title: Immunovirological response to triple nucleotide reverse-transcriptase inhibitors and ritonavir-boosted protease inhibitors in treatment-naive HIV-2-infected patients: The ACHIEV2E Collaboration Study Group.
abstract: BACKGROUND
  Triple nucleoside reverse-transcriptase inhibitors (NRTIs) are recommended by the World Health Organization as first-line regimen in treatment-naïve HIV-2-infected patients. However, ritonavir-boosted protease inhibitor (PI/r)-containing regimens are frequently prescribed. In the absence of previous randomized trials, we retrospectively compared these regimens in observational cohorts.
  
  
  METHODS
  HIV-2-infected patients from 7 European cohorts who started triple NRTI or PI/r since January 1998 were included. Piecewise linear models were used to estimate CD4 cell count and plasma HIV-2 RNA level slopes, differentiating an early phase (until end of month 3) and a second phase (months 4-12). On-treatment analyses censored data at major treatment modification and systematically at month 12.
  
  
  RESULTS
  Forty-four patients started triple NRTI therapy and 126 started PI/r therapy. Overall, the median CD4 cell count was 191 cells/mm(3) and the median plasma HIV-2 RNA level was ≥2.7 log(10) copies/ml in 61% of the patients at combination antiretroviral therapy (cART) initiation; the median duration of the first cART was 20 months, not differing between groups. PI/r regimens were associated with better CD4 cell count and HIV-2 RNA level outcomes, compared with NRTI regimens. Estimated CD4 cell count slopes were +6 and +12 cells/mm(3)/month during the early phase (P = .22), and -60 cells/mm(3)/year versus +76 cells/mm(3)/year during the second phase (P = .002), for triple NRTI and PI/r, respectively. Estimated mean HIV-2 RNA levels at month 12 in patients with detectable viremia at cART initiation were 4.0 and 2.2 log(10) copies/ml, respectively (P = .005).
  
  
  CONCLUSIONS
  In this observational study, PI/r-containing regimens showed superior efficacy over triple NRTI regimens as first-line therapy in HIV-2-infected patients.
authors.affiliation: INSERM, U, France. antoine.benard@isped.u-bordeaux2.fr
authors.forename: Antoine
authors.initials: A
authors.lastname: Benard
authors.forename: Ard
authors.initials: A
authors.lastname: van Sighem
authors.forename: Audrey
authors.initials: A
authors.lastname: Taieb
authors.forename: Emilia
authors.initials: E
authors.lastname: Valadas
authors.forename: Jean
authors.initials: J
authors.lastname: Ruelle
authors.forename: Vicente
authors.initials: V
authors.lastname: Soriano
authors.forename: Alexandra
authors.initials: A
authors.lastname: Calmy
authors.forename: Claudia
authors.initials: C
authors.lastname: Balotta
authors.forename: Florence
authors.initials: F
authors.lastname: Damond
authors.forename: Françoise
authors.initials: F
authors.lastname: Brun-Vezinet
authors.forename: Geneviève
authors.initials: G
authors.lastname: Chene
authors.forename: Sophie
authors.initials: S
authors.lastname: Matheron
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D018791:CD4 Lymphocyte Count; D005060:Europe; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D017320:HIV Protease Inhibitors / Q000008:administration & dosage*; D015498:HIV-2 / Q000302:isolation & purification*; D006801:Humans; D012367:RNA, Viral / Q000097:blood; D012189:Retrospective Studies; D018894:Reverse Transcriptase Inhibitors / Q000008:administration & dosage*; D019438:Ritonavir / Q000008:administration & dosage*; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents; D017320:HIV Protease Inhibitors; D012367:RNA, Viral; D018894:Reverse Transcriptase Inhibitors; D019438:Ritonavir