Effectiveness of protease inhibitor monotherapy versus combination antiretroviral maintenance therapy: a meta-analysis

The unparalleled success of combination antiretroviral therapy (cART) is based on the combination of three drugs from two classes. There is insufficient evidence whether simplification to ritonavir boosted protease inhibitor (PI/r) monotherapy in virologically suppressed HIV-infected patients is eff...

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Bibliographic Details
Published in:PloS one 2011-07, Vol.6 (7), p.e22003-e22003
Main Authors: Mathis, Sandra, Khanlari, Bettina, Pulido, Federico, Schechter, Mauro, Negredo, Eugenia, Nelson, Mark, Vernazza, Pietro, Cahn, Pedro, Meynard, Jean-Luc, Arribas, Jose, Bucher, Heiner C
Format: Article
Language:English
Subjects:
Acquired immune deficiency syndrome
AIDS
Antiretroviral agents
Antiretroviral drugs
Antiretroviral therapy
Care and treatment
Clinical trials
Clinical Trials as Topic
DNA polymerases
Drug Therapy, Combination
Drugs
Failure analysis
Follow-Up Studies
Heterogeneity
Highly active antiretroviral therapy
HIV
HIV Infections - drug therapy
HIV Infections - virology
HIV patients
HIV Protease Inhibitors - therapeutic use
Human immunodeficiency virus
Humans
Inhibitors
Intention to Treat Analysis
Maintenance Chemotherapy
Medicine
Meta-analysis
Motivation
Patients
Protease
Protease inhibitors
Proteases
Randomization
Reintroduction
Risk
Risk Factors
Ritonavir
RNA-directed DNA polymerase
Side effects
Therapy
Treatment Outcome
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Summary:The unparalleled success of combination antiretroviral therapy (cART) is based on the combination of three drugs from two classes. There is insufficient evidence whether simplification to ritonavir boosted protease inhibitor (PI/r) monotherapy in virologically suppressed HIV-infected patients is effective and safe to reduce cART side effects and costs. We systematically searched Medline, Embase, the Cochrane Library, conference proceedings and trial registries to identify all randomised controlled trials comparing PI/r monotherapy to cART in suppressed patients. We calculated in an intention to treat (loss-of follow-up, discontinuation of assigned drugs equals failure) and per-protocol analysis (exclusion of protocol violators following randomisation) and based on three different definitions for virological failure pooled risk ratios for remaining virologically suppressed. We identified 10 trials comparing 3 different PIs with cART based on a PI/r plus 2 reverse transcriptase inhibitors in 1189 patients. With the most conservative approach (viral load
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0022003