HIV: quadruple vs triple combination antiretroviral therapy

Takeaway

• In treatment-naïve people with HIV, the effects of quadruple combination antiretroviral therapy (cART) were not better than triple cART for first-line treatment.

Why this matters

• Finding adds support to current guidelines and suggests no need to update recommendations of triple therapy on first-line treatment.

Study design

• Meta-analysis of 12 studies involving 4251 patients with HIV compared the effects of quadruple with triple cART in treatment-naive patients with HIV.
• Outcomes included undetectable HIV-1 RNA, CD4 T-cell count, virological failure, new AIDS-defining events, death, and severe adverse effects.
• Funding: None.

Key results

• Quadruple and triple cART demonstrated similar effects on all interested outcomes and none of the point estimates favoured quadruple cART.
• With the triple therapy as the reference group, the risk ratio (RR) was:
  • undetectable HIV-1 RNA (9 studies, n=3622; RR, 0.99; 95% CI, 0.93-1.05; I²=41%),
  • virological failure (5 studies, n=2887; RR, 1.00; 95% CI, 0.90-1.11; I²=23%),
  • new AIDS-defining events (3 studies, n=1338; RR, 1.17; 95% CI, 0.84-1.63; I²=0%),
  • death (5 studies, n=2379; RR, 1.23; 95% CI, 0.74-2.05; I²=0%), and
  • severe adverse effects (5 studies, n= 2951; RR, 1.09; 95% CI, 0.89-1.33; I²=48%).
• The overall mean difference in CD4 T-cell count increase between the groups was −19.55 cells/μL (95% CI, −43.02 to 3.92 cells/μL; I²=22%; 5 studies, n=1819).

Limitations

• Risk of bias.
• Heterogeneity among included studies.