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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\u003Cp id=\u0022p-1\u0022\u003EIn the ADVANZ-3 trial, among patients with advanced HIV-1, 96 weeks of daily combination treatment with efavirenz plus tenofovir\/emtricitabine is as effective in increasing CD4+ T-cell levels as daily combination treatment using atazanavir\/ritonavir plus tenofovir\/emtricitabine or lopinavir\/ritonavir plus tenofovir\/emtricitabine. Similar improvements are also seen for inflammation, coagulation, and bacterial translocation markers.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Eefavirenz\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHIV-1\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EADVANZ-3\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ENCT00532168\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eatazanavir\/ritonavir\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Elopinavir\/ritonavir\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Etenofovir\/emtricitabine\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ecombined antiretroviral therapy\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHIV \u0026amp; AIDS\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Einfectious diseases clinical trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\u003Cp id=\u0022p-2\u0022\u003EFinal results of the ADVANZ-3 trial [\u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00532168\u0026amp;atom=%2Fspmdc%2F15%2F48%2F20.atom\u0022\u003ENCT00532168\u003C\/a\u003E], presented by Christian Manzardo, MD, PhD, Hospital Clinic-IDIBAPS, Barcelona, Spain, confirmed that efavirenz (EFV)-based therapy is appropriate for HIV-1\u2013infected patients with very low CD4 T-cell counts and high plasma HIV-1 RNA levels, provided they are adherent to therapy and do not have transmitted drug-resistant mutations.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EIt is not known whether the type of combination antiretroviral therapy (cART) regimen (ie, a protease inhibitor [PI]\u2013based vs nonnucleoside reverse transcriptase inhibitor\u2013based regimen) impacts treatment outcomes in highly suppressed patients with HIV-1. In addition, only limited data exist concerning the effects of cART on bacterial translocation, inflammation, coagulation, and immune activation in patients with advanced HIV-1 infection.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EThe ADVANZ-3 trial was a randomized, controlled, open-label, multicenter phase 4 study to compare the immunological reconstitution and the virologic efficacy and safety of 3 different combinations of antiretroviral therapy given once a day. The study included antiretroviral-na\u00efve, HIV-1\u2013infected adults with very low CD4 cell counts (\u0026lt;\u2005100 CD4 cells\/mm\u003Csup\u003E3\u003C\/sup\u003E) and no drug resistance mutations at baseline.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EParticipants were randomized 1:1:1 to EFV 600 mg QD (n\u2005=\u200529), atazanavir\/ritonavir 300\/100 mg QD (n\u2005=\u200530), or lopinavir\/ritonavir (LPV\/r) 400\/100 mg BID (n\u2005=\u200530) in addition to tenofovir\/emtricitabine QD for 96 weeks. The primary study outcome was the median increase in the CD4+ T-cell count at week 48. Secondary end points included the proportion of patients with plasma HIV-1 viral load \u0026lt;\u200550 copies\/mL; the incidence of side effects; disease progression and death; and changes in the markers of immune activation and senescence, apoptosis, inflammation, bacterial translocation, and coagulation.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EAt baseline, participants (mean age 38 years; 82% men) had a median CD4 cell count of 34 cells\/mm\u003Csup\u003E3\u003C\/sup\u003E and a median plasma viral load of 5.26 log\u003Csup\u003E10\u003C\/sup\u003E\/mL. After 96 weeks, all 3 treatments were associated with increases in CD4+ T-cell counts (+284 cells\/mm\u003Csup\u003E3\u003C\/sup\u003E in the EFV arm, +295 in the atazanavir\/ritonavir group, and +345 among those treated with LPV\/r; \u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/48\/20\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Median Increase in CD4+ T-Cell Counta                ATV\/r, atazanavir\/ritonavir; EFV, efavirenz; LPV\/r, lopinavir\/ritonavir.                   aOn-treatment analysis.Reproduced with permission from C Manzardo, MD, PhD.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-953662290\u0022 data-figure-caption=\u0022\u0026amp;lt;div xmlns=\u0026amp;quot;http:\/\/www.w3.org\/1999\/xhtml\u0026amp;quot;\u0026amp;gt;Median Increase in CD4+ T-Cell Count\u0026amp;lt;sup\u0026amp;gt;a\u0026amp;lt;\/sup\u0026amp;gt;                ATV\/r, atazanavir\/ritonavir; EFV, efavirenz; LPV\/r, lopinavir\/ritonavir.                   \u0026amp;lt;sup\u0026amp;gt;a\u0026amp;lt;\/sup\u0026amp;gt;On-treatment analysis.Reproduced with permission from C Manzardo, MD, PhD.\u0026amp;lt;\/div\u0026amp;gt;\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/48\/20\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/48\/20\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/48\/20\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16622\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \u003Cp id=\u0022p-7\u0022 class=\u0022first-child\u0022\u003EMedian Increase in CD4+ T-Cell Count\u003Csup\u003Ea\u003C\/sup\u003E\n               \u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EATV\/r, atazanavir\/ritonavir; EFV, efavirenz; LPV\/r, lopinavir\/ritonavir.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003E\n                  \u003Csup\u003Ea\u003C\/sup\u003EOn-treatment analysis.\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EReproduced with permission from C Manzardo, MD, PhD.\u003C\/p\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-11\u0022\u003EThe percentages of patients achieving viral suppression on both the intention-to-treat and on-treatment analyses were similar (intention-to-treat 75%, 60%, and 58.6% and on-treatment 100%, 100%, and 90% for EFV, atazanavir\/ritonavir, and LPV\/r, respectively), as were decreases in the levels of inflammation, coagulation, and bacterial translocation markers. The incidence rate of adverse events was similar in the 3 groups; there were no deaths.\u003C\/p\u003E\u003Cp id=\u0022p-12\u0022\u003EAdditional studies are needed in this patient population for other first-line regimens such as those using other boosted PIs (eg, darunavir) or integrase inhibitors (eg, dolutegravir).\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2015 SAGE Publications\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/15\/48\/20.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzlm5q\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzlm5q\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}