Efavirenz-containing antiretroviral regimens are recommended as first-line therapy for HIV infection. However, efavirenz is not suitable for certain patients, including women contemplating pregnancy and those with severe psychiatric conditions.
A randomised open-label clinical trial, published in the Annals of Internal Medicine (2014;161(7):461-471)
, evaluated alternatives to efavirenz in 1,809 treatment-naÃ¯ve HIV-infected patients. Over two years, all three regimens — atazanavir/ritonavir, raltegravir and darunavir/ritonavir — showed equivalent, high rates of virologic control.
Tolerability differed among the treatments, with ritonavir-boosted atazanavir resulting in higher discontinuation rates than the other regimens, primarily because of hyperbilirubinaemia. “For combined virologic efficacy and tolerability, ritonavir-boosted darunavir was superior to ritonavir-boosted atazanavir, and raltegravir was superior to both protease inhibitors,” write Jeffrey Lennox, from Emory University, Georgia, and co-authors.
 Lennox JL, Landovitz RJ, Ribaudo HJ et al. Efficacy and tolerability of 3 nonnucleoside reverse transcriptase inhibitor–sparing antiretroviral regimens for treatment-naÃ¯ve volunteers infected with HIV-1: A randomized, controlled equivalence trial. Annals of Internal Medicine 2014;161(7):461-471.