Parsing the Options from Comparative Trials of Initial Antiretroviral Therapy

As options for first-line HIV therapy have become more potent and more tolerable, the range of appropriate choices for treatment-naive patients has expanded. Several reports presented at the 15th Retrovirus Conference described such choices.

In the CASTLE study, investigators compared once-daily boosted atazanavir with twice-daily lopinavir/ritonavir (soft gel-cap formulation), each with tenofovir/FTC, among 883 treatment-naive patients with baseline viral loads ≥5000 copies/mL [Abstract 37]. Although this study (sponsored by the maker of atazanavir) is slated to last 96 weeks, the primary endpoint is the proportion of patients with viral loads <50 copies/mL at 48 weeks. Seventy-eight percent of the boosted-atazanavir group achieved this goa…