SQV/r has been reported as non-inferior to LPV/r in terms of virological and safety outcomes [[26]]. The CCR5 antagonist MVC and unboosted ATV are not licensed in Europe for Selleckchem BTK inhibitor initial ART and as

such are not recommended. We recommend against the use of PI monotherapy as initial therapy for treatment-naïve patients (1C). Data on use of PI monotherapy as initial ART are limited. In one RCT comparing LPV/r vs. LPV/r plus ZDV and 3TC, the use of PI monotherapy as initial ART was associated with lower rates of virological suppression at 48 weeks and with the emergence of PI mutations [1]. There were no significant differences in tolerability. For this reason, PI monotherapy is not recommended as initial ART. However, as with other novel strategies there may be specific circumstances where a rationale for its use may be made. We recommend against the use of PI-based dual ART with a single NRTI, NNRTI, CCR5 receptor antagonist or INI as an initial therapy for treatment-naïve patients (1C). A number of studies have assessed the use of PI-based dual ART as initial therapy in treatment-naïve patients. Many of these are either open label (not powered to demonstrate non-inferiority compared with triple therapy), single-arm studies or have only been reported as conference abstracts.

The combination of an NNRTI with a PI/r has been shown to have similar virological efficacy compared with triple-combination regimens in one study [1]. There were no significant BGB324 cell line differences in time to either virological or regimen failure with a combination of LPV/r and EFV compared with either two NRTIs and EFV or two NRTIs and LPV/r. There was, however, an increased rate of drug resistance in the NRTI-sparing arm, with the emergence of more NNRTI-associated resistance mutations than the comparator arms. An increased rate of grade 3/4 toxicities was observed, predominantly low-density lipoprotein Pyruvate dehydrogenase cholesterol and triglyceride elevations. Comparison of a dual-therapy regimen containing one NRTI with

a PI/r (TDF and LPV/r vs. two NRTIs and LPV/r) failed to demonstrate non-inferiority of the dual-therapy arm compared with a standard triple-therapy combination [2]. The use of dual therapy with the CCR5-receptor antagonist MVC in combination with a PI/r has been assessed in one RCT but was not designed to show non-inferiority [3]. The comparative efficacy of the INI RAL plus a PI/r is being compared with standard triple therapy in several ongoing and/or unpublished studies [4-8]. Reports from one study [4, 5] suggest similar rates of virological suppression at 48 and 96 weeks. However, in a single-arm study investigating RAL in combination with DRV/r, a significantly increased risk of virological failure with emergent INI resistance was seen in patients with baseline VL >100 000 copies/mL compared with those with a baseline VL < 100 000 copies/mL [9].