期刊
HIV CLINICAL TRIALS
卷 13, 期 3, 页码 119-130出版社
THOMAS LAND PUBLISHERS, INC
DOI: 10.1310/hct1303-119
关键词
integrase inhibitor; investigational regimen; nucleoside-sparing regimen; protease inhibitor; ritonavir-sparing regimen
资金
- Merck
- Pfizer
- Gilead Sciences
- Abbott
- GlaxoSmithKline
- Bristol-Myers Squibb
- Achillon
- Avexa
- Boehringer Ingelheim
- Hoffmann LaRoche
- Schering Plough
- Taimed
- Tobira
- Tibotec
- Vertex
- ViiV
- Janssen-Cilag
- Merck-Sharp and Dohme
- Roche
Background: Nucleoside and ritonavir (RTV) toxicities have led to increased interest in nucleoside reverse transcriptase inhibitors (NRTIs) and RTV-sparing antiretroviral regimens. SPARTAN was a multicenter, randomized, open-label, noncomparative pilot study evaluating the efficacy, safety, and resistance profile of an investigational NRTI- and RTV-sparing regimen (experimental atazanavir [ATV] dose 300 mg bid + raltegravir [RAL] 400 mg bid [ATV+RAL]). The reference regimen consisted of ATV 300 mg/RTV 100 mg qd + tenofovir (TDF) 300 mg/emtricitabine (FTC) 200 mg qd (ATV/r+TDF/FTC). Methods: Treatment-naive HIV-infected patients with HIV-RNA >= 5,000 copies/mL were randomized 2:1 to receive twice-daily ATV+RAL (n=63) or once-daily ATV/r+TDF/FTC (n=31). Efficacy at 24 weeks was determined by confirmed virologic response (CVR; HIV-RNA <50 copies/mL) with noncompleters counted as failures based on all treated subjects. Results: The proportion of patients with CVR HIV RNA <50 copies/mL at week 24 was 74.6% (47/63) in the ATV+RAL arm and 63.3% (19/30) in the ATV/r+TDF/FTC arm. Systemic exposure to AN in the ATV+RAL regimen was higher than historically observed with ATV/r+TDF/FTC. Incidence of Grade 4 hyperbilirubinemia was higher on ATV+RAL (20.6%; 13/63) than on ATV/r+TDF/FTC (0%). The criteria for resistance testing (virologic failure [VF]: HIV-RNA >= 400 copies/mL) was met in 6/63 patients on ATV+RAL, and 1/30 on ATV/r+TDF/FTC; 4 VFs on ATV+RAL developed RAL resistance. Conclusions: ATV+RAL, an experimental NRTI- and RN-sparing regimen, achieved virologic suppression rates comparable to current standards of care for treatment-naive patients. The overall profile did not appear optimal for further clinical development given its development of resistance to RAL and higher rates of hyperbilirubinemia with twice-daily ATV compared with ATV/RTV.
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