Journal Article

Lopinavir–Ritonavir versus Nelfinavir for the Initial Treatment of HIV Infection

Ruane, Peter, Walmsley, Sharon, Johnson, Margaret, Lalonde, Richard, Japour, Anthony, Brun, Scott, Beall, Gildon, Bernstein, Barry, Arribas, José, Johnson, David, King, Martin, Sun, Eugene

2002

Overview

In this study of the initial treatment of human immunodeficiency virus (HIV) infection, 653 patients were randomly assigned to treatment with either lopinavir–ritonavir or nelfinavir. All patients also received stavudine and lamivudine. After 48 weeks, there was suppression of HIV RNA to fewer than 50 copies per milliliter in 67 percent of the patients in the lopinavir–ritonavir group, as compared with 52 percent of those in the nelfinavir group (P<0.001). Protease inhibitor–based combination antiretroviral therapy has led to dramatic improvements in morbidity and mortality associated with human immunodeficiency virus (HIV) infection. 1 – 4 However, virologic failure occurs within 12 months in up to 50 percent of patients in whom combination antiretroviral therapy is initiated. 5 – 7 Major factors contributing to failure are poor tolerability and toxicity of the drugs, incomplete adherence to the regimen on the part of patients, and pharmacokinetic properties that result in trough concentrations close to or below the levels required to inhibit HIV replication effectively. 8 , 9 Lopinavir is a novel peptidomimetic protease inhibitor with potent in vitro activity . . .

• Publisher: Massachusetts Medical Society
• Subject: Adult / Aged / Aged, 80 and over / Anti-HIV Agents - administration & dosage / Anti-HIV Agents - therapeutic use / Antibiotics. Antiinfectious agents. Antiparasitic agents / Antiretroviral Therapy, Highly Active / Antiviral agents / Biological and medical sciences / CD4 Lymphocyte Count / Double-Blind Method / Drug Resistance, Viral / Drug therapy / Female / HIV / HIV Infections - drug therapy / HIV Infections - immunology / HIV Infections - virology / HIV Protease Inhibitors - administration & dosage / HIV Protease Inhibitors - therapeutic use / HIV-1 - genetics / Human immunodeficiency virus / Humans / Infections / Lamivudine - administration & dosage / Lamivudine - therapeutic use / Lopinavir / Male / Medical sciences / Middle Aged / Nelfinavir - administration & dosage / Nelfinavir - therapeutic use / Pharmacology. Drug treatments / Proportional Hazards Models / Pyrimidinones - administration & dosage / Pyrimidinones - therapeutic use / Reverse Transcriptase Inhibitors - administration & dosage / Reverse Transcriptase Inhibitors - therapeutic use / Ritonavir - administration & dosage / Ritonavir - therapeutic use / Stavudine - administration & dosage / Stavudine - therapeutic use / Survival Analysis / Viral Load