***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective : To assess the safety and efficacy of two , single-tablet regimens for the initial treatment of HIV infection . Design : Phase 2 , r and omized , double-blind , double-dummy , multicenter , active-controlled study . Methods : Antiretroviral treatment-naive adults with a screening HIV-1 RNA at least 5000 copies/ml and a CD4 cell count more than 50 cells/μl were r and omized 2 : 1 to receive fixed-dose combination tablets of elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil fumarate ( EVG/COBI/FTC/TDF ; N = 48 ) or efavirenz/emtricitabine/tenofovir disoproxil fumarate ( EFV/FTC/TDF ; n = 23 ) for 48 weeks . The primary endpoint was proportion of participants with HIV-1 RNA less than 50 copies/ml at week 24 . Results : Participants receiving EVG/COBI/FTC/TDF exhibited a more rapid decline in HIV-1 RNA and a greater proportion suppressed viral load to less than 50 copies/ml than participants receiving EFV/FTC/TDF . Both EVG/COBI/FTC/TDF and EFV/FTC/TDF result ed in high rates of viral suppression and increases in CD4 cell count . Ninety and 83 % of participants suppressed HIV-1 RNA to less than 50 copies/ml both at the 24-week and 48-week visits for EVG/COBI/FTC/TDF and EFV/FTC/TDF , respectively . Once-daily administration of EVG/COBI/FTC/TDF  provided a mean EVG trough concentration 10-fold over its protein binding-adjusted IC95 across study visits . EVG/FTC/TDF/GS-9350 was generally well tolerated with a lower rate of drug-related central nervous system ( 17 % ) and psychiatric ( 10 % ) adverse events versus EFV/FTC/TDF ( 26 and 44 % , respectively ) . Decreases in estimated glomerular filtration rate occurred within the first few weeks of dosing in participants receiving EVG/COBI/FTC/TDF , remained within the normal range and did not progress at week 24 or 48 ; no participant experienced a clinical adverse event or discontinued study drug due to changes in serum creatinine or renal function . Conclusion : Once-daily EVG/COBI/FTC/TDF achieved and maintained a high rate of virologic suppression with fewer central nervous system and psychiatric adverse events compared to a current st and ard-of-care regimen of EFV/FTC/TDF Background Rates of cardiovascular disease are higher among HIV-infected patients as a result of the complex interplay between traditional risk factors , HIV-related inflammatory and immunologic changes , and effects of antiretroviral therapy ( ART ) . This study prospect ively evaluated changes in cardiovascular biomarkers in an underrepresented , racially diverse , HIV-1-infected population receiving abacavir/lamivudine as backbone therapy . Methods This 96-week , open-label , r and omized , multicenter study compared once-daily fosamprenavir/ritonavir 1400/100 mg and efavirenz 600 mg , both with ABC/3TC 600 mg/300 mg , in antiretroviral-naïve , HLA-B*5701-negative adults without major resistance mutations to study drugs . We evaluated changes from baseline to weeks 4 , 12 , 24 , 48 , and 96 in interleukin-6 ( IL-6 ) , high-sensitivity C-reactive protein ( hs-CRP ) , soluble vascular adhesion molecule-1 ( sVCAM-1 ) , d-dimer , plasminogen , and fibrinogen . Biomarker data were log-transformed before analysis , and changes from baseline were described using geometric mean ratios . Results This study enrolled 101 patients ( 51 receiving fosamprenavir/ritonavir ; 50 receiving efavirenz ) : 32 % female , 60 % African American , and 38 % Hispanic/Latino ; 66 % ( 67/101 ) completed 96 weeks on study . At week 96 , levels of IL-6 , sVCAM-1 , d-dimer , fibrinogen , and plasminogen were lower than baseline in both treatment groups , and the decrease was statistically significant for sVCAM-1 ( fosamprenavir/ritonavir and efavirenz ) , d-dimer ( fosamprenavir/ritonavir and efavirenz ) , fibrinogen ( efavirenz ) , and plasminogen ( efavirenz ) . Values of hs-CRP varied over time in both groups , with a significant increase over baseline at Weeks 4 and 24 in the efavirenz group . At week 96 , there was no difference between the groups in the percentage of patients with HIV-1 RNA < 50 copies/mL ( fosamprenavir/ritonavir 63 % ; efavirenz 66 % ) by ITT missing-equals-failure analysis . Treatment-related grade 2–4 adverse events were more common with efavirenz ( 32 % ) compared with fosamprenavir/ritonavir ( 20 % ) , and median lipid concentrations increased in both groups over 96 weeks of treatment . Conclusions In this study of underrepresented patients , treatment with abacavir/lamivudine combined with either fosamprenavir/ritonavir or efavirenz over 96 weeks , produced stable or declining biomarker levels except for hs-CRP , including significant and favorable decreases in thrombotic activity ( reflected by d-dimer ) and endothelial activation ( reflected by sVCAM-1 ) . Our study adds to the emerging data that some cardiovascular biomarkers are decreased with initiation of ART and control of HIV viremia . Trial registration Clinical Trials.gov identifier Initial viral decay rate may be useful when comparing the relative potency of antiretroviral regimens . Two hundred twenty-seven ART-naïve patients were r and omized to receive efavirenz ( EFV ) ( n = 74 ) , lopinavir/ritonavir ( LPV/r )  ( n = 77 ) , or atazanavir/ritonavir ( ATV/r ) ( n = 79 ) in combination with two NRTIs . The most frequently used NRTI combinations in the EFV and ATV/r groups were the nonthymidine analogues tenofovir and emtricitabine or lamivudine ( 70 % and 68 % , respectively ) and , in the LPV/r group , lamivudine and the thymidine analogue zidovudine ( 89 % ) . HIV-1 RNA was monitored during the first 28 days after treatment initiation . Phase 1 and 2 decay rate was estimated in a subset of 157 patients by RNA decrease from days 0 to 7 , and days 14 to 28 . One-way ANOVA and subsequent Tukey 's post hoc tests were used for groupwise comparisons . Mean ( 95 % CI ) HIV-1 RNA reductions from days 0 to 28 were 2.59 ( 2.45 - 2.73 ) , 2.42 ( 2.27 - 2.57 ) , and 2.13 ( 2.01 - 2.25 ) log(10 ) copies/ml for the EFV- , LPV/r- , and ATV/r-based treatment groups , respectively , with a significantly larger decrease in the EFV-based group at all time points compared with ATV/r ( p < 0.0001 ) , and with LPV/r at days 7 - 21 ( p < 0.0001 - 0.03 ) . LPV/r gave a greater RNA decrease compared with ATV/r from day 14 ( p = 0.02 ) . Phase 1 decay rate was significantly higher in the EFV group compared with LPV/r ( p = 0.003 ) or ATV/r ( p < 0.0001 ) . No difference was found in phase 2 decrease .  EFV-based treatment gave a more rapid decline in HIV-1 RNA than did either of the boosted protease inhibitor-based regimens . The observed differences may reflect different inherent regimen potencies Background : Raltegravir is an HIV-1 integrase str and -transfer inhibitor with potent in vitro activity . This study explored the antiretroviral activity and safety of raltegravir in treatment-naive patients with plasma HIV-1 RNA levels ≥5000 copies/mL and CD4 + T-cell counts ≥100 cells/mm3 . Methods : Multicenter , double-blind , r and omized , controlled study of raltegravir at doses of 100 , 200 , 400 , and 600 mg twice daily versus efavirenz at a dose of 600 mg/d , all in combination with tenofovir at a dose of 300 mg/d and lamivudine at a dose of 300 mg/d ( clinical trials.gov identifier : NCT00100048 ) . Results : In the 198 patients treated ( 160 on raltegravir and 38 on efavirenz ) , the mean HIV-1 RNA level ranged from 4.6 to 4.8 log10 copies/mL at baseline . At weeks 2 , 4 , and 8 , the proportion of patients achieving an HIV-1 RNA level < 50 copies/mL was greater in each of the raltegravir treatment groups than in the efavirenz group . By week 24 , all treatment groups appeared similar , with plasma HIV-1 RNA levels < 400 copies/mL in 85 % to 98 % of patients and < 50 copies/mL in 85 % to 95 % of patients . These reductions were maintained through week 48 in 85 % to 98 % of patients and in 83 % to 88 % of patients , respectively . Five ( 3 % ) patients on raltegravir and 1 ( 3 % ) on efavirenz experienced virologic failure before week 48 . Drug-related clinical adverse events were less common with raltegravir than with efavirenz . After 24 and 48 weeks of treatment , raltegravir did not result in increased serum levels of total cholesterol , low-density lipoprotein cholesterol , or triglycerides . Conclusions : Raltegravir at all doses studied was generally well tolerated in combination with tenofovir and lamivudine . Raltegravir  exhibited potent and durable antiretroviral activity similar to that of efavirenz at 24 and 48 weeks but achieved HIV-1 RNA levels below detection at a more rapid rate BACKGROUND The MERIT ( Maraviroc versus Efavirenz in Treatment-Naive Patients ) study compared maraviroc and efavirenz , both with zidovudine-lamivudine , in antiretroviral-naive patients with R5 human immunodeficiency virus type 1 ( HIV-1 ) infection . METHODS Patients screened for R5 HIV-1 were r and omized to receive efavirenz ( 600 mg once daily ) or maraviroc ( 300 mg once or twice daily ) with zidovudine-lamivudine . Co primary end points were proportions of patients with a viral load < 400 and < 50 copies/mL at week 48 ; the noninferiority of maraviroc was assessed . RESULTS The once-daily maraviroc arm was discontinued for not meeting prespecified noninferiority criteria . In the primary 48-week analysis ( n = 721 ) , maraviroc was noninferior for < 400 copies/mL ( 70.6 % for maraviroc vs 73.1 % for efavirenz ) but not for < 50 copies/mL ( 65.3 % vs 69.3 % ) at a threshold of -10 % . More maraviroc patients discontinued for lack of efficacy ( 11.9 % vs 4.2 % ) , but fewer discontinued for adverse events ( 4.2 % vs 13.6 % ) . In a post hoc re analysis excluding 107 patients ( 15 % ) with non-R5 screening virus by the current , more sensitive tropism assay , the lower bound of the 1-sided 97.5 % confidence interval for the difference between treatment groups was above -10 % for each end point . CONCLUSIONS Twice-daily maraviroc was not noninferior to efavirenz at < 50 copies/mL in the primary analysis . However , 15 % of patients would have been ineligible for inclusion by a more sensitive screening assay . Their retrospective exclusion result ed in similar response rates in both arms Trial registration . Clinical Trials.gov identifier : ( NCT00098293 ) BACKGROUND Efavirenz with tenofovir-disoproxil-fumarate and emtricitabine is a preferred antiretroviral regimen for treatment-naive patients infected with HIV-1 .  Rilpiv 
    Output:
    
In comparison with both InSTI-based and CCR5-based therapy , efavirenz-based treatment was associated with a higher risk of therapy discontinuation due to adverse events .
Results of our meta- analysis support the present clinical guidelines for antiretroviral-naive , HIV-infected patients , in which efavirenz is one of the most preferred regimens in the analyzed population .