Several attempts have been made to test different drug-sparing strategies to reduce the drug-burden and drug-related toxicities..
..Fourteen studies were included, allowing a meta-analysis on 5,205 patients. The meta-analysis performed on studies that presented data at 48 weeks showed that the relative risk (RR) of treatment failure (TF) (RR>1 favoring triple therapy) in 10 studies was 1.20 (95%CI: 0.91-1.59, I 2: 49.2%); the RR of virological failure (VF) in 8 studies was 1.54 (95%CI: 0.84-2.86, I 2: 54%); the RR of adverse drug reaction leading to discontinuation of the regimen at 48 weeks in 8 studies was 0.76 (95%CI: 0.43-1.33, I 2: 17.7%).
In patients with less than 200 CD4+, the RR of TF in 2 studies without maraviroc was 2.09 (95%CI: 1.05-4.17, I 2: 0.0%). Regarding the studies at 96 weeks there was no difference except in rate of development of resistance, RR 1.94 (95%CI: 1.06-3.53, I 2: 6.2%).
Dual therapy are as effective as those with three drugs, showing no difference according to the different dual therapies, except in patients with less than 200 CD4; however, they are associated with a higher selection of resistance-associated mutations at 96 weeks of therapy