A trio of Sustiva (efavirenz)-free combinations of antiretrovirals each worked well as a first-line treatment for HIV, although there were differences in tolerability. Publishing their findings in the Annals of Internal Medicine, researchers from the AIDS Clinical Trials Group conducted a Phase III randomized study of 1,809 treatment-naive HIV-positive people who had a viral load of greater than 1,000 at the outset.

Participants were divided into three treatment groups. All of them took Truvada (tenofovir/emtricitabine) plus: Reyataz (atazanavir) with Norvir (ritonavir); or Prezista (darunavir) with Norvir; or Isentress (raltegravir).

The regimens boasted greater than 92 percent viral suppression rates after 96 weeks of treatment. The investigators judged them equivalent in their ability to control the virus in the blood and to restore immune function. However, the Reyataz regimen was inferior in tolerability when compared with the other two regimens. When considering both virologic control and tolerability together, the best regimen was Isentress, followed by Prezista and then Reyataz.

“We are very pleased that our study showed the drug combinations tested, without efavirenz, are good options for initial HIV antiretroviral therapy,” the study’s principal investigator, Jeffrey Lennox, MD, a professor of medicine at Emory University School of Medicine and Grady Memorial Hospital, said in a press release. “This is critical information for patients who cannot tolerate efavirenz, and we believe this head-to-head comparison will provide useful information to guide clinicians about choosing among them.”

To read the study abstract, click here.

To read the press release, click here. (Note, the press release erroneously suggests that the study compared Sustiva-free regimens with Sustiva-containing regimens. The findings of this research cannot make claims as to the relative efficacy when comparing Sustiva-free regimens with Sustiva-containing regimens.)