Initial Antiretroviral Therapy: A Two-Class Combination is Optimal

Strategies for initial HIV antiretroviral therapy generally consist of either a protease inhibitor (PI) or a non-nucleoside reverse transcriptase inhibitor (NNRTI) added to a “backbone” of two nucleoside reverse transcriptase inhibitors (NRTIs). Most randomized trials comparing these strategies have measured short-term effects on viral replication, rather than long-term clinical outcomes.

In one of the first trials to assess clinical outcomes, 1397 treatment-naïve patients (median CD4 cell count 163/mm³) were randomized to initial treatment with one of the two-class strategies (2 NRTIs, plus either 1 NNRTI or 1 or 2 PIs) or a three-class strategy (1 or 2 NRTIs, plus 1 or 2 PIs, plus 1 NNRTI). Clinicians and patients selected drugs within the…