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Current U.S. Department of Health and Human Services guidelines list just four “preferred” regimens for first-line antiretroviral therapy, and all of them consist of tenofovir/FTC plus a third drug. Whether a nucleoside-sparing regimen can offer similar efficacy, while producing fewer side effects, has been of great interest.
In this single-arm, phase IIb, multicenter ACTG study, 112 treatment-naive patients received once-daily ritonavir-boosted darunavir plus twice-daily raltegravir. By week 48, 26% of patients had experienced virologic failure — and the rate was even higher (43%) in the subset of patients with baseline viral loads >100,000 copies/mL. Five of the 28 patients with virologic failure developed integrase resistance; all were fr…