On the basis of greater potential for adverse events and higher RTV dose and pill burden than ATV/r and DRV/r, the DHHS Panel recommends LPV/r+TDF/FTC or LPV/r+ABC/3TC as other regimens. There aren’t any studies specifically examining this regimen, but on 7 year follow-up for LPV/r and 2 NRTI’s patients demonstrated sustained virological suppression (Murphy 2008). However, patients who received LPV/r and 2 NRTIs achieved virological suppression less frequently than patients who received EFV plus 2 NRTIs in the ACTG 5142 study (Riddler 2008).
*There is evidence that TAF can be substited for TDF without loss of efficacy and with an improved side effect profile, particularly less impact on kidney function and on bone loss (Sax 2014).
Efficacy in clinical trials:
- A 7-year follow-up study of LPV/r and 2 NRTIs showed sustained virologic suppression in patients who were maintained on the originally assigned regimen (Murphy 2008).
- In the ACTG 5142 study, at 96 weeks, a smaller proportion of patients who received LPV/r plus 2 NRTIs achieved viral suppression (HIV RNA <50 copies/mL) than those who received EFV plus 2 NRTIs. However, the CD4 cell response was greater with LPV/r, and there was less drug resistance associated with virologic failure (Riddler 2008).
- Riddler SA, Haubrich R, DiRienzo AG, et al. Class-sparing regimens for initial treatment of HIV-1 infection. N Engl J Med. 2008;358(20):2095-2106. Available at PubMed.
- Murphy RL, da Silva BA, Hicks CB, et al. Seven-year efficacy of a lopinavir/ritonavir-based regimen in antiretroviral lnaive HIV-1-infected patients. HIV Clin Trials. 2008;9(1):1-10. Available at PubMed.
- Sax PE, Zolopa A, Brar I et al. Tenofovir Alafenamide Vs. Tenofovir Disoproxil Fumarate in Single Tablet Regimens for Initial HIV-1 Therapy. JAIDS 67.1 (2014): 52-58. Web.
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