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About the Authors:
Roger J. Bedimo
* E-mail: [email protected]
Affiliation: Department of Medicine, VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
Henning Drechsler
Affiliation: Department of Medicine, VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
Mamta Jain
Affiliation: Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
James Cutrell
Affiliation: Department of Medicine, VA North Texas Health Care System, Dallas, Texas, United States of America
Song Zhang
Affiliation: Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
Xilong Li
Affiliation: Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
Irfan Farukhi
Affiliation: Department of Nuclear Medicine, VA North Texas Health Care System, Dallas, Texas, United States of America
Rosinda Castanon
Affiliation: Department of Nuclear Medicine, VA North Texas Health Care System, Dallas, Texas, United States of America
Pablo Tebas
Affiliation: Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
Naim M. Maalouf
Affiliation: Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
Introduction
All currently recommended regimens for antiretroviral-naive HIV-infected patients include tenofovir with emtricitabine (FTC) or lamivudine (3TC) in combination with either a non-nucleoside reverse transcriptase inhibitor (NNRTI), a boosted protease inhibitor (PI), or an integrase inhibitor (http://aidsinfo.nih.gov/guidelines). Although these regimens are potent and well tolerated, some concerns have emerged over the long-term bone and renal toxicities of tenofovir-containing regimens, particularly in the aging HIV-infected population, and those with significant comorbidities and increased fracture risk [1]. The primary alternative nucleoside abacavir (ABC) has been associated with hypersensitivity reactions and increased cardiovascular risk in some observational cohorts [2], [3]. These issues, together with concerns about lower virologic potency observed in a clinical trial [4] have tempered enthusiasm for abacavir use as first line therapy, except when combined with the new integrase inhibitor dolutegravir. This has led to an interest in designing studies to evaluate the safety and efficacy of nucleoside-sparing regimens. Regimens that combine a boosted PI with efavirenz are complex due to frequent pharmacokinetic interactions and associated with increased hyperlipidemia [5]. Given the...