A systematic review of a single-class maintenance strategy with nucleoside reverse transcriptase inhibitors in HIV/AIDS

BACKGROUND: Single drug class regimens with nucleotide reverse transcriptase inhibitors (NRTIs) are generally not recommended as initial therapy, because they were inferior compared to therapy with 2 NRTIs plus efavirenz. However triple-NRTI combinations can be useful in specific circumstances such as in tuberculosis co-infection, pregnancy, or dyslipidemia. Here, we review the potential of such combinations to maintain viral suppression after induction of suppression by standard combination antiretroviral therapy (cART), and to evaluate the trade-off of NRTI-only regimens for metabolic control. METHODS: We conducted a systematic search of the literature in two databases from 1 January, 1998, up to 1 March, 2013: Medline through the search engine PubMed, and Embase. RESULTS: A total of 11 randomized controlled trials (RCTs) with 2105 patients, and 3 observational studies with 2639 patients were included. Studies including patients with mono- or dual-NRTI treatment before start of effective cART, showed a tendency to higher failure rate due to resistance based on archived viral mutations. In studies with ART-naive subjects before start of cART, triple-NRTI combination showed virologic activity comparable to two NRTIs plus a protease inhibitor, or a nonnucleoside reverse transcriptase inhibitor in all RCTs, but not in one cohort study. Switching improved serum lipids significantly. CONCLUSIONS: Of the studied triple-NRTI combinations only abacavir/lamivudine/zidovudine was sufficiently potent. Triple-NRTI maintenance after successful induction with two-class cART appeared successful in treatment-naive subjects, and remains a useful option in specific circumstances, especially when other drugs are not available or drug interactions are an issue.

• Population(s)
  • General HIV+ population
  • Other
• Engagement and Care Cascade
  • Treatment