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Ross LL, Walker AS, Lou Y, Tenorio AR, Gibb DM, Double J, Gilks C, McCoig CC, Munderi P, Musoro G, Kityo CM, Grosskurth H, Hakim J, Mugyenyi PN, Cutrell A, Perger T, Shaefer MS. Changes over time in creatinine clearance and comparison of emergent adverse events for HIV-positive adults receiving standard doses (300 mg/day) of lamivudine-containing antiretroviral therapy with baseline creatinine clearance of 30-49 vs ≥50 mL/min. PLoS One 2019; 14:e0225199. [PMID: 31725787 PMCID: PMC6855468 DOI: 10.1371/journal.pone.0225199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 10/28/2019] [Indexed: 11/18/2022] Open
Abstract
A retrospective analysis of the randomized controlled DART (Development of AntiRetroviral Therapy in Africa; ISRCTN13968779) trial in HIV-1-positive adults initiating antiretroviral therapy with co-formulated zidovudine/lamivudine plus either tenofovir, abacavir, or nevirapine was conducted to evaluate the safety of initiating standard lamivudine dosing in patients with impaired creatinine clearance (CLcr). Safety data collected through 96 weeks were analyzed after stratification by baseline CLcr (estimated using Cockcroft-Gault) of 30–49 mL/min (n = 168) versus ≥50 mL/min (n = 3,132) and treatment regimen. The Grade 3–4 adverse events (AEs) and serious AEs (for hematological, hepatic and gastrointestinal events), maximal toxicities for liver enzymes, serum creatinine and bilirubin and maximum treatment-emergent hematology toxicities were comparable for groups with baseline CLcr 30–49 versus CLcr≥50 mL/min. No new risks or trends were identified from this dataset. Substantial and similar increases in the mean creatinine clearance (>25 mL/min) were observed from baseline though Week 96 among participants who entered the trial with CLcr 30–49 mL/min, while no increase or smaller median changes in creatinine clearance (<7 mL/min) were observed for participants who entered the trial with CLcr ≥50 mL/min. Substantial increases (> 150 cells/ mm3) in mean CD4+ cells counts from baseline to Week 96 were also observed for participants who entered the trial with CLcr 30–49 mL/min and those with baseline CLcr ≥50 mL/min. Though these results are descriptive, they suggest that HIV-positive patients with CLcr of 30–49 mL/min would have similar AE risks in comparison to patients with CLcr ≥50 mL/min when initiating antiretroviral therapy delivering doses of 300 mg of lamivudine daily through 96 weeks of treatment. Overall improvements in CLcr were observed for patients with baseline CLcr 30–49 mL/min.
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Affiliation(s)
- Lisa L Ross
- Medical Affairs, ViiV Healthcare, Research Triangle Park, NC, United States of America
| | - A Sarah Walker
- Medical Research Council Clinical Trials Unit, University College, London, United Kingdom
| | - Yu Lou
- Statistics, PAREXEL International, Durham, NC, United States of America
| | - Allan R Tenorio
- Physicians Group, ViiV Healthcare, Research Triangle Park, NC, United States of America
| | - Diana M Gibb
- Medical Research Council Clinical Trials Unit, University College, London, United Kingdom
| | - Julia Double
- Safety and Medical Governance, GlaxoSmithKline, Stockley Park, United Kingdom
| | - Charles Gilks
- School of Population Health, University of Queensland, Brisbane, Australia
| | | | - Paula Munderi
- HIV Care Research Programme, MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda
| | - Godfrey Musoro
- Department of Medicine, University of Zimbabwe, Harare, Zimbabwe
| | - Cissy M Kityo
- HIV Clinical Trials Unit, Joint Clinical Research Centre, Kampala, Uganda
| | - Heiner Grosskurth
- HIV Care Research Programme, MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda
| | - James Hakim
- Department of Medicine, University of Zimbabwe, Harare, Zimbabwe
| | - Peter N Mugyenyi
- HIV Clinical Trials Unit, Joint Clinical Research Centre, Kampala, Uganda
| | - Amy Cutrell
- Healthcare Statistics, ViiV Healthcare, Research Triangle Park, NC, United States of America
| | - Teodora Perger
- Safety and Pharmacovigilance, ViiV Healthcare, London, United Kingdom
| | - Mark S Shaefer
- Medical Affairs, ViiV Healthcare, Research Triangle Park, NC, United States of America
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Ross LL, Shortino D, Shaefer MS. Changes from 2000 to 2009 in the Prevalence of HIV-1 Containing Drug Resistance-Associated Mutations from Antiretroviral Therapy-Naive, HIV-1-Infected Patients in the United States. AIDS Res Hum Retroviruses 2018; 34:672-679. [PMID: 29732898 PMCID: PMC6080107 DOI: 10.1089/aid.2017.0295] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Pre-existing HIV drug resistance can jeopardize first-line antiretroviral therapy (ART) success. Changes in the prevalence of drug resistance-associated mutations (DRMs) were analyzed from HIV-infected, ART-naive, U.S. individuals seeking ART treatment from 2000 to 2009. HIV DRM data from 3,829 ART-naive subjects were analyzed by year of sample collection using International Antiviral Society-United States (IAS-USA) and World Health Organization (WHO) “surveillance” DRM definitions; minor IAS-USA-defined DRMs were excluded. IAS-USA DRM prevalence between 2000 and 2009 was 14%, beginning with 8% in 2000 and 13% in 2009. The greatest incidence was observed in 2007 (17%). Overall, IAS-USA-defined non-nucleoside reverse transcriptase inhibitor (NNRTI) DRMs were 9.5%; nucleoside reverse transcriptase inhibitor (NRTI): 4%, and major protease inhibitor (PI): 3%. The most frequently detected IAS-USA-defined DRMs by class were NNRTI: K103N/S (4%), NRTI: M41L (1.5%), and PI: L90M (1%). Overall, WHO-defined DRM prevalence was 13% (5% in 2000; 13% in 2009). By class, NNRTI prevalence was 6%, NRTI: 6%, and PI: 3.2%. The most frequent WHO-defined DRMs were NRTI: codon T215 (3.0%), NNRTI: K103N/S (4%), and PI: L90 (1%). WHO-defined NNRTI DRMs declined significantly (p = .0412) from 2007 to 2009. The overall prevalence of HIV-1 containing major IAS-USA or WHO-defined DRMs to ≥2 or ≥3 classes was 2% and <1%, respectively. The prevalence of HIV-1 with WHO-defined dual- or triple-class resistance significantly declined (p = .0461) from 2008 (4%) to 2009 (<1%). In this U.S. cohort, the prevalence of HIV-1 DRMs increased from 2000 onward, peaked between 2005 and 2007, and then declined between 2008 and 2009; the detection of WHO-defined dual- or triple-class DRM similarly decreased from 2008 to 2009.
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Affiliation(s)
- Lisa L. Ross
- ViiV Healthcare, Research Triangle Park, North Carolina
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d'Ettorre G, Zaffiri L, Ceccarelli G, Andreotti M, Massetti AP, Vella S, Mastroianni CM, Vullo V. Simplified Maintenance Therapy with Abacavir/Lamivudine/Zidovudine plus Tenofovir After Sustained HIV Load Suppression: Four Years of Follow-up. HIV CLINICAL TRIALS 2015; 8:182-8. [PMID: 17621465 DOI: 10.1310/hct0803-182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To assess the virologic and immunologic outcome of a treatment simplification strategy based on the substitution of protease inhibitor (PI)-based regimen with abacavir/lamivudine/zidovudine (ABC/3TC/ZDV, also known as trizivir or TZV) plus tenofovir (TDF) in viral-suppressed patients. METHOD The study population included 17 HIV-infected patients with undetectable viral loads over 12 months of a stable PI-based therapy. Patients were switched to a combination of TZV (2 pills twice a day) plus TDF (1 pill once a day) and were followed up for 48 months. They were studied for intracellular HIV DNA, CD4 cell count, HIV RNA levels, and lipid metabolism. RESULTS All patients had undetectable HIV RNA for the entire period of the follow-up. After 24 months of treatment with TZV plus TDF, the levels of cellular HIV DNA significantly decreased (p = .021). When we stratified the patients on the basis of HIV DNA outcome, we observed a significant increase of CD4 count only in patients who had undetectable HIV DNA after 24 months of TZV/TDF treatment. On the contrary, the CD4 count did not change in patients whose HIV DNA was still detectable at 24 months. The percentage of patients taking lipid-lowering agents declined significantly after switching to TZV/TDF. CONCLUSION This small pilot study suggests that a single-class quadruple regimen of TZV/TDF may represent a safe and appealing approach in the setting of simplification/switching antiretroviral strategies.
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Affiliation(s)
- Gabriella d'Ettorre
- Department of Infectious and Tropical Diseases, University of La Sapienza, Rome
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Sprenger HG, Bierman WF, van der Werf TS, Gisolf EH, Richter C. A systematic review of a single-class maintenance strategy with nucleoside/nucleotide reverse transcriptase inhibitors in HIV/AIDS. Antivir Ther 2014; 19:625-36. [PMID: 24429420 DOI: 10.3851/imp2726] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Single-drug class regimens with nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs) are generally not recommended as initial therapy because they are inferior compared with therapy with two NRTIs plus efavirenz. However, triple-NRTI combinations can be useful in specific circumstances such as in tuberculosis coinfection, pregnancy or dyslipidaemia. Here, we review the potential of such combinations to maintain viral suppression after induction of suppression by standard combination antiretroviral therapy (cART) and to evaluate the trade-off of NRTI-only regimens for metabolic control. METHODS We conducted a systematic search of the literature in two databases from 1 January 1998 up to 1 March 2013: Medline, through the search engine PubMed, and Embase. RESULTS A total of 11 randomized controlled trials (RCTs) with 2,105 patients and 3 observational studies with 2,639 patients were included. Studies including patients with mono- or dual-NRTI treatment before start of effective cART showed a tendency to higher failure rate because of resistance based on archived viral mutations. In studies with ART-naive subjects before start of cART, triple-NRTI combination showed virological activity comparable to two NRTIs plus a protease inhibitor or a non-nucleoside reverse transcriptase inhibitor in all RCTs, but not in one cohort study. Switching improved serum lipids significantly. CONCLUSIONS Of the studied triple-NRTI combinations only abacavir/lamivudine/zidovudine was sufficiently potent. Triple-NRTI maintenance after successful induction with two-class cART appeared successful in treatment-naive subjects and remains a useful option in specific circumstances, especially when other drugs are not available or drug interactions are an issue.
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Affiliation(s)
- Herman G Sprenger
- Department of Internal Medicine, Division of General Internal Medicine and Infectious Diseases, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
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Ross LL, Rouse E, Gerondelis P, DeJesus E, Cohen C, Horton J, Ha B, Lanier ER, Elion R. Low-abundance HIV species and their impact on mutational profiles in patients with virological failure on once-daily abacavir/lamivudine/zidovudine and tenofovir. J Antimicrob Chemother 2009; 65:307-15. [PMID: 20008905 PMCID: PMC2809245 DOI: 10.1093/jac/dkp419] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background HIV clonal genotypic analysis (CG) was used to investigate whether a more sensitive analysis method would detect additional low-abundance mutations compared with population genotyping (PG) in antiretroviral-naive patients who experienced virological failure (VF) during treatment with abacavir/lamivudine/zidovudine and tenofovir. Methods HIV was analysed by PG and CG (771 baseline and 657 VF clones) from subjects with VF (confirmed HIV RNA ≥ 400 copies/mL at 24–48 weeks). Results Fourteen of 123 subjects (11%) met VF criteria; their median baseline HIV RNA was 5.4 log10 copies/mL, and 4.0 log10 copies/mL at VF. By baseline PG, 2/14 had HIV-1 with nucleoside reverse transcriptase inhibitor (NRTI) or non-NRTI mutations. By baseline CG, 9/14 had HIV-1 with NNRTI and/or NRTI mutations; 7/9 had study drug-associated mutations. By PG at VF, 10/14 had selected for resistance mutations [2, K65R; 1, M184V; and 7, thymidine analogue mutations (TAMs) ± M184V]. By CG at VF, for subjects with TAMs, T215F was more commonly detected (5/14 samples) than T215Y (2/14). For one subject who selected K65R at VF, both K65R-containing clones and TAM-containing clones (both T215A and T215F) were observed independently but not conjunctively in the same clone in a post-VF sample. Conclusions The majority of subjects with VF had major and minor mutations detected at VF; CG detected additional low-abundance variants at baseline and VF that could have influenced mutation selection pathways. Both PG and CG data suggest TAMs, not K65R selection, are the preferred resistance route, biased towards 215F selection. No HIV clone contained both K65R and T215F/Y mutations, suggesting in vivo antagonism between the two mutations. The once-daily zidovudine usage and high baseline viraemia may also have contributed to rapid selection of HIV with multiple mutations in VFs.
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Affiliation(s)
- L L Ross
- GlaxoSmithKline, 5 Moore Drive, Research Triangle Park, NC 27709, USA.
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Ross L, Elion R, Lanier R, Dejesus E, Cohen C, Redfield RR, Gathe JC, Hsu RK, Yau L, Paulsen D, Ha B. Modulation of K65R selection by zidovudine inclusion: analysis of HIV resistance selection in subjects with virologic failure receiving once-daily abacavir/lamivudine/zidovudine and tenofovir DF (study COL40263). AIDS Res Hum Retroviruses 2009; 25:665-72. [PMID: 19563238 DOI: 10.1089/aid.2008.0302] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
COL40263 was a pilot 48-week, open-label, multicenter study evaluating the efficacy and safety of once-daily coformulated abacavir/lamivudine/zidovudine plus tenofovir in ART-naive, HIV-infected subjects. We examined the patterns of resistance that were selected on-therapy through 48 weeks in subjects with virologic nonresponse (VF). A total of 123 antiretroviral-naive HIV-1-infected subjects with plasma HIV-1 RNA > or = 30,000copies/ml were enrolled. For subjects with confirmed VF (HIV-1 RNA > or = 400 copies/ml at week 24 or later), HIV population genotypic and phenotypic analysis was performed. Of the 123 enrolled subjects, 14 (11%) had confirmed plasma HIV-1 RNA > or = 400 copies/ml through week 48. Of these subjects, 3/14 had evidence of drug resistance at baseline: 2/14 had HIV with K103N, Y188F/H/L/Y, and/or T215A and 1/14 had reduced zidovudine susceptibility. At the last time point analyzed, 4/14 subjects had wild-type HIV, while 10/14 subjects had HIV with either thymidine analogue mutations (TAMS) alone (3/10), TAMS + M184V (4/10), M184V only (1/10), or K65R/K (2/10). Matched phenotype was obtained for 13/14 subjects and 8/13 (62%) subjects had reduced susceptibility to one or more study drugs: 2/13 tenofovir, 3/13 abacavir, 4/13 zidovudine, and 7/13 lamivudine. The resistance pattern in COL40263 subjects with VF differs significantly from that reported for tenofovir-containing triple-nucleoside regimens. TAMs were detected in the majority (7/10) of samples from subjects with VF who selected any resistance mutation. These data suggest that TAMs selection is a preferred resistance route of this combination, with zidovudine modulating the resistance pathway against selection for K65R.
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Affiliation(s)
- Lisa Ross
- GlaxoSmithKline, Research Triangle Park, North Carolina 27709
| | - Richard Elion
- George Washington School of Medicine, Washington, DC 20817
| | - Randall Lanier
- GlaxoSmithKline, Research Triangle Park, North Carolina 27709
| | | | - Calvin Cohen
- Community Research Initiative, Brookline, Massachusetts 02445
| | - Robert R. Redfield
- University of Maryland Institute of Human Virology, Baltimore, Maryland 21201
| | | | - Ricky K. Hsu
- Saint Vincent's Medical Center, New York, New York 10011
| | - Linda Yau
- GlaxoSmithKline, Research Triangle Park, North Carolina 27709
| | - D. Paulsen
- GlaxoSmithKline, Research Triangle Park, North Carolina 27709
| | - Belinda Ha
- GlaxoSmithKline, Research Triangle Park, North Carolina 27709
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Hirsch MS, Günthard HF, Schapiro JM, Brun-Vézinet F, Clotet B, Hammer SM, Johnson VA, Kuritzkes DR, Mellors JW, Pillay D, Yeni PG, Jacobsen DM, Richman DD. Antiretroviral drug resistance testing in adult HIV-1 infection: 2008 recommendations of an International AIDS Society-USA panel. Clin Infect Dis 2008; 47:266-85. [PMID: 18549313 DOI: 10.1086/589297] [Citation(s) in RCA: 350] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Resistance to antiretroviral drugs remains an important limitation to successful human immunodeficiency virus type 1 (HIV-1) therapy. Resistance testing can improve treatment outcomes for infected individuals. The availability of new drugs from various classes, standardization of resistance assays, and the development of viral tropism tests necessitate new guidelines for resistance testing. The International AIDS Society-USA convened a panel of physicians and scientists with expertise in drug-resistant HIV-1, drug management, and patient care to review recently published data and presentations at scientific conferences and to provide updated recommendations. Whenever possible, resistance testing is recommended at the time of HIV infection diagnosis as part of the initial comprehensive patient assessment, as well as in all cases of virologic failure. Tropism testing is recommended whenever the use of chemokine receptor 5 antagonists is contemplated. As the roll out of antiretroviral therapy continues in developing countries, drug resistance monitoring for both subtype B and non-subtype B strains of HIV will become increasingly important.
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Ferrer E, Gatell JM, Sanchez P, Domingo P, Puig T, Niubo J, Cortes C, Veloso S, Pedrol E, Leon A, Gutierrez M, Podzamczer D. Zidovudine/lamivudine/abacavir plus tenofovir in HIV-infected naive patients: a 96-week prospective one-arm pilot study. AIDS Res Hum Retroviruses 2008; 24:931-4. [PMID: 18671476 DOI: 10.1089/aid.2007.0271] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We evaluated a single-class quadruple nucleoside/nucleotide regimen in a 96-week prospective one-arm pilot study in adult HIV-infected naive patients with CD4 >100 cells/microl. Standard zidovudine/lamivudine/abacavir and tenofovir doses were given. Virologic efficacy was evaluated by intent-to-treat (ITT), switch = failure and on-treatment (OT) analyses. A total of 54 patients were included (median CD4 count 254 cells/microl, VL 79,706 copies/ml). A median drop in VL of 2 log at 14 days and >3 log since week 12 was observed. A total of 34/54 (63%) patients (ITT) and 34/39 (87%) patients (OT) had VL <50 copies/ml at 96 weeks. Four (7%) patients switched therapy due to adverse events, 5 (9%) had virologic failure, and 1 died. Similar efficacy results were observed irrespective of baseline VL (> or <5 log) or CD4 cells (> or <250/microl). A median CD4 gain of +223 cells/microl was achieved. K65R + 41L + 219Q were detected in one patient at virologic failure. Only two patients presented fat loss on clinical evaluation. A decrease in total cholesterol (p = 0.007) and LDLc (p = 0.016) was observed. Our data suggest that zidovudine/lamivudine/abacavir plus tenofovir is a simple, effective, and well-tolerated NNRTI/PI-sparing regimen, even for patients with high viral loads. Larger trials comparing this option with standard initial antiretroviral regimens should be conducted.
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Affiliation(s)
- Elena Ferrer
- Infectious Disease and Hospital Universitari de Bellvitge, L'Hospitalet, Barcelona, Spain
| | | | - Pochita Sanchez
- Infectious Disease and Hospital Universitari de Bellvitge, L'Hospitalet, Barcelona, Spain
| | - Pere Domingo
- Internal Medicine Service, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Teresa Puig
- Internal Medicine Service, Hospital Arnau de Vilanova, Lleida, Spain
| | - Jordi Niubo
- Microbiology Services, Hospital Universitari de Bellvitge, L'Hospitalet, Barcelona, Spain
| | - Cristina Cortes
- Internal Medicine Service, Hospital de L'Hospitalet, L'Hospitalet, Barcelona, Spain
| | - Sergio Veloso
- Internal Medicine Service, Hospital Joan XXIII and Universitat Rovira i Virgili, Tarragona, Spain
| | - Enric Pedrol
- HIV Unit, Hospital de Granollers, Granollers, Spain
| | - Agathe Leon
- Infectious Disease Service, Hospital Clinic, Barcelona, Spain
| | - Mar Gutierrez
- Internal Medicine Service, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Daniel Podzamczer
- Infectious Disease and Hospital Universitari de Bellvitge, L'Hospitalet, Barcelona, Spain
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Abstract
An HIV patient’s chance for long-term treatment success is maximized when their first-line regimen produces an undetectable viral load. A persistently detectable viral load leads to the development of resistance and subsequent immunological and virological failure. It is important to select a regimen with excellent efficacy, tolerability and toxicity profile that is also easy to administer. Tenofovir/emtricitabine provides an effective and well-tolerated nucleoside analog reverse transcriptase inhibitor (NRTI) combination. Regimens with ritonavir-boosted protease inhibitors (PIs) and non-nucleoside reverse transcriptase inhibitors are superior to ritonavir-unboosted PIs and NRTIs in reducing viral load. Data suggest that regimens with lopinavir/ritonavir or efavirenz have the best long-term chance of producing an undetectable viral load.
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Affiliation(s)
- Jintanat Ananworanich
- South East Asia Research Collaboration with Hawaii (SEARCH), 104 Rajdumri Road, Pathumwan, Bangkok, 10330, Thailand
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Gulick RM, Lalama CM, Ribaudo HJ, Shikuma CM, Schackman BR, Schouten J, Squires KE, Koletar SL, Pilcher CD, Reichman RC, Klingman KL, Kuritzkes DR. Intensification of a triple-nucleoside regimen with tenofovir or efavirenz in HIV-1-infected patients with virological suppression. AIDS 2007; 21:813-23. [PMID: 17415036 DOI: 10.1097/qad.0b013e32805e8753] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare a quadruple-nucleoside with an efavirenz-containing regimen for treatment of HIV-1 infection. DESIGN A randomized, open-label study of the AIDS Clinical Trials Group (ACTG). METHODS Subjects receiving zidovudine/lamivudine/abacavir on ACTG 5095 with HIV-1 RNA less than 200 copies/ml were randomly assigned to intensify either with tenofovir or efavirenz. Subjects were followed for time to treatment failure, defined as either virological failure or treatment discontinuation. Analyses were intent-to-treat. RESULTS One hundred and seventy subjects (21% women; 56% non-white) entered the study. At baseline, 95 and 73% had HIV-1-RNA levels less than 200 and 50 copies/ml, respectively; the median CD4 cell count was 453 cells/microl. Over a median 79 weeks follow-up, 165 (97%) completed the study, three (2%) discontinued, and two (1%) died. Treatment failure occurred in 31 subjects: 18 (21%) (quadruple nucleosides) and 13 (15%) (efavirenz-containing regimen); however the failure-time curves crossed and demonstrated a non-constant treatment effect over time, characterized by more early treatment failures on the efavirenz-containing regimen and more late treatment failures on the four-nucleoside regimen. HIV-1 RNA remained suppressed in more than 88% of subjects to less than 200 copies/ml and in more than 78% to less than 50 copies/ml at weeks 24, 48, and 72, without differences by treatment arm. There were no significant differences between the regimens in CD4 cell increases, time to new grade 3/4 adverse events, or adherence. CONCLUSION The safety, tolerability, and efficacy of the four-nucleoside regimen were not significantly different from the efavirenz-containing regimen. These pilot data support further investigation of the quadruple-nucleoside regimen.
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Affiliation(s)
- Roy M Gulick
- Weill Medical College of Cornell University, 525 East 68th Street, New York, NY 10021, USA.
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