Noninfectious HIV-related comorbidities and HAART toxicities: Choosing alternative antiretroviral strategies

HIV Therapy

Volumn 4, Issue 5, 2010, Pages 553-565

  Gazzola, Lidia ^a   Tincati, Camilla ^a   D'Arminio Monforte, Antonella ^a  

^a UNIVERSITY OF MILAN   (Italy)

Author keywords

HAART; HIV related comorbidity; new ARV classes; NRTI sparing regimen; toxicity

Indexed keywords

ABACAVIR; ANTIRETROVIRUS AGENT; ATAZANAVIR; ATAZANAVIR PLUS RITONAVIR; DARUNAVIR PLUS RITONAVIR; DIDANOSINE; EFAVIRENZ; EFAVIRENZ PLUS LAMIVUDINE PLUS ZIDOVUDINE; FOSAMPRENAVIR; INDINAVIR; LAMIVUDINE PLUS ZIDOVUDINE; LOPINAVIR PLUS RITONAVIR; MARAVIROC; NELFINAVIR; NEVIRAPINE; NONNUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITOR; PLACEBO; PROTEINASE INHIBITOR; RALTEGRAVIR; RITONAVIR; RNA DIRECTED DNA POLYMERASE INHIBITOR; SAQUINAVIR; STAVUDINE; TENOFOVIR; THYMIDINE DERIVATIVE; ZIDOVUDINE;

ACUTE KIDNEY FAILURE; BONE DENSITY; BONE DISEASE; CARDIOVASCULAR DISEASE; CARDIOVASCULAR RISK; CHOLESTEROL BLOOD LEVEL; CHRONIC KIDNEY DISEASE; COMORBIDITY; CRYSTALLURIA; DISEASE ASSOCIATION; DRUG EFFECT; DRUG EFFICACY; DRUG RESEARCH; DRUG SAFETY; DRUG SCREENING; DRUG TOLERABILITY; DRUG TREATMENT FAILURE; DRUG WITHDRAWAL; DYSLIPIDEMIA; DYSURIA; HEART INFARCTION; HIGHLY ACTIVE ANTIRETROVIRAL THERAPY; HOMEOSTASIS; HUMAN; HUMAN IMMUNODEFICIENCY VIRUS INFECTED PATIENT; HUMAN IMMUNODEFICIENCY VIRUS INFECTION; HYPERINSULINEMIA; HYPERLACTATEMIA; INSULIN RESISTANCE; KIDNEY DISEASE; KIDNEY INJURY; KIDNEY PAPILLA NECROSIS; KIDNEY TUBULE ACIDOSIS; LIPID BLOOD LEVEL; LIPOATROPHY; LIPODYSTROPHY; LIVER TOXICITY; METABOLIC DISORDER; METABOLIC SYNDROME X; MONOTHERAPY; MYOPATHY; NEPHROLITHIASIS; NEPHROTOXICITY; NONALCOHOLIC FATTY LIVER; NONHUMAN; OSTEOPOROSIS; PANCREATITIS; PERIPHERAL NEUROPATHY; PREMATURE AGING; REVIEW; RISK ASSESSMENT; SIDE EFFECT; TRIACYLGLYCEROL BLOOD LEVEL; UNSPECIFIED SIDE EFFECT;

EID: 78049484507     PISSN: 17584310     EISSN: None     Source Type: Journal    
DOI: 10.2217/hiv.10.44     Document Type: Review

References (90)

1. Palella FJ, Delaney K, Moorman A et al.: Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. N. Engl. J. Med. 338(13), 853-860 (1998).
2. Mocroft A, Vella S, Benfield T et al.: Changing patterns of mortality across Europe in patients infected with HIV-1. EuroSIDA Study Group. Lancet 352(9142), 1725-1730 (1998). (Pubitemid 28534954)
3. d'Arminio Monforte A, Sabin C, Phillips A et al.: The changing incidence of AIDS events in patients receiving highly active antiretroviral therapy. Arch. Intern. Med. 165(4), 416-423 (2005).
4. Collaboration ATC: Life expectancy of individuals on combination antiretroviral therapy in high-income countries: a collaborative analysis of 14 cohort studies. Lancet 372(9635), 293-299 (2008).
5. Obel N, Thomsen H, Kronborg G et al.: Ischemic heart disease in HIV-infected and HIV-uninfected individuals: a population-based cohort study. Clin. Infect. Dis. 44(12), 1625-1631 (2007).
6. Klein D, Hurley L, Quesenberry CJ, Sidney S: Do protease inhibitors increase the risk for coronary heart disease in patients with HIV-1 infection? J. Acquir. Immune Defic. Syndr. 30(5), 471-477 (2002).
7. Currier J, Taylor A, Boyd F et al.: Coronary heart disease in HIV-infected individuals. J. Acquir. Immune Defic. Syndr. 33(4), 506-512 (2003).
8. Brown T, Qaqish R: Antiretroviral therapy and the prevalence of osteopenia and osteoporosis: a meta-analytic review. AIDS 20(17), 2165-2174 (2006). Systematic review of the published literature on bone metabolism disorders aimed at determining the role of HIV, antiretroviral (ARV) therapy and protease inhibitor (PI)-based treatment in favoring bone mineral density (BMD) reduction and osteoporosis.
9. Odden M, Scherzer R, Bacchetti P et al.: Cystatin C level as a marker of kidney function in human immunodeficiency virus infection: the FRAM study. Arch. Intern. Med. 167(20), 2213-2219 (2007). (Pubitemid 350106741)
10. Lohse N, Hansen A, Pedersen G et al.: Survival of persons with and without HIV infection in Denmark, 1995-2005. Ann. Intern. Med. 146(2), 87-95 (2007).
11. Dubé M, Sattler F: Inflammation and complications of HIV disease. J. Infect. Dis. 201(12), 1783-1785 (2010).
12. Desai S, Landay A: Early immune senescence in HIV disease. Curr. HIV/AIDS Rep. 7(1), 4-10 (2010). Examines accelerated aging in HIV-infected people as a result of an activation-induced inflammatory condition, which is a consequence of a continuous antigenic-driven injury.
13. Appay V, Sauce D: Immune activation and inflammation in HIV-1 infection: causes and consequences. J. Pathol. 214(2), 231-241 (2008).
14. Desquilbet L, Jacobson L, Fried L et al.: HIV-1 infection is associated with an earlier occurrence of a phenotype related to frailty. J. Gerontol. A. Biol. Sci. Med. Sci. 62(11), 1279-1286 (2007).
15. Deeks S, Phillips A: HIV infection, antiretroviral treatment, ageing, and non-AIDS related morbidity. BMJ 338, A3172 (2009).
16. Carr A, Cooper D: Adverse effects of antiretroviral therapy. Lancet 356(9239), 1423-1430 (2000).
17. Reisler R, Han C, Burman W, Tedaldi E, Neaton J: Grade 4 events are as important as AIDS events in the era of HAART. J. Acquir. Immune Defic. Syndr. 34(4), 379-386 (2003). (Pubitemid 37444465)
18. + count-guided interruption of antiretroviral treatment. N. Engl. J. Med. 355(22), 2283-2296 (2006). Since there are many concerns regarding HAART-related complications at present, the SMART study has clearly demonstrated the risks of an intermittent ARV strategy.
19. Villarroya F, Domingo P, Giralt M: Drug-induced lipotoxicity: lipodystrophy associated with HIV-1 infection and antiretroviral treatment. Biochim. Biophys. Acta 1801(3), 392-399 (2010).
20. Haubrich R, Riddler S, Di Rienzo G et al.: Metabolic outcomes in a randomized trial of nucleoside, nonnucleoside and protease inhibitor-sparing regimens for initial HIV treatment. AIDS 23(9), 1109-1118 (2009). Metabolic outcomes of ACTG 5142: the changes in body fat composition and in fasting lipid profile have been examined in three different ARV regimens, non-nucleoside reverse transcriptase inhibitor (NNRTI)-based, PI-based and nucleoside reverse transcriptase inhibitor (NRTI)-sparing (NNRTI plus PI).
21. Hadigan C, Corcoran C, Stanley T et al.: Fasting hyperinsulinemia in human immunodeficiency virus-infected men: relationship to body composition, gonadal function, and protease inhibitor use. J. Clin. Endocrinol. Metab. 85(1), 35-41 (2000).
22. De Wit S, Sabin C, Weber R et al.: Incidence and risk factors for new-onset diabetes in HIV-infected patients. Diabetes Care 31(6), 1224-1229 (2008).
23. Yan Q, Hruz P: Direct comparison of the acute in vivo effects of HIV protease inhibitors on peripheral glucose disposal. J. Acquir. Immune Defic. Syndr. 40(4), 398-403 (2005).
24. Noor M, Flint O, Maa J, Parker R: Effects of atazanavir/ritonavir and lopinavir/ritonavir on glucose uptake and insulin sensitivity: demonstrable differences in vitro and clinically. AIDS 20(14), 1813-1821 (2006).
25. Mills A, Nelson M, Jayaweera D et al.: Once-daily darunavir/ritonavir vs lopinavir/ritonavir in treatment-naive, HIV-1-infected patients: 96-week analysis. AIDS 23(13), 1679-1688 (2009).
26. Mallolas J, Podzamczer D, Milinkovic A et al.: Efficacy and safety of switching from boosted lopinavir to boosted atazanavir in patients with virological suppression receiving a LPV/r-containing HAART: the ATAZIP study. J. Acquir. Immune Defic. Syndr. 51(1), 29-36 (2009).
27. El Hadri K, Glorian M, Monsempes C et al.: In vitro suppression of the lipogenic pathway by the nonnucleoside reverse transcriptase inhibitor efavirenz in 3T3 and human preadipocytes or adipocytes. J. Biol. Chem. 279(15), 15130-15141 (2004).
28. Friis-Møller N, Sabin C, Weber R et al.: Combination antiretroviral therapy and the risk of myocardial infarction. N. Engl. J. Med. 349(21), 1993-2003 (2003).
29. Friis-Møller N, Reiss P, Sabin C et al.: Class of antiretroviral drugs and the risk of myocardial infarction. N. Engl. J. Med. 356(17), 1723-1735 (2007)
30. Worm S, Sabin C, Weber R et al.: Risk of myocardial infarction in patients with HIV infection exposed to specific individual antiretroviral drugs from the 3 major drug classes: the data collection on adverse events of anti-HIV drugs (D:A:D) study. J. Infect. Dis. 201(3), 318-330 (2010). Results from the D:A:D study: the risk of myocardial infarction with exposure to single drugs from the three major ARV classes has been established.
31. Lang S, Mary-Krause M, Cotte L et al.: Impact of individual antiretroviral drugs on the risk of myocardial infarction in human immunodeficiency virus-infected patients: a case-control study nested within the French Hospital Database on HIV ANRS cohort CO4. Arch. Intern. Med. 170(14), 1228-1238 (2010).
32. Lundgren J, Neuhaus J, Babiker A et al.: Use of nucleoside reverse transcriptase inhibitors and risk of myocardial infarction in HIV-infected patients enrolled in the SMART study. Presented at: IAS. Mexico City, Mexico, 3-8 August, 2008.
33. Durand M, Sheehy O, Baril JG et al.: Relation between use of nucleoside reverse transcriptase inhibitors (NRTI) and risk of myocardial infarction (MI): a nested case control study using Quebec's public health insurance database (QPHID). Presented at: IAS. Cape Town, South Africa, 19-22 July 2009.
34. Brothers C, Hernandez J, Cutrell A et al.: Risk of myocardial infarction and abacavir therapy: no increased risk across 52 GlaxoSmithKline-sponsored clinical trials in adult subjects. J. Acquire. Immune Defic. Syndr. 51(1), 20-28 (2009).
35. th CROI. Montreal, Canada, 8-11 February 2009.
36. Currier J: Update on cardiovascular complications in HIV infection. Top. HIV Med. 17(3), 98-103 (2009).
37. Gallant J, Staszewski S, Pozniak A et al.: Efficacy and safety of tenofovir DF vs stavudine in combination therapy in antiretroviral-naive patients: a 3-year randomized trial. JAMA 292(2), 191-201 (2004).
38. Mallon P, Miller J, Cooper D, Carr A: Prospective evaluation of the effects of antiretroviral therapy on body composition in HIV-1-infected men starting therapy. AIDS 17(7), 971-979 (2003). (Pubitemid 36549708)
39. th CROI. San Francisco, CA, USA, 16-19 February 2010.
40. Röling J, Schmid H, Fischereder M, Draenert R, Goebel F: HIV-associated renal diseases and highly active antiretroviral therapy-induced nephropathy. Clin. Infect. Dis. 42(10), 1488-1495 (2006). The current knowledge about acute and chronic HIV-associated renal disease and the toxic drug effects of ARV therapies are reviewed.
41. Daugas E, Rougier J, Hill G: HAART-related nephropathies in HIV-infected patients. Kidney Int. 67(2), 393-403 (2005).
42. Chugh S, Bird R, Alexander E: Ritonavir and renal failure. N. Engl. J. Med. 336(2), 138 (1997).
43. Green S, McKendrick M, Schmid M, Mohsen A, Prakasam S: Renal calculi developing de novo in a patient taking saquinavir. Int. J. STD AIDS 9(9), 555 (1998).
44. Engeler D, John H, Rentsch K, Ruef C, Oertle D, Suter S: Nelfinavir urinary stones. J. Urol. 167(3), 1384-1385 (2002).
45. Brewster U, Perazella M: Acute interstitial nephritis associated with atazanavir, a new protease inhibitor. Am. J. Kidney Dis. 44(5), E81-E84 (2004).
46. Pacanowski J, Poirier JM, Petit I, Meynard JL, Girard PM: Atazanavir urinary stones in an HIV-infected patient. AIDS. 20(16), 2131 (2006).
47. Chang HR, Pella PM: Atazanavir urolithiasis. N. Engl. J. Med. 355(20), 2158-2159 (2006).
48. Anderson PL, Lichtenstein KA, Gerig NE, Kiser JJ, Bushman LR: Atazanavir-containing renal calculi in an HIV-infected patient. AIDS. 21(8), 1060-1062 (2007).
49. Mocroft A, Kirk O, Reiss P et al.: Estimated glomerular filtration rate, chronic kidney disease and antiretroviral drug use in HIV-positive patients. AIDS. 24(11), 1667-1678 (2010). The incidence of chronic kidney disease in EuroSIDA cohort and the relationship between chronic kidney disease and exposure to individual ARV drugs is described.
50. Barrios A, García-Benayas T, González-Lahoz J, Soriano V: Tenofovir-related nephrotoxicity in HIV-infected patients. AIDS 18(6), 960-963 (2004).
51. Peyrière H, Reynes J, Rouanet I et al.: Renal tubular dysfunction associated with tenofovir therapy: report of 7 cases. J. Acquir. Immune Defic. Syndr. 35(3), 269-273 (2004).
52. Mauss S, Berger F, Schmutz G: Antiretroviral therapy with tenofovir is associated with mild renal dysfunction. AIDS 19(1), 93-95 (2005). (Pubitemid 40111024)
53. Squires K, Pozniak A, Pierone GJ et al.: Tenofovir disoproxil fumarate in nucleoside-resistant HIV-1 infection: a randomized trial. Ann. Intern. Med. 139(5 Pt 1), 313-320 (2003).
54. Jones R, Stebbing J, Nelson M et al.: Renal dysfunction with tenofovir disoproxil fumarate-containing highly active antiretroviral therapy regimens is not observed more frequently: a cohort and case-control study. J. Acquir. Immune Defic. Syndr. 37(4), 1489-1495 (2004).
55. Cossarizza A, Moyle G: Antiretroviral nucleoside and nucleotide analogues and mitochondria. AIDS 18(2), 137-151 (2004).
56. Lonergan J, Behling C, Pfander H, Hassanein T, Mathews W: Hyperlactatemia and hepatic abnormalities in 10 human immunodeficiency virus-infected patients receiving nucleoside analogue combination regimens. Clin. Infect. Dis. 31(1), 162-166 (2000).
57. Joly V, Yeni P: Nucleoside analogue-sparing strategy for the treatment of chronic HIV infection: potential interest and clinical experience. Antivir. Ther. 10(1), 29-40 (2005).
58. Staszewski S, Morales-Ramirez J, Tashima K et al.: Efavirenz plus zidovudine and lamivudine, efavirenz plus indinavir, and indinavir plus zidovudine and lamivudine in the treatment of HIV-1 infection in adults. Study 006 Team. N. Engl. J. Med. 341(25), 1865-1873 (1999).
59. Negredo E, Moltó J, Burger D et al.: Lopinavir/ritonavir plus nevirapine as a nucleoside-sparing approach in antiretroviral-experienced patients (NEKA study). J. Acquir. Immune Defic. Syndr. 38(1), 47-52 (2005).
60. Negredo E, Miró O, Rodríguez-Santiago B et al.: Improvement of mitochondrial toxicity in patients receiving a nucleoside reverse-transcriptase inhibitor-sparing strategy: results from the Multicenter Study with Nevirapine and Kaletra (MULTINEKA). Clin. Infect. Dis. 49(6), 892-900 (2009).
61. Harris M, Coté H, Ochoa C et al.: A randomized, open-label study of a nucleoside analogue reverse transcriptase inhibitor-sparing regimen in antiretroviralnaive HIV-infected patients. J. Acquir. Immune Defic. Syndr. 50(3), 335-337 (2009).
62. Allavena C, Ferré V, Brunet-François C et al.: Efficacy and tolerability of a nucleoside reverse transcriptase inhibitor-sparing combination of lopinavir/ritonavir and efavirenz in HIV-1-infected patients. J. Acquir. Immune Defic. Syndr. 39(3), 300-306 (2005).
63. Riddler S, Haubrich R, DiRienzo A et al.: Class-sparing regimens for initial treatment of HIV-1 infection. N. Engl. J. Med. 358(20), 2095-2106 (2008). Results from ACTG 5142: the virologic efficacy, immunologic response and side-effect profile of three ARV regimens are compared: NNRTI-based, PI-based and NRTI-sparing (NNRTI plus PI).
64. Arribas J, Pulido F, Delgado R et al.: Lopinavir/ritonavir as single-drug therapy for maintenance of HIV-1 viral suppression: 48-week results of a randomized, controlled, open-label, proof-of-concept pilot clinical trial (OK Study). J. Acquir. Immune Defic. Syndr. 40(3), 280-287 (2005).
65. Pulido F, Arribas J, Delgado R et al.: Lopinavir-ritonavir monotherapy versus lopinavir-ritonavir and two nucleosides for maintenance therapy of HIV. AIDS 22(2), F1-F9 (2008).
66. Cameron D, da Silva B, Arribas J et al.: A 96-week comparison of lopinavir-ritonavir combination therapy followed by lopinavirritonavir monotherapy versus efavirenz combination therapy. J. Infect. Dis. 198(2), 234-240 (2008).
67. Bierman W, van Agtmael M, Nijhuis M, Danner S, Boucher C: HIV monotherapy with ritonavir-boosted protease inhibitors: a systematic review. AIDS 23(3), 279-291 (2009). Gives an overview of all ritonavir-boosted protease inhibitor-monotherapy studies and, by a meta-analytic review of randomized controlled trials, compares the efficacy of LPV/r monotherapy to triple ARV regimens.
68. Delfraissy J, Flandre P, Delaugerre C et al.: Lopinavir/ritonavir monotherapy or plus zidovudine and lamivudine in antiretroviralnaive HIV-infected patients. AIDS 22(3), 385-393 (2008).
69. Karlstrom O, Josephson F, Sonnerborg A: Early virologic rebound in a pilot trial of ritonavir-boosted atazanavir as maintenance monotherapy. J. Acquir. Immune Defic. Syndr. 44(4), 417-422 (2007) (Pubitemid 46555376)
70. Wilkin TJ, McKinnon JE, DiRienzo AG et al.: Regimen simplification to atazanavirritonavir alone as maintenance antiretroviral therapy : final 48-week clinical and virologic outcomes. J. Infect. Dis. 199(6), 866-871 (2009).
71. Arribas J, Horban A, Gerstoft J et al.: The MONET trial: darunavir/ritonavir with or without nucleoside analogues, for patients with HIV-RNA below 50 copies/ml. AIDS 24(2), 223-230 (2010). The first randomized controlled trial of ritonavir-boosted protease inhibitor monotherapy to show noninferior efficacy compared triple ARV regimens.
72. Katlama C, Valentin M, Algarte-Genin M: Efficacy of darunavir/ritonavir as single-drug maintenance therapy in patients with HIV-1 viral suppression: a randomized open-label non-inferiority trial, MONOI-ANRS 136. Presented at: IAS. Cape Town, South Africa, 19-22 July 2009.
73. Clumeck N, Dedes N, Pozniak A; EACS Executive Committee: Guidelines for clinical management and treatment of HIV infected adults in Europe, version 5. Presented at: 12th EACS. Cologne, Germany, 11-14 November 2009.
74. Lennox J, Dejesus E, Berger D et al.: Raltegravir versus efavirenz regimens in treatment-naive HIV-1-infected patients: 96-week efficacy, durability, subgroup, safety, and metabolic analyses. J. Acquir. Immune Defic. Syndr. 55(1), 39-48 (2010).
75. Steigbigel R, Cooper D, Kumar P et al.: Raltegravir with optimized background therapy for resistant HIV-1 infection. N. Engl. J. Med. 359(4), 339-354 (2008).
76. Eron J, Young B, Cooper D et al.: Switch to a raltegravir-based regimen versus continuation of a lopinavir-ritonavir-based regimen in stable HIV-infected patients with suppressed viraemia (SWITCHMRK 1 and 2): two multicentre, double-blind, randomised controlled trials. Lancet 375(9712), 396-407 (2010). Investigates the potential of a switching strategy from lopinavir/ritonavir to raltegravir: although an improvement in lipid profile was observed, patients switched to raltegravir experienced a higher rate of virologic rebound.
77. Martinez E, Larrousse M, Llibre JM et al.: Substitution of raltegravir for ritonavirboosted protease inhibitors in HIV-infected patients: the SPIRAL study. AIDS. 24(11), 1697-1707 (2010). In this study patients with sustained virologic suppression switching from a boosted-PI to raltegravir experienced an improvement in lipid profile and noninferior virologic efficacy.
78. Moltó J, Sanz-Moreno J, Valle M et al.: Minimal removal of raltegravir by hemodialysis in HIV-infected patients with end-stage renal disease. Antimicrob. Agents Chemother. 54(7), 3047-3048 (2010).
79. Cocchi S, Bonucchi D, Pulizzi R: Raltegravir and enfuvirtide as a 'bridge' antiretroviral therapy in kidney-transplanted patients with HIV infection receiving everolimus and low-dose cyclosporine: a case-control study. Presented at: ICAR. Brescia, Italy, 20-22 June 2010.
80. Zhu L, Mahnke L, Butterton J: Pharmacokinetics and safety of twice-daily atazanavir (300mg) and raltegravir (400mg) in healthy subjects. Presented at: 16th CROI. Montreal, Canada, 8-11 February 2009.
81. Ripamonti D, Maggiolo F, Bombana E: Efficacy, safety and tolerability of dual therapy with raltegravir and atazanavir in antiretroviral experienced patients. Presented at: IAS. Cape Town, South Africa, 19-22 July 2009.
82. Gulick R, Lalezari J, Goodrich J et al.: Maraviroc for previously treated patients with R5 HIV-1 infection. N. Engl. J. Med. 359(14), 1429-1441 (2008).
83. Saag M, Prudence I, Heera J: A multicenter, randomized, double-blind, comparative trial of a novel CCR5 antagonist, maraviroc versus efavirenz, both in combination with Combivir (zidovudine [ZDV]/lamivudine [3TC]), for the treatment of antiretroviral naive patients infected with R5 HIV 1: week 48 results of the MERIT study. Presented at: IAS. Sidney, Australia, 22-25 July 2007.
84. Quinones M, Martinez H, Jimenez F et al.: CC chemokine receptor 5 influences late-stage atherosclerosis. Atherosclerosis 195(1), E92-E103 (2007).
85. Zernecke A, Liehn E, Gao J, Kuziel W, Murphy P, Weber C: Deficiency in CCR5 but not CCR1 protects against neointima formation in atherosclerosis-prone mice: involvement of IL-10. Blood 107(11), 4240-4243 (2006).
86. Veillard N, Kwak B, Pelli G et al.: Antagonism of RANTES receptors reduces atherosclerotic plaque formation in mice. Circ. Res. 94(2), 253-261 (2004). (Pubitemid 38197459)
87. Gibellini D, De Crignis E, Ponti C et al.: HIV-1 triggers apoptosis in primary osteoblasts and HOBIT cells through TNFα activation. J. Med. Virol. 80(9), 1507-1514 (2008).
88. Corbeau P, Reynes J. CCR5 antagonism in HIV infection: ways, effects, and side effects. AIDS 23(15), 1931-1943 (2009). The biology of CCR5 is reviewed and the virological and immunological consequences of blocking CCR5 are discussed.
89. Mills A, Mildvan D, Podzamczer D et al.: Once-daily maraviroc (MVC) + atazanavir/ritonavir (ATV/r) vs emtricitabine/tenofovir (TDF/FTC) + ATV/r in treatment naive patients: a week 24 planned interim analysis. Presented at: IAS. Vienna, Austria, 18-23 July 2010.
90. DHHS Panel on Antiretroviral Guidelines for Adults and Adolescents: Guidelines for the use of antiretroviral agents in HIV-1 infected adults and adolescents. DC: Department of Health and Human Services, Washington, DC, USA, 2009 www.aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf