Ritonavir-Boosted Darunavir Plus Two Nucleoside Reverse Transcriptase Inhibitors versus Other Regimens for Initial Antiretroviral Therapy for People with HIV Infection: A Systematic Review
Background. Darunavir is a second-generation protease-inhibitor used with ritonavir (DRV/r) and two nucleoside reverse-transcriptase inhibitors as an option in first-line antiretroviral treatment (ART). Methods. We systematically reviewed randomized controlled trials (RCTs) of DRV/r versus other reg...
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| Format: | Article |
| Language: | English |
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Wiley
2017-01-01
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| Series: | AIDS Research and Treatment |
| Online Access: | http://dx.doi.org/10.1155/2017/2345617 |
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| author | Tatevik Balayan Hacsi Horvath George W. Rutherford |
| author_facet | Tatevik Balayan Hacsi Horvath George W. Rutherford |
| author_sort | Tatevik Balayan |
| collection | DOAJ |
| description | Background. Darunavir is a second-generation protease-inhibitor used with ritonavir (DRV/r) and two nucleoside reverse-transcriptase inhibitors as an option in first-line antiretroviral treatment (ART). Methods. We systematically reviewed randomized controlled trials (RCTs) of DRV/r versus other regimens in patients initiating ART. We searched five bibliographic databases and other key resources. We had no language limitations. We assessed bias risk with the Cochrane tool and used GRADE to assess evidence quality. We report findings in terms of risk ratio (RR) with 95% confidence intervals (CI). Findings. Three RCTs met inclusion criteria. In plasma viral load suppression, DRV/r outperformed ritonavir-boosted lopinavir at 48 weeks (RR 1.13, 95% CI 1.03–1.25), 96 weeks (RR 1.11, 95% CI 1.02–1.21), and 192 weeks (RR 1.20, 95% CI 1.07–1.35). DRV/r was similar to dolutegravir at 48 weeks (RR 0.96, 95% CI 0.87–1.06) but less effective at 96 weeks (RR 0.84, 95% CI 0.75–0.93). At 96 weeks, DRV/r underperformed raltegravir (RR 0.94, 95% CI 0.88–0.99) but was similar to ritonavir-boosted atazanavir (RR 1.02, 95% CI 0.96–1.09). Overall bias risk was moderate. Evidence quality was also moderate. Interpretation. Initial ART regimens using DRV/r should be considered in future World Health Organization guidelines. |
| format | Article |
| id | doaj-art-7f9451e4019d4b918299a3260607065c |
| institution | Kabale University |
| issn | 2090-1240 2090-1259 |
| language | English |
| publishDate | 2017-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | AIDS Research and Treatment |
| spelling | doaj-art-7f9451e4019d4b918299a3260607065c2025-08-20T03:35:20ZengWileyAIDS Research and Treatment2090-12402090-12592017-01-01201710.1155/2017/23456172345617Ritonavir-Boosted Darunavir Plus Two Nucleoside Reverse Transcriptase Inhibitors versus Other Regimens for Initial Antiretroviral Therapy for People with HIV Infection: A Systematic ReviewTatevik Balayan0Hacsi Horvath1George W. Rutherford2Global Health Sciences, University of California, San Francisco, San Francisco, CA, USAGlobal Health Sciences, University of California, San Francisco, San Francisco, CA, USAGlobal Health Sciences, University of California, San Francisco, San Francisco, CA, USABackground. Darunavir is a second-generation protease-inhibitor used with ritonavir (DRV/r) and two nucleoside reverse-transcriptase inhibitors as an option in first-line antiretroviral treatment (ART). Methods. We systematically reviewed randomized controlled trials (RCTs) of DRV/r versus other regimens in patients initiating ART. We searched five bibliographic databases and other key resources. We had no language limitations. We assessed bias risk with the Cochrane tool and used GRADE to assess evidence quality. We report findings in terms of risk ratio (RR) with 95% confidence intervals (CI). Findings. Three RCTs met inclusion criteria. In plasma viral load suppression, DRV/r outperformed ritonavir-boosted lopinavir at 48 weeks (RR 1.13, 95% CI 1.03–1.25), 96 weeks (RR 1.11, 95% CI 1.02–1.21), and 192 weeks (RR 1.20, 95% CI 1.07–1.35). DRV/r was similar to dolutegravir at 48 weeks (RR 0.96, 95% CI 0.87–1.06) but less effective at 96 weeks (RR 0.84, 95% CI 0.75–0.93). At 96 weeks, DRV/r underperformed raltegravir (RR 0.94, 95% CI 0.88–0.99) but was similar to ritonavir-boosted atazanavir (RR 1.02, 95% CI 0.96–1.09). Overall bias risk was moderate. Evidence quality was also moderate. Interpretation. Initial ART regimens using DRV/r should be considered in future World Health Organization guidelines.http://dx.doi.org/10.1155/2017/2345617 |
| spellingShingle | Tatevik Balayan Hacsi Horvath George W. Rutherford Ritonavir-Boosted Darunavir Plus Two Nucleoside Reverse Transcriptase Inhibitors versus Other Regimens for Initial Antiretroviral Therapy for People with HIV Infection: A Systematic Review AIDS Research and Treatment |
| title | Ritonavir-Boosted Darunavir Plus Two Nucleoside Reverse Transcriptase Inhibitors versus Other Regimens for Initial Antiretroviral Therapy for People with HIV Infection: A Systematic Review |
| title_full | Ritonavir-Boosted Darunavir Plus Two Nucleoside Reverse Transcriptase Inhibitors versus Other Regimens for Initial Antiretroviral Therapy for People with HIV Infection: A Systematic Review |
| title_fullStr | Ritonavir-Boosted Darunavir Plus Two Nucleoside Reverse Transcriptase Inhibitors versus Other Regimens for Initial Antiretroviral Therapy for People with HIV Infection: A Systematic Review |
| title_full_unstemmed | Ritonavir-Boosted Darunavir Plus Two Nucleoside Reverse Transcriptase Inhibitors versus Other Regimens for Initial Antiretroviral Therapy for People with HIV Infection: A Systematic Review |
| title_short | Ritonavir-Boosted Darunavir Plus Two Nucleoside Reverse Transcriptase Inhibitors versus Other Regimens for Initial Antiretroviral Therapy for People with HIV Infection: A Systematic Review |
| title_sort | ritonavir boosted darunavir plus two nucleoside reverse transcriptase inhibitors versus other regimens for initial antiretroviral therapy for people with hiv infection a systematic review |
| url | http://dx.doi.org/10.1155/2017/2345617 |
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