KUALA LUMPUR, Malaysia — In a comparison of HIV treatments, the single-tablet regimen did not come out on top, contrary to expectations. It had a less durable response than a combination therapy.

This counterintuitive result was a topic of debate after the data were presented here at the 7th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention.

Lead investigator Benoit Trottier, MD, and his team from the Clinique médicale L'Actuel in Montreal retrospectively analyzed 586 people with AIDS.

Patients initially received a single-tablet regimen of efavirenz, emtricitabine, and tenofovir (Atripla) or a combination therapy. The 3 combination regimens consisted of 2 nucleoside reverse-transcriptase inhibitors plus raltegravir, plus darunavir and ritonavir, or plus atazanavir and ritonavir.

At baseline, the median viral load was 4.7 log10 HIV RNA copies/mL, with 36% of patients having more than 100,000 copies/mL, and the median CD4 count was 310 cells/mm³, with 16% having fewer than 200 cells/mm³. Median follow-up time was 2.7 years.

 
Even with a higher pill burden and a twice-daily schedule, the initial use of raltegravir-based regimens was associated with a better outcome.
 

There was no statistical difference in the rate of discontinuation between the single-table regimen and the combination regimens (33% vs 37%; = .168). However, after adjustment, a stratified analysis suggested that patients whose initial therapy was the raltegravir regimen were more likely to remain on that treatment than those whose initial therapy was the darunavir combination or, more importantly, the single-tablet regimen (= .002).

Of note, the study did not look at treatment efficacy.

"Even with a higher pill burden and a twice-daily schedule, the initial use of raltegravir-based regimens was associated with a better outcome," Dr. Trottier reported.

"Raltegravir has proven to be durable in other studies, so I am not completely surprised," said Iskandar Azwa, from the University of Malaya in Kuala Lumpur, Malaysia. "I'm a strong believer in raltegravir. It's a good clean drug with a minimal side-effect profile."

However, "all other studies so far suggest that single-tablet regimens generally do better overall, so that was a bit of a surprise," he told Medscape Medical News.

Session chair Joel Gallant, MD, from Johns Hopkins University School of Medicine in Baltimore, explained that "we know that Atripla is associated with neuropsychiatric side effects [because of the efavirenz component], which lead to discontinuation in some patients." So the observed inferiority was likely related to the specific single-tablet regimen used, not such regimens in general, he noted.

Dr. Trottier, Dr. Azwa, and Dr. Gallant have disclosed no relevant financial relationships.

The 7th International AIDS Society (IAS) Conference on HIV Pathogenesis, Treatment and Prevention: Abstract TUPDB0106. Presented July 2, 2013.

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