title: Effectiveness of antiretroviral therapy after protease inhibitor failure: an analytic overview.
abstract: To examine effectiveness of subsequent antiretroviral therapy (ART), studies published during the period of 1 January 1997 through 31 May 2003 involving patients who had failed a protease inhibitor (PI)-containing regimen and were switched to another regimen were reviewed. Twelve studies describing 1197 patients were analyzed. A total of 38% of patients had human immunodeficiency virus (HIV) RNA levels of <500 copies/mL at 24 weeks. After adjustment for baseline HIV RNA level, the rate of virologic suppression ranged from 16% for patients switching drugs within previously failed classes to 54% for nonnucleoside reverse-transcriptase inhibitor (NNRTI)-naive patients switched to boosted PI- and NNRTI-containing regimens. ART regimens in patients who failed a PI-containing regimen provided virologic suppression only in a few patients. The best response was seen in NNRTI-naive patients receiving NNRTI- and boosted PI-containing regimens. New approaches are needed to achieve better suppression in pretreated HIV-infected patients.
authors.affiliation: Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA. lenal@bu.edu
authors.forename: Elena
authors.initials: E
authors.lastname: Losina
authors.forename: Runa
authors.initials: R
authors.lastname: Islam
authors.forename: Alison C
authors.initials: AC
authors.lastname: Pollock
authors.forename: Paul E
authors.initials: PE
authors.lastname: Sax
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Freedberg
authors.forename: Rochelle P
authors.initials: RP
authors.lastname: Walensky
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D002986:Clinical Trials as Topic; D015331:Cohort Studies; D004334:Drug Administration Schedule; D017320:HIV Protease Inhibitors / Q000627:therapeutic use*; D054303:HIV Reverse Transcriptase / Q000037:antagonists & inhibitors; D015497:HIV-1 / Q000187:drug effects / Q000201:enzymology / Q000254:growth & development; D006801:Humans; D011446:Prospective Studies; D012367:RNA, Viral / Q000097:blood; D012189:Retrospective Studies; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*; D017211:Treatment Failure; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents; D017320:HIV Protease Inhibitors; D012367:RNA, Viral; D018894:Reverse Transcriptase Inhibitors; D054303:HIV Reverse Transcriptase