Authors: John Hornberger Kit Simpson Ashwini Shewade Birgitta Dietz Robert Baran Thomas Podsadecki
Publish Date: 2010/10/07
Volume: 27, Issue: 11, Pages: 763-773
Abstract
Several national and international guidelines recommend the use of antiretroviral therapy containing a protease inhibitor PI with ritonavir RTV boosting for human immunodeficiency virus HIVinfected treatmentnaïve patients RTVboosted PIs such as lopinavir LPV/r atazanavir ATV + RTV darunavir DRV + RTV fosamprenavir FPV + RTV and saquinavir SQV + RTV are usually recommended in regimens for initial therapy The guideline recommendations are generally based on the clinical efficacy of the regimens A broadened perspective of assessing the evidence related to selection of a PI for optimal firstline therapy might consider additional factors for evaluation such as effectiveness in actual clinical practice and costeffectiveness of individual drugs in formulating recommendations Among the guidelinerecommended PIs LPV/r is one of the earliest PIs approved has been a wellrecognized boosted PI for treatmentnaïve patients in all guidelines and demonstrates the most evidence on longterm clinical and economic effectiveness Studies have shown its efficacy in various controlled and realworld settings in different populations the relationship of adherence to virologic efficacy and the implications of resistance when used in sequence with other PI regimens In the absence of published evidence for other guidelinerecommended PIs that will greatly facilitate a fully transparent comparative effectiveness evaluation the cumulative evidence from this broader perspective indicates all PIs should not be viewed as equally safe and effective across all patients for initial therapy nor should any single PI within the class be considered preferred for all treatmentnaïve patients
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