Protease inhibitor vs non-nucleoside reverse transcriptase inhibitor as a component of initial HAART
Highly active antiretroviral regimens that included a drug from the group of non-nucleoside reverse transcriptase inhibitors suppressed HIV activity to a greater extent than regimens that included a drug from the protease inhibitor group.
The question of choosing between a group of protease inhibitors (PIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs) as the optimal component of initial highly active antiretroviral therapy (HAART) remains an open question. An indirect comparative analysis carried out previously showed the advantage of the HAART mode, which includes IP, over the mode, including NNRTI. However, the results of indirect comparisons are not as reliable as the results of direct comparisons.
The purpose of the meta-analysis performed by R. Chou et al. (USA), this was a direct comparison of the HAART modes above with a subsequent comparison of the data obtained with the results of the indirect analysis. Data included 12 studies of at least 24 weeks duration, in which a comparative evaluation of HAART regimens, including NNRTIs and NPs, in the treatment of HIV-infected patients with limited experience or absence complete history of use of antiretroviral drugs has been performed. The authors of the work also selected 14 studies for the indirect comparison: 6 for the study of the HAART diet, including NNRTIs, and 8 for PI, in comparison with HAART, which included nucleoside inhibitors of reverse transcriptase.
According to the results of a direct meta-analysis, the use of HAART modes, including NNRTIs, led to a more pronounced suppression of viral activity compared to the use of modes that included PI (odds ratio ( OR) 1.60, 95% confidence interval (CI) 1.31- 1.96). The degree of difference was less pronounced in works with a high quality methodology, but the advantage of HAART, including NNRTIs, remained. Significant differences in the frequency of infection progression and death (OS 0.87, 95% CI 0.56-1.35), as well as discontinuation of treatment due to the development of adverse events (OS 0.68, 95% CI 0.43-1.08) were not detected.
At the same time, indirect analysis showed a lower degree of suppression of viral activity when using modes that included NNRTIs, compared to modes that included PI (OR 0.26, CI 95 % 0.07-0.91). Significant differences in the frequency of infection progression and the development of fatal outcomes (OS 1.28, 95% CI 0.56-2.94), as well as discontinuation of therapy due to the development of adverse events (OS 1.46, 95% CI 0.66-3.24) have not been identified.
Thus, according to the results of a direct analysis, highly active antiretroviral therapy regimens, including the drug from the group of non-nucleoside reverse transcriptase inhibitors, suppressed HIV activity to a greater extent than regimens that included the drug from the group of protease inhibitors, while the results of treatment did not differ significantly. The results of indirect comparisons, according to the authors of the book, may not be reliable for complex medical interventions such as HAART.