="Orkin">C. Orkin</name><affiliation><nlm:affiliation>Infection and Immunity, Barts Health NHS Trust, London, UK.</nlm:affiliation></affiliation></author><author><name sortKey="Llibre, J M" sort="Llibre, J M" uniqKey="Llibre J" first="J M" last="Llibre">J M Llibre</name><affiliation><nlm:affiliation>University Hospital Germans Trias i Pujol, Infectious Diseases and "Fight AIDS" Foundation, Badalona, Barcelona, Spain.</nlm:affiliation></affiliation></author><author><name sortKey="Gallien, S" sort="Gallien, S" uniqKey="Gallien S" first="S" last="Gallien">S. Gallien</name><affiliation><nlm:affiliation>Immunology and Infectious Diseases, Henri Mondor Hospital, Paris Est Créteil University, Créteil, France.</nlm:affiliation></affiliation></author><author><name sortKey="Antinori, A" sort="Antinori, A" uniqKey="Antinori A" first="A" last="Antinori">A. Antinori</name><affiliation><nlm:affiliation>HIV/AIDS Department, National Institute for Infectious Diseases "Lazzaro Spallanzani", Rome, Italy.</nlm:affiliation></affiliation></author><author><name sortKey="Behrens, Gmn" sort="Behrens, Gmn" uniqKey="Behrens G" first="Gmn" last="Behrens">Gmn Behrens</name><affiliation><nlm:affiliation>Department for Clinical Immunology and Rheumatology, Hannover Medical School, Hannover, Germany.</nlm:affiliation></affiliation></author><author><name sortKey="Carr, A" sort="Carr, A" uniqKey="Carr A" first="A" last="Carr">A. Carr</name><affiliation><nlm:affiliation>Centre for Applied Medical Research, St Vincent's Hospital, Sydney, Australia.</nlm:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2017">2017</date><idno type="RBID">pubmed:28737291</idno><idno type="pmid">28737291</idno><idno type="doi">10.1111/hiv.12534</idno><idno type="wicri:Area/PubMed/Corpus">000945</idno><idno type="wicri:explorRef" wicri:stream="PubMed" wicri:step="Corpus" wicri:corpus="PubMed">000945</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Nucleoside reverse transcriptase inhibitor-reducing strategies in HIV treatment: assessing the evidence.</title><author><name sortKey="Orkin, C" sort="Orkin, C" uniqKey="Orkin C" first="C" last="Orkin">C. Orkin</name><affiliation><nlm:affiliation>Infection and Immunity, Barts Health NHS Trust, London, UK.</nlm:affiliation></affiliation></author><author><name sortKey="Llibre, J M" sort="Llibre, J M" uniqKey="Llibre J" first="J M" last="Llibre">J M Llibre</name><affiliation><nlm:affiliation>University Hospital Germans Trias i Pujol, Infectious Diseases and "Fight AIDS" Foundation, Badalona, Barcelona, Spain.</nlm:affiliation></affiliation></author><author><name sortKey="Gallien, S" sort="Gallien, S" uniqKey="Gallien S" first="S" last="Gallien">S. Gallien</name><affiliation><nlm:affiliation>Immunology and Infectious Diseases, Henri Mondor Hospital, Paris Est Créteil University, Créteil, France.</nlm:affiliation></affiliation></author><author><name sortKey="Antinori, A" sort="Antinori, A" uniqKey="Antinori A" first="A" last="Antinori">A. Antinori</name><affiliation><nlm:affiliation>HIV/AIDS Department, National Institute for Infectious Diseases "Lazzaro Spallanzani", Rome, Italy.</nlm:affiliation></affiliation></author><author><name sortKey="Behrens, Gmn" sort="Behrens, Gmn" uniqKey="Behrens G" first="Gmn" last="Behrens">Gmn Behrens</name><affiliation><nlm:affiliation>Department for Clinical Immunology and Rheumatology, Hannover Medical School, Hannover, Germany.</nlm:affiliation></affiliation></author><author><name sortKey="Carr, A" sort="Carr, A" uniqKey="Carr A" first="A" last="Carr">A. Carr</name><affiliation><nlm:affiliation>Centre for Applied Medical Research, St Vincent's Hospital, Sydney, Australia.</nlm:affiliation></affiliation></author></analytic><series><title level="j">HIV medicine</title><idno type="eISSN">1468-1293</idno><imprint><date when="2017" type="published">2017</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Antiretroviral (ARV) therapy, comprising a backbone of two nucleos(t)ide reverse transcriptase inhibitors (NRTIs) plus another ARV, is the recognized standard of care (SOC), which has helped extend life expectancy in people living with HIV. In a quest to reduce lifelong drug exposure and minimize or avoid the toxicity of NRTIs, "NRTI-reducing" regimens have been investigated. This descriptive review assessing the results of NRTI-reducing strategies from the largest randomized trials focuses on virological efficacy, resistance, regimen safety (in terms of bone mineral density, renal function, lipids and central nervous system function) and simplicity. The review considers efficacy across various NRTI-sparing strategies, for example an integrase strand transfer inhibitor (INSTI) plus a ritonavir-boosted protease inhibitor (PI/r) or PI/r + lamivudine (3TC), in both naïve and switch regimes. Of 10 key studies in treatment-naïve adults assessing five NRTI-reducing strategies, only four studies demonstrated noninferiority vs. SOC [GARDEL, NEAT 001, AIDS Clinical Trials Group 5142 and PROGRESS]. In switch settings, 17 studies (10 randomized) were reviewed that used four strategies, including three studies assessing an INSTI plus a nonnucleoside reverse transcriptase inhibitor . Noninferiority of the NRTI-reducing arm was shown in six of 10 studies (ATLAS-M, SALT, DUAL, OLE, LATTE-2 and SWORD). In general, NRTI-reducing therapy did not always result in an improvement in short- or long-term adverse events; however, in many cases, these endpoints were not reported. Some of these studies reported higher virological failure rates with more frequent emergence of resistance mutations. None of these NRTI-reducing strategies has been compared against a single-pill regimen, including those containing tenofovir alafenamide. Only strategies demonstrating noninferior efficacy, a benefit in safety/tolerability, and a favourable cost-efficacy ratio, preferably in a single pill, will eventually match the current SOC of triple ARV therapy.</div></front></TEI><pubmed><MedlineCitation Status="Publisher" Owner="NLM"><PMID Version="1">28737291</PMID><DateCreated><Year>2017</Year><Month>07</Month><Day>24</Day></DateCreated><DateRevised><Year>2017</Year><Month>08</Month><Day>23</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1468-1293</ISSN><JournalIssue CitedMedium="Internet"><PubDate><Year>2017</Year><Month>Jul</Month><Day>24</Day></PubDate></JournalIssue><Title>HIV medicine</Title><ISOAbbreviation>HIV Med.</ISOAbbreviation></Journal><ArticleTitle>Nucleoside reverse transcriptase inhibitor-reducing strategies in HIV treatment: assessing the evidence.</ArticleTitle><ELocationID EIdType="doi" ValidYN="Y">10.1111/hiv.12534</ELocationID><Abstract><AbstractText>Antiretroviral (ARV) therapy, comprising a backbone of two nucleos(t)ide reverse transcriptase inhibitors (NRTIs) plus another ARV, is the recognized standard of care (SOC), which has helped extend life expectancy in people living with HIV. In a quest to reduce lifelong drug exposure and minimize or avoid the toxicity of NRTIs, "NRTI-reducing" regimens have been investigated. This descriptive review assessing the results of NRTI-reducing strategies from the largest randomized trials focuses on virological efficacy, resistance, regimen safety (in terms of bone mineral density, renal function, lipids and central nervous system function) and simplicity. The review considers efficacy across various NRTI-sparing strategies, for example an integrase strand transfer inhibitor (INSTI) plus a ritonavir-boosted protease inhibitor (PI/r) or PI/r + lamivudine (3TC), in both naïve and switch regimes. Of 10 key studies in treatment-naïve adults assessing five NRTI-reducing strategies, only four studies demonstrated noninferiority vs. SOC [GARDEL, NEAT 001, AIDS Clinical Trials Group 5142 and PROGRESS]. In switch settings, 17 studies (10 randomized) were reviewed that used four strategies, including three studies assessing an INSTI plus a nonnucleoside reverse transcriptase inhibitor . Noninferiority of the NRTI-reducing arm was shown in six of 10 studies (ATLAS-M, SALT, DUAL, OLE, LATTE-2 and SWORD). In general, NRTI-reducing therapy did not always result in an improvement in short- or long-term adverse events; however, in many cases, these endpoints were not reported. Some of these studies reported higher virological failure rates with more frequent emergence of resistance mutations. None of these NRTI-reducing strategies has been compared against a single-pill regimen, including those containing tenofovir alafenamide. Only strategies demonstrating noninferior efficacy, a benefit in safety/tolerability, and a favourable cost-efficacy ratio, preferably in a single pill, will eventually match the current SOC of triple ARV therapy.</AbstractText><CopyrightInformation>© 2017 The Authors. HIV Medicine published by John Wiley & Sons Ltd on behalf of British HIV Association.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Orkin</LastName><ForeName>C</ForeName><Initials>C</Initials><AffiliationInfo><Affiliation>Infection and Immunity, Barts Health NHS Trust, London, UK.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Llibre</LastName><ForeName>J M</ForeName><Initials>JM</Initials><AffiliationInfo><Affiliation>University Hospital Germans Trias i Pujol, Infectious Diseases and "Fight AIDS" Foundation, Badalona, Barcelona, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Gallien</LastName><ForeName>S</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>Immunology and Infectious Diseases, Henri Mondor Hospital, Paris Est Créteil University, Créteil, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Antinori</LastName><ForeName>A</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>HIV/AIDS Department, National Institute for Infectious Diseases "Lazzaro Spallanzani", Rome, Italy.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Behrens</LastName><ForeName>Gmn</ForeName><Initials>G</Initials><AffiliationInfo><Affiliation>Department for Clinical Immunology and Rheumatology, Hannover Medical School, Hannover, Germany.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>German Center for Infection Research, St Vincent's Hospital, Sydney, Australia.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Carr</LastName><ForeName>A</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Centre for Applied Medical Research, St Vincent's Hospital, Sydney, Australia.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D016454">Review</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2017</Year><Month>07</Month><Day>24</Day></ArticleDate></Article><MedlineJournalInfo><Country>England</Country><MedlineTA>HIV Med</MedlineTA><NlmUniqueID>100897392</NlmUniqueID><ISSNLinking>1464-2662</ISSNLinking></MedlineJournalInfo><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">HIV</Keyword><Keyword MajorTopicYN="N">antiretroviral backbone</Keyword><Keyword MajorTopicYN="N">nucleoside reverse transcriptase inhibitor-reducing strategies</Keyword></KeywordList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="accepted"><Year>2017</Year><Month>06</Month><Day>07</Day></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2017</Year><Month>7</Month><Day>25</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2017</Year><Month>7</Month><Day>25</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2017</Year><Month>7</Month><Day>25</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>aheadofprint</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">28737291</ArticleId><ArticleId IdType="doi">10.1111/hiv.12534</ArticleId></ArticleIdList></PubmedData></pubmed></record>Pour manipuler ce document sous Unix (Dilib)
EXPLOR_STEP=$WICRI_ROOT/Wicri/Asie/explor/AustralieFrV1/Data/PubMed/Corpus
HfdSelect -h $EXPLOR_STEP/biblio.hfd -nk 000945 | SxmlIndent | more
Ou
HfdSelect -h $EXPLOR_AREA/Data/PubMed/Corpus/biblio.hfd -nk 000945 | SxmlIndent | more
Pour mettre un lien sur cette page dans le réseau Wicri
{{Explor lien
|wiki= Wicri/Asie
|area= AustralieFrV1
|flux= PubMed
|étape= Corpus
|type= RBID
|clé= pubmed:28737291
|texte= Nucleoside reverse transcriptase inhibitor-reducing strategies in HIV treatment: assessing the evidence.
}}
Pour générer des pages wiki
HfdIndexSelect -h $EXPLOR_AREA/Data/PubMed/Corpus/RBID.i -Sk "pubmed:28737291" \
| HfdSelect -Kh $EXPLOR_AREA/Data/PubMed/Corpus/biblio.hfd \
| NlmPubMed2Wicri -a AustralieFrV1
| This area was generated with Dilib version V0.6.33. |  |