Comparison of PI vs PI ATV vs ATV/r BMS 089 ARV-trial.com Comparison of PI vs PI ATV vs ATV/r BMS 089 LPV/r mono vs LPV/r + ZDV/3TC MONARK LPV/r QD vs BID M02-418 M05-730 A5073 LPV/r + 3TC vs LPV/r + 2 NRTI GARDEL ATV/r vs FPV/r ALERT ATV/r vs DRV/r ATADAR FPV/r vs LPV/r KLEAN SQV/r vs LPV/r GEMINI ATV/r vs LPV/r CASTLE DRV/r vs LPV/r ARTEMIS 1

CASTLE Study: ATV/r QD vs LPV/r BID, in combination with TDF/FTC ARV-trial.com CASTLE Study: ATV/r QD vs LPV/r BID, in combination with TDF/FTC Design Randomisation* 1 : 1 Open-label W48 W96 N = 440 ATV/r 300/100 mg QD TDF/FTC fdc QD > 18 years ARV-naïve or < 1 week of prior ARV exposure HIV RNA > 5,000 c/mL Any CD4 cell count N = 443 LPV/r 400/100 mg BID TDF/FTC fdc QD *Randomisation was stratified by HIV RNA (< or > 100,000 c/mL) at screening and geographic region Objective Non inferiority of ATV/r vs LPV/r at W48: % HIV RNA < 50 c/mL by intention to treat, confirmed virologic response, non completer equals failure (CVR, NC = F) (lower margin of the 2-sided 95% CI for the difference = - 10%, 90% power) CASTLE Molina JM. Lancet 2008;372:646-55 2

CASTLE Study: ATV/r QD vs LPV/r BID, in combination with TDF/FTC ARV-trial.com CASTLE Study: ATV/r QD vs LPV/r BID, in combination with TDF/FTC Baseline characteristics and patient disposition ATV/r N = 440 LPV/r N = 443 Median age, years 34 36 Female 31% HIV RNA (log10 c/mL), median 5.01 4.96 HIV RNA > 100,000 c/mL 51% 47% CD4 cell count (/mm3), median 205 204 CD4 < 50 per mm3 13% 11% Hepatitis B / hepatitis C coinfection 5% / 9% 5% / 7% Discontinuation by W48 9% For lack of efficacy N = 5 N = 8 For adverse event N = 10 N = 14 Discontinuation on or after W48 3% N = 7 N = 1 LPV/r was administered as soft-gel capsules during the first 48 weeks CASTLE Molina JM. Lancet 2008;372:646-55 3

CASTLE Study: ATV/r QD vs LPV/r BID, in combination with TDF/FTC ARV-trial.com CASTLE Study: ATV/r QD vs LPV/r BID, in combination with TDF/FTC Response to treatment at week 48 HIV RNA < 50 c/mL (ITT) 25 50 100 75 78 76 % 95% CI for the difference = - 3.8; 7.1 Primary analysis = - 3.6; 7.4 ATV/r (N = 440) LPV/r (N = 443) CVR, NC = F TLOVR HIV RNA < 50 c/mL at W48 (CVR, NC = F) by baseline HIV RNA Baseline ATV/r LPV/r RNA < 5 log10 c/mL RNA > 5 log10 c/mL 82% 74% 81% 72% Post hoc analysis: lower virologic response rate associated with lower CD4 counts for LPV/r (p = 0.0085) but not for ATV/r (p = 0.51) Mean CD4/mm3 increase at W48 (observed values): 203 (ATV/r) vs 219 (LPV/r) CVR, NC = F : confirmed virologic response, non completer equals failure CASTLE Molina JM. Lancet 2008;372:646-55 4

CASTLE Study: ATV/r QD vs LPV/r BID, in combination with TDF/FTC ARV-trial.com CASTLE Study: ATV/r QD vs LPV/r BID, in combination with TDF/FTC Virologic failure Definition: failure to achieve confirmed HIV RNA < 400 c/mL by W48, or rebound of HIV RNA > 400 c/mL after achieving confirmed HIV RNA < 400 c/mL without re-suppression, or discontinuation due to insufficient HIV RNA response before W48 Emergence of resistance in virologic failure ATV/r N = 440 LPV/r N = 443 Confirmed virologic response-defined virologic failure 25 (6%) 26 (6%) Failure to achieve confirmed HIV RNA < 400 c/mL 11 3 Rebound after confirmed HIV RNA < 400 c/mL 10 17 Discontinuation due to insufficient HIV RNA response 4 6 Assessed for emergence of resistance mutations 19 20 Any PI-resistance mutation Polymorphic mutations Major mutations 8 2 * M184I/V / TDF-resistance mutation / TAM 5 / 1 / 1 4 / 0 / 1 * 1 patient with M46I and N88S; 1 patient with L10F, V32I, K43T, M46I, A71I, G73S, L90M CASTLE Molina JM. Lancet 2008;372:646-55 5

CASTLE Study: ATV/r QD vs LPV/r BID, in combination with TDF/FTC ARV-trial.com CASTLE Study: ATV/r QD vs LPV/r BID, in combination with TDF/FTC Safety at W48: ATV/r vs LPV/r Serious adverse events occurred in similar proportions: 12% vs 10% Grade 2 to 4 treatment-related nausea and diarrhoea were less frequent with ATV/r: 4% vs 8% and 2% vs 11%, respectively Initiation of anti-diarrhoeal medication: 9% vs 22% Grade 2 to 4 jaundice: 4% of ATV/r patients vs none of LPV/r patients Grade 3/4 hyperbilirubinaemia: 34% vs < 1% Grade 3/4 elevations in triglycerides and total cholesterol were significantly less frequent with ATV/r: < 1% vs 4% and 7% vs 18%, respectively Median change in calculated creatinine clearance (Cockroft) was similar in both groups = - 1% Mean increases in total cholesterol, non-HDL cholesterol and triglycerides were significantly lower on ATV/r (p < 0.0001 for the 3) Use of lipid-lowering agents through W48: 2% vs 8% CASTLE Molina JM. Lancet 2008;372:646-55 6

CASTLE Study: ATV/r QD vs LPV/r BID, in combination with TDF/FTC ARV-trial.com CASTLE Study: ATV/r QD vs LPV/r BID, in combination with TDF/FTC Summary ATV/r QD was non inferior to LPV/r BID, when co-administered with TDF/FTC Similar virologic reponse of the 2 PI/r in patients with high HIV RNA at enrolment Results suggest reduced virologic response to LPV/r in patients with baseline CD4 < 50/mm3 mainly because of intolerance to LPV/r in this highly immunosuppressed subgroup Development of major PI-associated resistance mutations occurred in 2 ATV/r patients and no LPV/r patients Incidence of diarrhoea and nausea was lower with ATV/r than with LPV/r Incidence of hyper bilirubinemia with ATV/r was high, but less than 1% of patients discontinued due to jaundice Lipid elevations were less pronounced with ATV/r CASTLE Molina JM. Lancet 2008;372:646-55 7

CASTLE Study: ATV/r QD vs LPV/r BID, in combination with TDF/FTC ARV-trial.com CASTLE Study: ATV/r QD vs LPV/r BID, in combination with TDF/FTC Conclusion ATV/r QD demonstrated similar antiviral efficacy to LPV/r BID, when coadministered with TDF/FTC (1) With less gastrointestinal toxicity But with a higher rate of hyperbilirubinemia At W96 (2), HIV RNA < 50 c/mL was obtained in 74% of ATV/r patients vs 68% of LPV/r patients (p < 0.05 in the intent-to-treat analysis) confirming non-inferiority of ATV/r to LPV/r Safety analysis at W96 confirmed W48 results Treatment-related gastrointestinal adverse events were more frequent with LPV/r Hyperbilirubinemia and/or jaundice was the most frequent ATV/r-related adverse event Lipid elevations were significantly higher with LPV/r These results support current recommendation of ATV/r + TDF + FTC QD as a preferred first-line regimen for the treatment of HIV-infected patients CASTLE (1) Molina JM. Lancet 2008;372:646-55 ; (2) Molina JM. JAIDS 2010;53:323-32 8