Comparison of the Effectiveness of Low-Dose Indinavir/Ritonavir (IDV/r)- versus Atazanavir/Ritonavir (ATV/r)-Based Generic Antiretroviral Therapy in NNRTI-Experienced HIV-1-Infected Patients in India

Abstract

Background: Currently, data on the effectiveness of second-line antiretroviral regimens using indinavir/ritonavir (IDV/r) and atazanavir/ritonavir (ATV/r) along with 2 nucleoside reverse transcriptase inhibitor (NRTI) in resource-poor settings is limited. Methods: Observational follow-up study on 441 patients who experienced treatment failure to first-line nonnucleoside reverse transcriptase inhibitor (NNRTI)-based treatment. Multivariate Cox Proportional Hazards Model was used to assess comparative effectiveness of treatment regimens. Results: A total of 63 patients (14.8%) had failed second line treatments, of which 53 patients (17.2%) were using IDV/r while 10 patients (8.5%) were on ATV/r. After adjusting for age, weight, gender, and baseline CD4 count, patients who took IDV/r were more than twice as likely to experience treatment failure as compared to those who were on ATV/r (hazard ratio [HR] 2.18; 95% confidence interval [CI] 1.14, 4.15). Successful response to second-line therapy was not different between the 2 treatment groups when patients weighed less than 55 kg at baseline (log rank P value ¼ 1.00) in contrast to the individuals weighing 55 kg (P < .0001). Conclusion: We found that successful response to second-line therapy was twice as likely in the ATV/r group; however, this difference was eliminated in patients less than 55 kg.

Comparative efficacy and safety of second-line antiretroviral therapy for treatment of HIV/AIDS: a systematic review and network meta-analysis

“…We obtained data from 12 papers pertaining to eight studies (figure 1). [9][10][11][12][13][14][30][31][32][33][34][35] These studies included 4778 patients from five continents, and most studies were from resource-limited settings (table). The appendix provides a list of included and excluded studies at full-text review (pp 5-15).…”

“…We did fixed-effects network meta-analysis of the mean differences in change in CD4 cell count from baseline to 24 and 48 weeks, using results from six studies (five randomised controlled trials and two cohort studies) 10,11,14,31,[33][34][35] involving 4304 participants. Findings showed that increases in mean CD4 count were significantly higher with ritonavir-boosted lopinavir plus raltegravir than with ritonavir-boosted lopinavir plus two NRTIs at 48 weeks (mean difference 23•02 cells per µL, 95% CrI 10•09-36•17; figure 4).…”

Antimicrobial Resistance Pattern of Escherichia Coli From Urinary Tract Infections in Relation to ESBL and pap gene Production and Fosfomycin Sensitivity

“…The increase of multidrug-resistant (MDR) bacteria induced a renewed interest in old antibiotics, such as fosfomycin (6) . Because of its broad-spectrum activity,sustained urinary concentrationsand its safety profile.…”