Jeffrey L. Lennox, MD; Raphael J. Landovitz, MD, MSc; Heather J. Ribaudo, PhD
Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-1084.
Lennox J., Landovitz R., Ribaudo H.; Three Nonnucleoside Reverse Transcriptase Inhibitor–Sparing Antiretroviral Regimens for Treatment-Naive Volunteers Infected With HIV-1. Ann Intern Med. 2015;162:461-462. doi: 10.7326/L15-5066-3
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Published: Ann Intern Med. 2015;162(6):461-462.
Dr. Stephan proposes a potential bias against ritonavir-boosted atazanavir due to the necessity to reimburse ritonavir copayments. He also suggests that efforts to ensure adequate representation of women may have enriched the study for impoverished participants predisposed to discontinue ritonavir-containing regimens to avoid costs. We did not target any particular socioeconomic subgroup of women for enrollment nor have we suggested that we did so. The potential biases associated with ritonavir use during the study were anticipated and addressed during trial design. As noted in the article, all participants not receiving ritonavir from a federal insurance program were reimbursed in a timely manner. Furthermore, the protocol encouraged sites to make within-class regimen switches; as a result, 72% of those who discontinued ritonavir-boosted atazanavir switched to ritonavir-boosted darunavir.
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