Is Long-Term Treatment Better with Raltegravir Than with Efavirenz?

Initial therapy with raltegravir is a preferred option in U.S. treatment guidelines, largely because of the results of the STARTMRK trial, which compared raltegravir with efavirenz and was funded by the manufacturer of raltegravir. Although the primary analysis of the trial was at week 48, the study continued for 5 years. Now, the investigators report the final results.

Initially, 563 treatment-naive HIV-infected adults were randomized to receive either twice-daily raltegravir or once-daily efavirenz, along with matching placebo; all participants also received coformulated tenofovir/FTC, for a daily burden of four pills. A total of 210 patients in the raltegravir group and 184 in the efavirenz group completed the entire 5-year study. In an a…