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No new nucleoside reverse transcriptase inhibitor (NRTI) has been approved since 2004, but guidelines continue to lean heavily on NRTI-based combinations. With drugs from six different antiretroviral classes now available, one would expect that a successful NRTI-sparing regimen could be developed. However, every NRTI-sparing regimen evaluated so far has failed to deliver, including two that were tested in 2011.
The first of these regimens — once-daily ritonavir-boosted darunavir + twice-daily raltegravir — yielded an unacceptably high failure rate of 26% at 48 weeks in a single-arm multicenter study involving 112 treatment-naive patients (JW AIDS Clin Care Sep 12 2011). The second regimen — ritonavir-boosted atazanavir + maraviroc — was test…