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Suárez‐García I, Alejos B, Ruiz‐Algueró M, García Yubero C, Moreno C, Bernal E, Pérez‐Is L, Zubero Z, de Zárraga Fernández MA, Samperiz Abad G, Jarrín I. Effectiveness and tolerability of dolutegravir and abacavir/lamivudine administered as two separate pills compared to their equivalent single-tablet regimen in a multicentre cohort in Spain. J Int AIDS Soc 2021; 24:e25758. [PMID: 34291580 PMCID: PMC8295592 DOI: 10.1002/jia2.25758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 05/07/2021] [Accepted: 05/19/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION We aimed to assess the effectiveness and tolerability of dolutegravir (DTG), abacavir (ABC) and lamivudine (3TC) administered as branded STR (DTG/ABC/3TC) or as two separate pills (DTG and either branded ABC/3TC [DTG+(ABC/3TC)b] or generic ABC/3TC [DTG+(ABC/3TC)g]). METHODS We included individuals from the multicentre cohort of the Spanish HIV/AIDS Research Network (CoRIS) who received DTG/ABC/3TC, DTG+(ABC/3TC)b or DTG+(ABC/3TC)g during 2015 to 2018. We used multivariable logistic regression to compare the proportion of antiretroviral-naïve individuals who achieved viral suppression (VS) (viral load ≤50 copies/mL) at 24 weeks of initiating with DTG+(ABC/3TC)b or DTG+(ABC/3TC)g versus DTG/ABC/3TC. We also calculated the proportion of virologically suppressed individuals who maintained VS at 24 weeks after switching from DTG/ABC/3TC to DTG+(ABC/3TC)g. RESULTS During the study period, 829, 68 and 47 treatment-naïve individuals started treatment with DTG/ABC/3TC, DTG+(ABC/3TC)b or DTG+(ABC/3TC)g respectively. The proportions of individuals who changed their regimens due to side effects during the first 24 weeks were 3.7%, 4.4% and 6.4% respectively (p = 0.646). We did not find significant differences in VS at 24 weeks among individuals starting with DTG+(ABC/3TC)b or DTG+(ABC/3TC)g compared to those initiating with DTG/ABC/3TC. Among 177 virologically suppressed individuals who switched from DTG/ABC/3TC to DTG+(ABC/3TC)g, 170 (96.0%) maintained VS at 24 weeks. CONCLUSIONS In naïve individuals, the effectiveness and tolerability at 24 weeks of DTG plus ABC/3TC administered as two separate pills, either as branded or generic ABC/3TC, was similar to the STR DTG/ABC/3TC. Switching the STR DTG/ABC/3TC to its separate components DTG+(ABC/3TC)g in virologically suppressed individuals did not seem to impair its effectiveness.
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Affiliation(s)
- Inés Suárez‐García
- Infectious Diseases GroupDepartment of Internal MedicineHospital Universitario Infanta Sofía (FIIB HUIS HHEN)MadridSpain
- Universidad EuropeaMadridSpain
| | - Belén Alejos
- National Epidemiology CentreInstituto de Salud Carlos IIIMadridSpain
| | | | - Cristina García Yubero
- Department of Hospital PharmacyHospital Universitario Infanta Sofía (FIIB HUIS HHEN)MadridSpain
| | - Cristina Moreno
- National Epidemiology CentreInstituto de Salud Carlos IIIMadridSpain
| | - Enrique Bernal
- Infectious Diseases SectionHospital General Universitario Reina SofíaMurciaSpain
| | - Laura Pérez‐Is
- FINBA/ISPAHospital Universitario Central de AsturiasAvilésSpain
| | - Zuriñe Zubero
- Department of Infectious Diseases. HospitalUniversitario BasurtoBizkaiaSpain
| | | | | | - Inma Jarrín
- National Epidemiology CentreInstituto de Salud Carlos IIIMadridSpain
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Zubiaur P, Saiz-Rodríguez M, Villapalos-García G, Navares-Gómez M, Koller D, Abad-Santos F. HCP5 rs2395029 is a rapid and inexpensive alternative to HLA-B*57:01 genotyping to predict abacavir hypersensitivity reaction in Spain. Pharmacogenet Genomics 2021; 31:53-59. [PMID: 33044391 DOI: 10.1097/fpc.0000000000000421] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Abacavir (ABC) is an HIV nucleotide-analogue reverse transcriptase inhibitor that can produce a severe hypersensitivity reaction (ABC-HSR) in about 5% of the patients. The HLA-B*57:01 allele is associated with the development of ABC-HSR. Therefore, HLA-B*57:01 genotyping is required prior to the prescription of ABC. The technique routinely used in our laboratory is the sequence-specific oligonucleotide probes (SSOP) reverse hybridization method followed by Sanger sequencing. This technique is time-consuming and expensive. The single-nucleotide polymorphism (SNP) HCP5 rs2395029 was described to be in complete linkage disequilibrium with HLA-B*57:01. In this study, we aimed to assess the linkage disequilibrium between HCP5 rs2395029 and HLA-B*57:01 in patients receiving medical assistance at our hospital. We selected 226 HIV-infected patients from our hospital who had been routinely genotyped since 2009 with the SSOP and Sanger sequencing method: 49 HLA-B*57:01 positives and 177 negatives. We genotyped them for HCP5 rs2395019 by real time PCR (qPCR). We exploratory performed two copy number variation assays flanking HCP5 rs2395019 to explore possible deletions that could break the linkage disequilibrium with HLA-B*57:01. The concordance between HLA-B*57:01 and the HCP5 rs2395029 G allele was absolute, with a specificity and sensitivity of 100% (95% confidence interval: 93.0-100.0% and 98.0-100.0%, respectively) and estimated positive and negative predictive values of 84.4% (48.1-93.9%) and 99.9% (99.4-100.0%), respectively. No deletions were found at HCP5 flanking regions. The duration and cost of the SSOP-based method was considerably higher than the SNP-based method. Therefore, the HCP5 rs2395029 genotyping method may be alternatively used in the clinical practice.
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Affiliation(s)
- Pablo Zubiaur
- Clinical Pharmacology Department, Hospital Universitario de la Princesa, Instituto Teófilo Hernando, Universidad Autónoma de Madrid (UAM)
| | - Miriam Saiz-Rodríguez
- Clinical Pharmacology Department, Hospital Universitario de la Princesa, Instituto Teófilo Hernando, Universidad Autónoma de Madrid (UAM)
| | - Gonzalo Villapalos-García
- Clinical Pharmacology Department, Hospital Universitario de la Princesa, Instituto Teófilo Hernando, Universidad Autónoma de Madrid (UAM)
| | - Marcos Navares-Gómez
- Clinical Pharmacology Department, Hospital Universitario de la Princesa, Instituto Teófilo Hernando, Universidad Autónoma de Madrid (UAM)
| | - Dora Koller
- Clinical Pharmacology Department, Hospital Universitario de la Princesa, Instituto Teófilo Hernando, Universidad Autónoma de Madrid (UAM)
| | - Francisco Abad-Santos
- Clinical Pharmacology Department, Hospital Universitario de la Princesa, Instituto Teófilo Hernando, Universidad Autónoma de Madrid (UAM)
- UICEC Hospital Universitario de la Princesa, Plataforma SCReN (Spanish Clinical Reseach Network), Instituto de Investigación Sanitaria la Princesa (IP)
- Pharmacology Department, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
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Sarkar A, Balogun K, Guzman Lenis MS, Acosta S, Mount HT, Serghides L. In utero exposure to protease inhibitor-based antiretroviral regimens delays growth and developmental milestones in mice. PLoS One 2020; 15:e0242513. [PMID: 33211746 PMCID: PMC7676697 DOI: 10.1371/journal.pone.0242513] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 11/03/2020] [Indexed: 12/26/2022] Open
Abstract
Antiretroviral therapy (ART) in pregnancy has dramatically reduced HIV vertical transmission rates. Consequently, there is a growing number of children that are HIV exposed uninfected (CHEUs). Studies suggest that CHEUs exposed in utero to ART may experience developmental delays compared to their peers. We investigated the effects of in utero ART exposure on perinatal neurodevelopment in mice, through assessment of developmental milestones. Developmental milestone tests (parallel to reflex testing in human infants) are reflective of brain maturity and useful in predicting later behavioral outcomes. We hypothesized that ART in pregnancy alters the in utero environment and thereby alters developmental milestone outcomes in pups. Throughout pregnancy, dams were treated with boosted-atazanavir combined with either abacavir/lamivudine (ATV/r/ABC/3TC), or tenofovir/emtricitabine (ATV/r/TDF/FTC), or water as control. Pups were assessed daily for general somatic growth and on a battery of tests for primitive reflexes including surface-righting, negative-geotaxis, cliff-aversion, rooting, ear-twitch, auditory-reflex, forelimb-grasp, air-righting, behaviors in the neonatal open field, and olfactory test. In utero exposure to either ART regimen delayed somatic growth in offspring and evoked significant delays in the development of negative geotaxis, cliff-aversion, and ear-twitch reflexes. Exposure to ATV/r/ABC/3TC was also associated with olfactory deficits in male and forelimb grasp deficits in female pups. To explore whether delays persisted into adulthood we assessed performance in the open field test. We observed no significant differences between treatment arm for males. In females, ATV/r/TDF/FTC exposure was associated with lower total distance travelled and less ambulatory time in the centre, while ATV/r/ABC/3TC exposure was associated with higher resting times compared to controls. In utero PI-based ART exposure delays the appearance of primitive reflexes that involve vestibular and sensory-motor pathways in a mouse model. Our findings suggest that ART could be disrupting the normal progress/maturation of the underlying neurocircuits and encourage further investigation for underlying mechanisms.
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Affiliation(s)
- Ambalika Sarkar
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Kayode Balogun
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Monica S. Guzman Lenis
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Sebastian Acosta
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Howard T. Mount
- Departments of Psychiatry & Physiology, Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Lena Serghides
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
- Women’s College Research Institute, Toronto, Ontario, Canada
- Department of Immunology, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
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Chin BS, Lee JH, Kim G. Similar Durability of Two Single Tablet Regimens, Dolutegravir/Abacavir/Lamivudine and Elvitegravir/Cobicistat/Tenofovir/Emtricitabine: Single Center Experience. J Korean Med Sci 2020; 35:e235. [PMID: 32715668 PMCID: PMC7384898 DOI: 10.3346/jkms.2020.35.e235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 05/21/2020] [Indexed: 01/11/2023] Open
Abstract
Integrase inhibitor is uniquely available as single tablet regimen (STR) in Korea. In this study, the durability until 96 weeks was compared between dolutegravir/abacavir/lamivudine (D/A/L) and elvitegravir/cobicistat/tenofovir/emtricitabine (E/T/E) in treatment naïve human immunodeficiency virus 1 (HIV-1) infected individuals. From 2014 to 2017, 153 and 234 subjects started D/A/L and E/T/E, respectively. During 96 weeks, 73 discontinued initial STR and the reason of discontinuation was typable in 44. The frequency of drug adverse event related discontinuation (AEDC) was higher in D/A/L (13.1% vs. 6.4%, P = 0.023) while most non-AE related discontinuations occurred in E/T/E (8/9), such as drug-drug interaction, meal requirement and virologic failure. AEDC occurred usually within 24 weeks (20/35) and D/A/L to E/T/E AEDC incidence rate ratio was 3.71 (95% confidence interval, 1.36-10.10) in this period. Regarding the durability, D/A/L and E/T/E revealed no significant difference at week 96 (P = 0.138) while durability of D/A/L was worse in the aspect of AEDC (P = 0.013).
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Affiliation(s)
- Bum Sik Chin
- Division of Infectious Diseases, Department of Internal Medicine, National Medical Center, Seoul, Korea.
| | - Jin Hee Lee
- Laboratory for Future Emergency Medical Service, National Medical Center, Seoul, Korea
| | - Gayeon Kim
- Division of Infectious Diseases, Department of Internal Medicine, National Medical Center, Seoul, Korea
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Fukuda A, Nagao T, Kitaichi T, Koga I, Kobayashi A, Miura T. Safety analysis of Lexiva tablets 700 (fosamprenavir calcium hydrate) in post-marketing surveillance in Japan. Curr Med Res Opin 2020; 36:455-464. [PMID: 31794279 DOI: 10.1080/03007995.2019.1700495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: Fosamprenavir, a protease inhibitor (PI) to treat human immunodeficiency virus (HIV)-infected patients, has been approved in more than 40 countries and mainly used with nucleoside reverse transcriptase inhibitors. In Japan, Lexiva tablet (fosamprenavir calcium hydrate) has been marketed since January 2005 and used in clinical practice. The safety and effectiveness of fosamprenavir in HIV-infected Japanese patients were evaluated in an observational surveillance study (OTH112334).Methods: A post-marketing surveillance study (PMS) of fosamprenavir usage in HIV-infected Japanese subjects evaluating drug safety was conducted under Good Post-marketing Study Practice from January 2005 to December 2014.Results: Of 364 patients receiving fosamprenavir, 51% received emtricitabine/tenofovir disoproxil fumarate. Adverse events whose causal relationship could not be completely ruled out (adverse drug reactions; ADRs) were reported in 43.7%; the most common were diarrhoea (10.4%), hyperlipidaemia (8.5%) and hypertriglyceridaemia (6.9%). Serious ADRs were reported in 26 patients (32 events), including 1 death attributed to hepatic failure. Most ADRs occurred within 180 days after fosamprenavir was started. ADRs were more frequent in patients with the Centers for Disease Control and Prevention category B (AIDS or lipid disorders) or in those taking fosamprenavir combined with abacavir and lamivudine. Although spontaneous bleeding has been reported in hemophiliac patients taking other PIs, in this survey, only one muscle haemorrhage case was reported in 24 hemophiliac patients.Conclusions: The results of this PMS analysis in Japan support its known safety profile and identified no new safety risks for people living with HIV/AIDS in Japan currently on, or beginning treatment with, fosamprenavir.
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Affiliation(s)
| | | | | | | | - Akihiro Kobayashi
- Biomedical Data Sciences Department, GlaxoSmithKline K.K, Tokyo, Japan
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Baldin G, Ciccullo A, Rusconi S, Madeddu G, Sterrantino G, Freedman A, Giacometti A, Celani L, Latini A, Rossetti B, Cossu MV, Giacomelli A, Lagi F, Capetti A, Di Giambenedetto S. Single tablet regimen with abacavir/lamivudine/dolutegravir compared with two-drug regimen with lamivudine and dolutegravir as different strategies of simplification from a multicenter HIV cohort study. Infez Med 2019; 27:410-414. [PMID: 31846991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
We investigated the effectiveness and safety of a dual therapy (DT) with lamivudine plus dolutegravir versus a single tablet regimen (STR) with abacavir/lamivudine/dolutegravir. We performed a retrospective analysis in a cohort of virologically suppressed HIV+ patients switching to lamivudine-dolutegravir or abacavir/lamivudine/dolutegravir. We evaluated the incidence of virological failure and treatment discontinuation, as well as their predictors. Non-parametric tests were applied to assess changes in immunological and metabolic parameters. In all, 616 patients were analyzed: 380 began STR and 236 DT. In the STR group three patients experienced VF; in the DT group seven patients experienced VF. No differences in cause of treatment discontinuation were found. The estimated probability of continuing therapy at 48 weeks were 88.5 % in DT and 90.3% in STR, without a statistically significant difference (Log-rank 0.338). Regarding the metabolic profile, in the STR group there was a reduction in LDL cholesterol levels at week 48 (p=0.008), whereas in the lamivudine group there was a significant reduction in total cholesterol level at week 48 (p=0.044). Regarding the renal function, in both groups we registered a reduction in estimated glomerular filtration rate (eGFR), with a median reduction of 8.4 ml/min in the STR group (p<0.001) and 10.2 mL/min in DT (p<0.001). We found a difference in strategy option: in a context of side effect and comorbidities, dual therapy strategy was preferred. Conversely, simplification and compliance improvement more frequently translated into a DTG-STR strategy.
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Affiliation(s)
- Gianmaria Baldin
- Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy; Mater Olbia Hospital, Olbia, Italy
| | - Arturo Ciccullo
- Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
| | - Stefano Rusconi
- Infectious Diseases Unit, DIBIC Luigi Sacco, University of Milan, Milan, Italy
| | - Giordano Madeddu
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Gaetana Sterrantino
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Andrew Freedman
- Department of Infectious Diseases, University Hospital of Wales, Cardiff, UK
| | - Andrea Giacometti
- Infectious Diseases Clinic, Department of Biomedical Sciences and Public Health, Polytechnic University of Marche, Ancona, Italy
| | - Luigi Celani
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Alessandra Latini
- Infectious Dermatology and Allergology Unit, IFO S. Gallicano Institute (IRCCS), Rome, Italy
| | - Barbara Rossetti
- Infectious Diseases Unit, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Maria Vittoria Cossu
- Division of Infectious Diseases, Department of Infectious Diseases, Luigi Sacco University Hospital, Milan, Italy
| | - Andrea Giacomelli
- Infectious Diseases Unit, DIBIC Luigi Sacco, University of Milan, Milan, Italy
| | - Filippo Lagi
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Amedeo Capetti
- Division of Infectious Diseases, Department of Infectious Diseases, Luigi Sacco University Hospital, Milan, Italy
| | - Simona Di Giambenedetto
- Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy; Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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Mussini C, Roncaglia E, Borghi V, Rusconi S, Nozza S, Cattelan AM, Segala D, Bonfanti P, Di Biagio A, Barchi E, Focà E, Degli Antoni A, Bonora S, Francisci D, Limonta S, Antinori A, D’Ettorre G, Maggiolo F. A prospective randomized trial on abacavir/lamivudine plus darunavir/ritonavir or raltegravir in HIV-positive drug-naïve patients with CD4<200 cells/uL (the PRADAR study). PLoS One 2019; 14:e0222650. [PMID: 31560700 PMCID: PMC6764686 DOI: 10.1371/journal.pone.0222650] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 09/02/2019] [Indexed: 01/11/2023] Open
Abstract
Background Very few data are available on treatment in HIV Late presenter population that still represents a clinical challenge. Methods Prospective, multicenter, randomized open-label, 2 arm, phase-3 trial comparing the 48-week virological response of two different regimens: abacavir/lamivudine + darunavir/r vs abacavir/lamivudine + raltegravir in antiretroviral naive with CD4+ counts < 200/mm3 and a viral load (VL)<500,000 copies/mL. The primary Endpoint was the proportion of patients with undetectable viremia (VL<50 copies/mL) after 48 weeks. The planned sample size for this trial was 350 patients. Results In 3 years, 53 patients were screened and 46 enrolled: 22 randomized to raltegravir and 24 to darunavir/r; 7 patients were excluded, 4 because of a VL >500,000 copies/mL and 3 for HLAB5701 positivity. The snapshot analysis at 48 weeks showed a virologic success of 77.3% in raltegravir and 66.7% in darunavir/r. Time to starting treatment was 34.5 days in raltegravir and 53 days in darunavir/r. At the as treated analysis, the median CD4 counts at 48 weeks was 297 cells/μL in raltegravir and 239 cells/μL in darunavir/r. No difference in total cholesterol, while triglycerides were higher in the darunavir/r arm. No statistical analyses were performed due to the low number of patients enrolled. Conclusions Late presenter patients are frequent but very difficult to enroll in clinical trials, especially in western countries. These regimens and the conditions of many patients could not allow the test and treat strategy. The rate of virologic success was higher than 65% in both arms with a median CD4 cell count >200/μL at week 48. Trial registration EUDRACT number: 2011-005973-21
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Affiliation(s)
- Cristina Mussini
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
- * E-mail:
| | - Enrica Roncaglia
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Vanni Borghi
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefano Rusconi
- Clinic of Infectious Diseases, DIBIC Luigi Sacco, University of Milan, Milan, Italy
| | - Silvia Nozza
- Clinic of Infectious Diseases, University Vita e Salute, San Raffaele Hospital, Milan, Italy
| | | | - Daniela Segala
- Clinic of Infectious Diseases, Sant’Anna Hospital, Ferrara, Italy
| | - Paolo Bonfanti
- Department of Infectious Diseases, Lecco Hospital, Lecco, Italy
| | | | - Enrico Barchi
- Department of Infectious Diseases, Santa Maria Nuova Hospital, Reggio Emilia, Italy
| | - Emanuele Focà
- Clinic of Infectious Diseases, University of Brescia and ASST Spedali Civili, Brescia, Italy
| | | | - Stefano Bonora
- Clinic of Infectious Diseases, University of Torino, Torino, Italy
| | - Daniela Francisci
- Clinic of Infectious Diseases, University of Perugia, Perugia, Italy
| | - Silvia Limonta
- Clinic of Infectious Diseases, DIBIC Luigi Sacco, University of Milan, Milan, Italy
| | - Andrea Antinori
- National Institute for Infectious Diseases L. Spallanzani, Rome, Italy
| | | | - Franco Maggiolo
- Department of Infectious Diseases, Bergamo Hospital, Bergamo, Italy
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Archary M, Mcllleron H, Bobat R, LaRussa P, Sibaya T, Wiesner L, Hennig S. Population pharmacokinetics of abacavir and lamivudine in severely malnourished human immunodeficiency virus-infected children in relation to treatment outcomes. Br J Clin Pharmacol 2019; 85:2066-2075. [PMID: 31141195 PMCID: PMC6710509 DOI: 10.1111/bcp.13998] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 05/02/2019] [Accepted: 05/15/2019] [Indexed: 12/15/2022] Open
Abstract
AIMS Describe the pharmacokinetics (PK) of the antiretroviral drugs abacavir and lamivudine in malnourished paediatric patients and relate to viral load outcomes after 12 and 48 weeks of treatment. METHODS Severely malnourished human immunodeficiency virus-infected children were randomized to early (within 14 days) or delayed (after nutritional recovery) initiation of antiretroviral treatment (ART) using World Health Organization weight-band dosages. Abacavir and lamivudine concentrations were measured as a secondary objective on day 1 and day 14 and patients were followed-up to week 48. Population PK of abacavir and lamivudine were described using NONMEM. RESULTS In total, 623 abacavir and 627 lamivudine concentrations were collected from 75 paediatric patients aged 0.1-10.8 (median 1.4) years. Abacavir PK was described by a 2-compartment model, patients randomized to early ART showed increased bioavailability of 31%. Apparent clearance (CL/F, L/h/7 kg) of abacavir increased from day 1 to day 14 from 3.33 (95% confidence interval 2.71-4.12) to 5.86 (95% confidence interval 4.78-7.3). A 1-compartment model described lamivudine PK, variability on CL/F was explained by maturation with age, with age at half-matured CL/F being 4 months. For both drugs allometrically scaled total body weight was related to CL/F and apparent volume of distribution. PK exposure did not correlate with virological outcomes or death at 12 or 48 weeks. CONCLUSION Increases in Abacavir's CL/F between day 1 to day 14, bioavailability and PK variability with early start of ART was found in this cohort of severely malnourished children; however, these changes did not influence virological outcomes. The study supports the use of weight-band dosage tables.
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Affiliation(s)
- Moherndran Archary
- Department of Paediatrics and Children Health, King Edward VIII HospitalUniversity of KwaZulu‐NatalDurbanSouth Africa
- Department of Paediatrics and Children HealthUniversity of KwaZulu‐NatalDurbanSouth Africa
| | - Helen Mcllleron
- Division of Clinical Pharmacology, Department of MedicineUniversity of Cape TownCape TownSouth Africa
| | - Raziya Bobat
- Department of Paediatrics and Children HealthUniversity of KwaZulu‐NatalDurbanSouth Africa
| | - Philip LaRussa
- Department of Paediatrics, College of Physicians & SurgeonsColumbia UniversityNew YorkNew YorkUSA
| | - Thobekile Sibaya
- Department of Paediatrics and Children HealthUniversity of KwaZulu‐NatalDurbanSouth Africa
| | - Lubbe Wiesner
- Division of Clinical Pharmacology, Department of MedicineUniversity of Cape TownCape TownSouth Africa
| | - Stefanie Hennig
- School of PharmacyThe University of QueenslandBrisbaneQLDAustralia
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Rybka J, Małkowski B, Olejniczak M, Chmielowska E, Sokołowska E, Kuliczkowski K, Wróbel T. Comparing radioactive tracers 18F-FDG and 18F-FLT in the staging of diffuse large B-cell lymphoma by PET/CT examination: A single-center prospective study. ADV CLIN EXP MED 2019; 28:1095-1099. [PMID: 31237123 DOI: 10.17219/acem/104558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Positron emission tomography in combination with computer tomography (PET/CT) is a very important method of imaging patients with non-Hodgkin lymphomas (NHLs). It is used to define the initial grade of the disease and to assess early response to treatment and after chemotherapy. The most commonly used radioactive tracer is 18F-FDG, but 18F-FLT seems to be more specific. OBJECTIVES The aim of our study was to compare the staging of diffuse large B-cell lymphoma (DLBCL) with PET/CT examination using 18F-FLT and 18F-FDG. MATERIAL AND METHODS The study included 33 patients with newly diagnosed DLBCL (17 women and 16 men). The median age of the patients was 57 years. In each patient, 2 PET/CT examinations were performed before treatment, one using 18F-FLT and the second using 18F-FDG. RESULTS The average maximum 18F-FDG uptake in the whole group of patients was higher than the average maximum of 18F-FLT. This was also true of individual patients; however, 3 patients with an aggressive disease course had greater FLT uptake than the other patients. CONCLUSIONS Our analysis suggests that PET/CT exams using 18F-FLT may be a useful diagnostic tool in patients with DLBCL.
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Affiliation(s)
- Justyna Rybka
- Department of Hematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, Poland
| | - Bogdan Małkowski
- Department of Positron Emission Tomography and Molecular Imagining, Collegium Medicum, Nicolaus Copernicus University, Toruń, Poland
| | | | | | | | - Kazimierz Kuliczkowski
- Department of Hematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, Poland
| | - Tomasz Wróbel
- Department of Hematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, Poland
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Goh OQ, Colby DJ, Pinyakorn S, Sacdalan C, Kroon E, Chan P, Chomchey N, Kanaprach R, Prueksakaew P, Suttichom D, Trichavaroj R, Spudich S, Robb ML, Phanuphak P, Phanuphak N, Ananworanich J. Switch to dolutegravir is well tolerated in Thais with HIV infection. J Int AIDS Soc 2019; 22:e25324. [PMID: 31294931 PMCID: PMC6621926 DOI: 10.1002/jia2.25324] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 05/22/2019] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Dolutegravir (DTG) is recommended as part of first-line antiretroviral therapy (ART) for people living with HIV(PLHIV). We sought to determine the rate of adverse events (AEs) and discontinuations among Thais treated during acute HIV infection (AHI) and switched to DTG-based regimens. METHODS Thai participants in the SEARCH010/RV254 cohort who initiated ART during AHI and switched to DTG for at least 48 weeks were prospectively observed and included in the analysis. Rates and characteristics of DTG-related AEs and discontinuations were described. RESULTS A total of 313 Thai participants were included in the analysis. The median age was 29 years, 96% were male, 64% had a Bachelor's degree or higher and 16% had a body mass index (BMI) <18.5 kg/m2 . Participants were on ART for a median of 124 weeks before switching to DTG. The median (IQR) body weight increased from 63 (56 to 70) kg before to 65 (58 to 73) kg (p < 0.0001) after 48 weeks of DTG. Forty-nine (16%) developed DTG-related AEs, corresponding to an incidence of 16.6 per 100 person-years. Neuropsychiatric symptoms were most frequently encountered (n = 25, 8%), followed by laboratory abnormalities (n = 16, 5%). Six (2%) discontinued DTG, corresponding to an incidence of 2.4 per 100 person-years. All discontinuations were due to increased liver enzymes in the presence of hepatitis C virus coinfection. In the multivariate analysis, incident hepatitis C virus infection was the only risk factor for discontinuing DTG (hazard ratio 59.4, 95% CI 8.5 to 297.9, p < 0.0001). Neither low BMI nor concurrent abacavir therapy was associated with discontinuation. CONCLUSIONS DTG was well tolerated with few discontinuations in this cohort of young men. Incident hepatitis C virus infection was a driver of liver-related AEs leading to discontinuations. In populations at risk, regular testing for hepatitis C virus during ART is recommended to anticipate possible AEs, guide management and improve safety.
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Affiliation(s)
- Orlanda Q Goh
- SEARCHThe Thai Red Cross AIDS Research CentreBangkokThailand
- Johns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
- Duke‐National University of Singapore Medical SchoolSingaporeSingapore
| | - Donn J Colby
- SEARCHThe Thai Red Cross AIDS Research CentreBangkokThailand
| | - Suteeraporn Pinyakorn
- The Henry M. Jackson Foundation for the Advancement of Military MedicineBethesdaMDUSA
- United States Military HIV Research ProgramWalter Reed Army Institute of ResearchSilver SpringMDUSA
| | - Carlo Sacdalan
- SEARCHThe Thai Red Cross AIDS Research CentreBangkokThailand
| | - Eugène Kroon
- SEARCHThe Thai Red Cross AIDS Research CentreBangkokThailand
| | - Phillip Chan
- SEARCHThe Thai Red Cross AIDS Research CentreBangkokThailand
| | - Nitiya Chomchey
- SEARCHThe Thai Red Cross AIDS Research CentreBangkokThailand
| | | | | | | | - Rapee Trichavaroj
- Department of RetrovirologyArmed Forces Research Institute of Medical SciencesUnited States ComponentBangkokThailand
| | | | - Merlin L Robb
- The Henry M. Jackson Foundation for the Advancement of Military MedicineBethesdaMDUSA
- United States Military HIV Research ProgramWalter Reed Army Institute of ResearchSilver SpringMDUSA
| | | | | | - Jintanat Ananworanich
- SEARCHThe Thai Red Cross AIDS Research CentreBangkokThailand
- The Henry M. Jackson Foundation for the Advancement of Military MedicineBethesdaMDUSA
- United States Military HIV Research ProgramWalter Reed Army Institute of ResearchSilver SpringMDUSA
- Department of Global HealthUniversity of AmsterdamAmsterdamThe Netherlands
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11
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Kim J, Bang JH, Shin JY, Yang BR, Lee J, Park BJ. Hypertension Risk with Abacavir Use among HIV-Infected Individuals: A Nationwide Cohort Study. Yonsei Med J 2018; 59:1245-1252. [PMID: 30450860 PMCID: PMC6240567 DOI: 10.3349/ymj.2018.59.10.1245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 10/12/2018] [Accepted: 10/12/2018] [Indexed: 01/10/2023] Open
Abstract
PURPOSE A high risk of cardiovascular disease (CVD) is reported for HIV-infected individuals. While a link between abacavir and CVD risk is suggested, an association between abacavir and hypertension remains unclear. This study evaluated hypertension risk with abacavir use in comparison to non-abacavir antiretroviral treatment (ART). MATERIALS AND METHODS From a nationwide cohort of HIV-infected individuals on their initial ART, 6493 who were free of hypertension at baseline were analyzed. The use of ART was treated as a time-varying covariate measured as a daily unit. Incidence rate of hypertension was calculated, and Cox proportional hazard models were used to estimate adjusted hazard ratios (HRs) with 95% confidence interval (CI) of incident hypertension overall and among subgroups. RESULTS From the 6493 participants, 24072 person-years (PY) of follow-up were contributed during 2008-2016. The incidence rates of hypertension were 4.6 and 3.6 per 100 PY for abacavir and non-abacavir ART users, respectively. The population attributable fraction of abacavir use on hypertension was 12%. Abacavir exposure did not elevate the risk of hypertension among overall study population [HR, 1.2 (95% CI, 1.0-1.4), p=0.061]. However, those with poor ART adherence, defined as a medication possession ratio <50% [HR, 1.9 (95% CI, 1.5-2.4), p<0.0001] or requiring prophylactic antibiotics [HR, 1.2 (95% CI, 1.0-1.3), p=0.023], were at risk of hypertension induced by abacavir, as were men, individuals aged ≥40 years, and patients visiting tertiary hospitals in urban areas. CONCLUSION When present, poor ART adherence, requiring prophylactic antibiotics, male sex, and older age may warrant additional concern for hypertension in patients treated with abacavir.
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Affiliation(s)
- Jungmee Kim
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Hwan Bang
- Division of Infectious Diseases, Seoul National University, Seoul Metropolitan Government Boramae Medical Center, Seoul, Korea
| | - Ju Young Shin
- School of Pharmacy, Sungkyunkwan University, Suwon, Korea
| | - Bo Ram Yang
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Korea
| | - Joongyub Lee
- Department of Prevention and Management, Inha University Hospital, School of Medicine, Inha University, Incheon, Korea
| | - Byung Joo Park
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea.
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12
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Dorjee K, Choden T, Baxi SM, Steinmaus C, Reingold AL. Risk of cardiovascular disease associated with exposure to abacavir among individuals with HIV: A systematic review and meta-analyses of results from 17 epidemiologic studies. Int J Antimicrob Agents 2018; 52:541-553. [PMID: 30040992 PMCID: PMC7791605 DOI: 10.1016/j.ijantimicag.2018.07.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 05/21/2018] [Accepted: 07/14/2018] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Abacavir's potential to cause cardiovascular disease (CVD) among people living with HIV (PLWH) is debated. We conduct a systematic review and meta-analyses to assess CVD risk from recent and cumulative abacavir exposure. METHODS We searched Medline, Embase, Web of Science, abstracts from Conference on Retroviruses and Opportunistic Infections, and International AIDS Society/AIDS Conferences and bibliographies of review articles to identify research studies published through 2018 on CVD risk associated with abacavir exposure among PLWH. Studies assessing risk of CVD associated with recent (exposure within last 6 months) or cumulative abacavir exposure across all age-groups were eligible. Risks were quantified using fixed- and random-effects models. RESULTS Of 378 unique citations, 68 full-text research articles and abstracts were reviewed. Seventeen studies assessed risk of CVD from recent or cumulative abacavir exposure. Summary relative risk (sRR) is increased for recent exposure (n=16 studies, sRR=1.61; 95% confidence interval: 1.48-1.75), higher in antiretroviral-therapy-naive population (n=5, 1.91; 1.48-2.46) and all studies reported RR>1. The sRR for recent exposure was similarly increased for the outcome of acute myocardial infarction, and for studies that adjusted for substance abuse, smoking, prior CVD, traditional CVD risk factors, and CD4 cell-count/HIV viral load. The sRR was increased for cumulative abacavir exposure (per year) (n=4, 1.12; 1.05-1.20) but no increase was seen after adjusting for recent exposure (n=5, 1.00; 0.93-1.08). CONCLUSIONS Our findings suggest an increased risk of CVD from recent abacavir exposure. The risk remained elevated after adjusting for potential confounders. Further investigations are needed to understand CVD risk from cumulative exposure.
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Affiliation(s)
- Kunchok Dorjee
- Division of Epidemiology, School of Public Health, University of California Berkeley, Berkeley, CA, USA; Center for Tuberculosis Research, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
| | - Tsering Choden
- School of Public Health, Department of Epidemiology and Biostatistics, State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - Sanjiv M Baxi
- Division of Epidemiology, School of Public Health, University of California Berkeley, Berkeley, CA, USA; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Craig Steinmaus
- Division of Epidemiology, School of Public Health, University of California Berkeley, Berkeley, CA, USA
| | - Arthur L Reingold
- Division of Epidemiology, School of Public Health, University of California Berkeley, Berkeley, CA, USA
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13
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Olalla J, Pérez-Stachowski J, Tortajada B, Del Arco A, Márquez E, De la Torre J, Nieto M, García de Lomas JM, Prada JL, García-Alegría J. Efficacy and safety of the switch of Triumeq® to generic (abacavir + lamivudine) + Tivicay®: data at 24 weeks. BMC Pharmacol Toxicol 2018; 19:63. [PMID: 30305176 PMCID: PMC6180504 DOI: 10.1186/s40360-018-0252-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 10/01/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Generic drugs may help to support antiretroviral treatment. We want to assess the efficacy and safety at 24 weeks of the change of coformulated (abacavir + lamivudine + dolutegravir) to (abacavir + lamivudine) coformulated as a generic pharmaceutical specialty + dolutegravir. METHODS Between February and June 2017, switch from Triumeq® to a generic pharmaceutical specialty co-formulated tablet (abacavir + lamivudine) plus Tivicay® was made. Demographic, viroimmunological characteristics and the Charlson index were collected. Six months after switching, efficacy and safety were evaluated. RESULTS Switch was made in 93 patients, with a mean age of 47 years, after six months there were five patients (5.4%) with viral loads between 50 and 400 copies, no patient had viral loads of greater amount. There were 2 interruptions due to toxicity (2.15%), in relation to symptoms of the central nervous system. There were no differences in the amount of years with HAART, nor in the previous months with the STR regimen based on abacavir + lamivudine + dolutegravir, nor in the Charlson index. The effective saving in 2017 derived from the change in these 93 patients was € 125.512. CONCLUSIONS The change from a regimen of abacavir + lamivudine + dolutegravir seems to be safe and effective at 24 weeks.
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Affiliation(s)
- Julián Olalla
- Internal Medicine Service, Hospital Costa del Sol, Autovía A-7, km 187, 29603 Marbella, Spain
| | - Javier Pérez-Stachowski
- Internal Medicine Service, Hospital Costa del Sol, Autovía A-7, km 187, 29603 Marbella, Spain
| | | | - Alfonso Del Arco
- Internal Medicine Service, Hospital Costa del Sol, Autovía A-7, km 187, 29603 Marbella, Spain
| | - Efrén Márquez
- Pharmacy Service, Hospital Costa del Sol, Marbella, Spain
| | - Javier De la Torre
- Internal Medicine Service, Hospital Costa del Sol, Autovía A-7, km 187, 29603 Marbella, Spain
| | - Miriam Nieto
- Pharmacy Service, Hospital Costa del Sol, Marbella, Spain
| | | | - José Luis Prada
- Internal Medicine Service, Hospital Costa del Sol, Autovía A-7, km 187, 29603 Marbella, Spain
| | - Javier García-Alegría
- Internal Medicine Service, Hospital Costa del Sol, Autovía A-7, km 187, 29603 Marbella, Spain
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14
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Lanzafame M, Nicole S, Rizzardo S, Piacentini D, Chiesi S, Lattuada E, Diani E, Carelli M, Vento S, Gibellini D. Immunovirological outcome and HIV-1 DNA decay in a small cohort of HIV-1-infected patients deintensificated from Abacavir/Lamivudine/Dolutegravir to Lamivudine plus Dolutegravir. New Microbiol 2018; 41:262-267. [PMID: 30311623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 01/03/2019] [Indexed: 06/08/2023]
Abstract
Combination abacavir/lamivudine/dolutegravir (ABC/3TC/DTG) is approved as a first-line treatment for antiretroviral naïve patients. This report investigated the immunovirological outcome and total HIV-1 DNA decay in a small cohort of naïve HIV-1-positive patients treated with this regimen. In the presence of viral suppression and increased lymphocyte T CD4+ cells, the quantitative analysis of total HIV-1 DNA content revealed a significant decay after 12 months of treatment. Subsequently, we deintensificated the treatment of these patients from (ABC/3TC/DTG) to lamivudine plus dolutegravir (3TC/DTG) after 12 months of virological suppression, as a strategy of "induction-maintenance" therapy. The analysis of HIV-1 RNA viral load, total HIV-1 DNA, CD4+ T lymphocyte count and CD8+ HLA-DR+ T lymphocyte percentage after a mean 3.5 months of therapy deintensification showed no significant difference with respect to data detected after 12 months of ABC/3TC/DTG treatment in the presence of continuous viral suppression. These results indicate that the deintensification of highly active antiretroviral therapy (HAART) from ABC/ 3TC/DTG to 3TC/DTG effectively controls HIV-1 replication and in the early period does not induce any significant variations of total HIV-1 DNA. This suggests that HAART deintensification might be proposed as a therapeutic evolution in the treatment of HIV-1 infection.
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Affiliation(s)
- Massimiliano Lanzafame
- Unità Semplice Organizzativa "Diagnosi e Terapia dell'infezione da HIV", University of Verona, Verona, Italy
| | - Stefano Nicole
- Unità Complessa di Malattie Infettive, University of Verona, Verona, Italy
| | | | - Daniela Piacentini
- Unità Complessa di Malattie Infettive, University of Verona, Verona, Italy
| | - Sheila Chiesi
- Unità Complessa di Malattie Infettive, University of Verona, Verona, Italy
| | - Emanuela Lattuada
- Unità Complessa di Malattie Infettive, University of Verona, Verona, Italy
| | - Erica Diani
- Microbiology and Virology Section, Department of Diagnostic and Public Health, University of Verona, Verona, Italy
| | - Maria Carelli
- Microbiology and Virology Section, Department of Diagnostic and Public Health, University of Verona, Verona, Italy
| | - Sandro Vento
- Department of Medicine, Nazarbayev University, Astana, Kazakhstan
- University Medical Center, Astana, Kazakhstan
| | - Davide Gibellini
- Microbiology and Virology Section, Department of Diagnostic and Public Health, University of Verona, Verona, Italy
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Gallant J, Lazzarin A, Mills A, Orkin C, Podzamczer D, Tebas P, Girard PM, Brar I, Daar ES, Wohl D, Rockstroh J, Wei X, Custodio J, White K, Martin H, Cheng A, Quirk E. Bictegravir, emtricitabine, and tenofovir alafenamide versus dolutegravir, abacavir, and lamivudine for initial treatment of HIV-1 infection (GS-US-380-1489): a double-blind, multicentre, phase 3, randomised controlled non-inferiority trial. Lancet 2017; 390:2063-2072. [PMID: 28867497 DOI: 10.1016/s0140-6736(17)32299-7] [Citation(s) in RCA: 222] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 08/03/2017] [Accepted: 08/07/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND Integrase strand transfer inhibitors (INSTIs) are recommended components of initial antiretroviral therapy with two nucleoside reverse transcriptase inhibitors. Bictegravir is a novel, potent INSTI with a high in-vitro barrier to resistance and low potential as a perpetrator or victim of clinically relevant drug-drug interactions. We aimed to assess the efficacy and safety of bictegravir coformulated with emtricitabine and tenofovir alafenamide as a fixed-dose combination versus coformulated dolutegravir, abacavir, and lamivudine. METHODS We did this double-blind, multicentre, active-controlled, randomised controlled non-inferiority trial at 122 outpatient centres in nine countries in Europe, Latin America, and North America. We enrolled HIV-1 infected adults (aged ≥18 years) who were previously untreated (HIV-1 RNA ≥500 copies per mL); HLA-B*5701-negative; had no hepatitis B virus infection; screening genotypes showing sensitivity to emtricitabine, tenofovir, lamivudine, and abacavir; and an estimated glomerular filtration rate of 50 mL/min or more. Participants were randomly assigned (1:1), via a computer-generated allocation sequence (block size of four), to receive coformulated bictegravir 50 mg, emtricitabine 200 mg, and tenofovir alafenamide 25 mg or coformulated dolutegravir 50 mg, abacavir 600 mg, and lamivudine 300 mg, with matching placebo, once daily for 144 weeks. Randomisation was stratified by HIV-1 RNA (≤100 000 copies per mL, >100 000 to ≤400 000 copies per mL, or >400 000 copies per mL), CD4 count (<50 cells per μL, 50-199 cells per μL, or ≥200 cells per μL), and region (USA or ex-USA). Investigators, participants, and study staff giving treatment, assessing outcomes, and collecting data were masked to group assignment. The primary endpoint was the proportion of participants with plasma HIV-1 RNA less than 50 copies per mL at week 48, as defined by the US Food and Drug Administration snapshot algorithm, with a prespecified non-inferiority margin of -12%. All participants who received one dose of study drug were included in primary efficacy and safety analyses. This trial is registered with ClinicalTrials.gov, number NCT02607930. FINDINGS Between Nov 13, 2015, and July 14, 2016, we randomly assigned 631 participants to receive coformulated bictegravir, emtricitabine, and tenofovir alafenamide (n=316) or coformulated dolutegravir, abacavir, and lamivudine (n=315), of whom 314 and 315 patients, respectively, received at least one dose of study drug. At week 48, HIV-1 RNA less than 50 copies per mL was achieved in 92·4% of patients (n=290 of 314) in the bictegravir, emtricitabine, and tenofovir alafenamide group and 93·0% of patients (n=293 of 315) in the dolutegravir, abacavir, and lamivudine group (difference -0·6%, 95·002% CI -4·8 to 3·6; p=0·78), demonstrating non-inferiority of bictegravir, emtricitabine, and tenofovir alafenamide to dolutegravir, abacavir, and lamivudine. No individual developed treatment-emergent resistance to any study drug. Incidence and severity of adverse events was mostly similar between groups except for nausea, which occurred less frequently in patients given bictegravir, emtricitabine, and tenofovir alafenamide than in those given dolutegravir, abacavir, and lamivudine (10% [n=32] vs 23% [n=72]; p<0·0001). Adverse events related to study drug were less common with bictegravir, emtricitabine, and tenofovir alafenamide than with dolutegravir, abacavir, and lamivudine (26% [n=82] vs 40% [n=127]), the difference being driven by a higher incidence of drug-related nausea in the dolutegravir, abacavir, and lamivudine group (5% [n=17] vs 17% [n=55]; p<0·0001). INTERPRETATION At 48 weeks, coformulated bictegravir, emtricitabine, and tenofovir alafenamide achieved virological suppression in 92% of previously untreated adults and was non-inferior to coformulated dolutegravir, abacavir, and lamivudine, with no treatment-emergent resistance. Bictegravir, emtricitabine, and tenofovir alafenamide was safe and well tolerated with better gastrointestinal tolerability than dolutegravir, abacavir, and lamivudine. Because coformulated bictegravir, emtricitabine, and tenofovir alafenamide does not require HLA B*5701 testing and provides guideline-recommended treatment for individuals co-infected with HIV and hepatitis B, this regimen might lend itself to rapid or same-day initiation of therapy in the clinical setting. FUNDING Gilead Sciences.
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Affiliation(s)
| | | | - Anthony Mills
- Southern California Men's Medical Group, Los Angeles, CA, USA
| | - Chloe Orkin
- Grahame Hayton Unit, Royal London Hospital, London, UK
| | | | - Pablo Tebas
- University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Eric S Daar
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - David Wohl
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Cassim H, Otwombe K, Lazarus E, Liberty A, Gray GE, Greeff OBW, Violari A. A retrospective case-cohort study comparing treatment outcomes in abacavir versus stavudine containing first line antiretroviral treatment regimens in children <3yrs old, at a paediatric programme based in Soweto, South Africa. PLoS One 2017; 12:e0180645. [PMID: 28686654 PMCID: PMC5501584 DOI: 10.1371/journal.pone.0180645] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 06/19/2017] [Indexed: 11/20/2022] Open
Abstract
Introduction The current World Health Organization guideline for first line antiretroviral therapy (ART) in HIV-infected children recommends the use of abacavir and lamivudine as nucleoside backbones and no longer includes stavudine. We compared treatment outcomes with abacavir (ABC) versus stavudine (d4T) in a cohort of HIV-1 infected children 6 and 12 months after antiretroviral therapy was initiated. Methods This was a retrospective case-cohort study, using programmatic data from children enrolled in the Paediatric Wellness Programme at the Perinatal HIV Research Unit in Soweto, South Africa between 2005 and 2013. Children on abacavir/stavudine who had initiated ART at age <3 years with a regimen including lamivudine and lopinavir/ritonavir and had at least one 6 or 12 month viral load result were eligible. All ABC cases identified were matched for age at ART initiation and gender to eligible d4T controls (1:2). Outcomes analysed at 6 and 12 months post ART initiation included virological failure, mortality, immunological failure and anthropometry. Chi-square tests compared categorical measures while Kruskal-Wallis compared continuous measures. Results We identified 57 eligible ABC cases and selected 114 matched d4T controls. Overall, 57% were females and 89% started treatment at age <1year. The median age at ART initiation was 3.11 (IQR: 1.98–6.05) months. There was no difference in the proportion of children virologically suppressed between the groups at 6 (ABC 54.5% vs. d4T 67.0%, p = 0.125) and 12 (ABC 66.7% vs. d4T 71.6%, p = 0.53) months post ART-initiation. The proportion of children with adherence levels >90% for ABC and d4T were similar too (95% in ABC vs. 86% in d4T, p = 0.10). The proportion of children who died over 12 months was 3.5% in the ABC and 7.9% in the d4T group (p = 0.27). Similarly, the anthropometric measures were comparable. Conclusions It is reassuring that in the short term, in this group of patients, the treatment outcomes were similar.
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Affiliation(s)
- Haseena Cassim
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- * E-mail:
| | - Kennedy Otwombe
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Erica Lazarus
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Afaaf Liberty
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Glenda E. Gray
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- South African Medical Research Council, Parow Valley, Cape Town, Western Cape, South Africa
| | - Oppel B. W. Greeff
- Department of Pharmacology, University of Pretoria, Pretoria, South Africa
| | - Avy Violari
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Alzate Angel JC, Duque Molina MM, García García HI. Zidovudine/Lamivudine vs. Abacavir/Lamivudine vs. Tenofovir/Emtricitabine in fixed-dose combinations as initial treatment for HIV patients: a systematic review and network meta-analysis. Colomb Med (Cali) 2017; 48:70-81. [PMID: 29021641 PMCID: PMC5625561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 03/02/2017] [Accepted: 04/26/2017] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Initial treatment of the HIV is based on the use of three drugs, two of which are nucleoside analog reverse-transcriptase inhibitors. There are three combinations of these drugs which have been approved by different guidelines, each with divergent results in terms of efficacy and safety. OBJECTIVE To compare the efficacy and safety of these three combinations. METHODS Systematic review and network meta-analysis of randomized clinical trials comparing fixed doses of Tenofovir Disoproxil Fumarate / Emtricitabine (TDF/FTC), Abacavir / Lamivudine (ABC/3TC) and Zidovudine / Lamivudine (ZDV/3TC). RESULTS Seven clinical trials met the eligibility criteria. The results suggested higher efficacy with TDF/FTC vs. ABC/3TC at 96 weeks and vs. ZDV/3TC at 48 weeks. However, there is clinical and statistical heterogeneity. Subgroup analysis were performed by third drug and by level of viral load prior to treatment, and found no differences in virological control. Network meta-analysis could only be carried out with TDF/FTC vs. ZDV/3TC, and the proportion of patients with virological response, with no differences at 48 weeks nor at 96 weeks. Direct comparisons showed an increased risk of bone marrow suppression of ZDV/3TC vs. TDF/FTC and of ABC/3TC hypersensitivity reactions vs. ZDV/3TC. CONCLUSIONS The results did not show differences in effectiveness among the interventions. However, due to the heterogeneity of the third drug and the follow-up time between the included studies, this result is not definitive. The results raise the need for further studies to help improve treatment recommendations in patients infected with HIV.
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Affiliation(s)
- Juan Carlos Alzate Angel
- Corporación para Investigaciones Biológicas, CIB (Corporation for Biological Research), Medellín, Colombia
- Academic Group of Epidemiology, Faculty of Medicine, Universidad de Antioquia, Medellín, Colombia
- Asistencia Científica de Alta Complejidad (Highly Complex Scientific Assistance), Medellín, Colombia
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Schelhaas S, Heinzmann K, Bollineni VR, Kramer GM, Liu Y, Waterton JC, Aboagye EO, Shields AF, Soloviev D, Jacobs AH. Preclinical Applications of 3'-Deoxy-3'-[ 18F]Fluorothymidine in Oncology - A Systematic Review. Theranostics 2017; 7:40-50. [PMID: 28042315 PMCID: PMC5196884 DOI: 10.7150/thno.16676] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 09/16/2016] [Indexed: 11/05/2022] Open
Abstract
The positron emission tomography (PET) tracer 3'-deoxy-3'-[18F]fluorothymidine ([18F]FLT) has been proposed to measure cell proliferation non-invasively in vivo. Hence, it should provide valuable information for response assessment to tumor therapies. To date, [18F]FLT uptake has found limited use as a response biomarker in clinical trials in part because a better understanding is needed of the determinants of [18F]FLT uptake and therapy-induced changes of its retention in the tumor. In this systematic review of preclinical [18F]FLT studies, comprising 174 reports, we identify the factors governing [18F]FLT uptake in tumors, among which thymidine kinase 1 plays a primary role. The majority of publications (83 %) report that decreased [18F]FLT uptake reflects the effects of anticancer therapies. 144 times [18F]FLT uptake was related to changes in proliferation as determined by ex vivo analyses. Of these approaches, 77 % describe a positive relation, implying a good concordance of tracer accumulation and tumor biology. These preclinical data indicate that [18F]FLT uptake holds promise as an imaging biomarker for response assessment in clinical studies. Understanding of the parameters which influence cellular [18F]FLT uptake and retention as well as the mechanism of changes induced by therapy is essential for successful implementation of this PET tracer. Hence, our systematic review provides the background for the use of [18F]FLT in future clinical studies.
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Affiliation(s)
- Sonja Schelhaas
- European Institute for Molecular Imaging (EIMI), Westfälische Wilhelms-Universität (WWU) Münster, Münster, Germany
| | | | - Vikram R Bollineni
- European Organization for Research and Treatment of Cancer Headquarters, Brussels, Belgium
| | - Gerbrand M Kramer
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Yan Liu
- European Organization for Research and Treatment of Cancer Headquarters, Brussels, Belgium
| | | | - Eric O Aboagye
- Comprehensive Cancer Imaging Centre, Imperial College London, UK
| | - Anthony F Shields
- Department of Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, Michigan, USA
| | - Dmitry Soloviev
- Cancer Research UK Cambridge Institute, University of Cambridge, UK
| | - Andreas H Jacobs
- European Institute for Molecular Imaging (EIMI), Westfälische Wilhelms-Universität (WWU) Münster, Münster, Germany.; Department of Geriatric Medicine, Johanniter Hospital, Bonn, Germany
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Arae H, Tateyama M, Nakamura H, Tasato D, Kami K, Miyagi K, Maeda S, Uehara H, Moromi M, Nakamura K, Fujita J. Evaluation of the Lipid Concentrations after Switching from Antiretroviral Drug Tenofovir Disoproxil Fumarate/Emtricitabine to Abacavir Sulfate/Lamivudine in Virologically-suppressed Human Immunodeficiency Virus-infected Patients. Intern Med 2016; 55:3435-3440. [PMID: 27904105 PMCID: PMC5216139 DOI: 10.2169/internalmedicine.55.7518] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 04/21/2016] [Indexed: 11/06/2022] Open
Abstract
Objective Recently, tenofovir disoproxil fumatate (TDF)-related side effects, such as renal nephrotoxicity and reduction of bone mineral density, have been reported. Consequently, increased switching from fixed-dose tablet TDF and emtricitabine (TDF/FTC) to abacavir and lamivudine (ABC/3TC) has occurred. Interestingly, while TDF has a lipid-lowering property, one of the ABC-related side effects is hyperlipidemia. Therefore, such switching could cause lipid elevation. To evaluate the change in lipid levels associated with switching from TDF/FTC to ABC/3TC in virologically-suppressed human immunodeficiency virus (HIV)-infected patients. Methods This is a retrospective, single-center study. We included the HIV-infected patients whose therapy included a drug switch from TDF/FTC to ABC/3TC between September 2009 and December 2012 at Ryukyu University Hospital. The exclusion criteria were HIV-RNA >40 copies/mL on the switching day, and a documented therapy change to a lipid-lowering agent or any other antiretroviral agents within 3 months before or after switching. We compared the low-density lipoprotein (LDL), high-density lipoprotein (HDL), total cholesterol (TC), and triglyceride (TG) levels before switching to three months after. Results A total of 18 patients met the inclusion criteria. The LDL, HDL, and TC levels significantly increased three months following the switch (p<0.05), with median (interquartile range) values of 17 (7, 32), 6 (2, 13), and 27 (10, 45) mg/dL, respectively. The TG values did not markedly change. Conclusion Switching from TDF/FTC to ABC/3TC resulted in significantly increased LDL, HDL, and TC levels.
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Affiliation(s)
- Hirotaka Arae
- Department of Pharmacy, Ryukyu University Hospital, Japan
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20
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Llibre JM, Cozzi-Lepri A, Pedersen C, Ristola M, Losso M, Mocroft A, Mitsura V, Falconer K, Maltez F, Beniowski M, Vullo V, Hassoun G, Kuzovatova E, Szlavik J, Kuznetsova A, Stellbrink HJ, Duvivier C, Edwards S, Laut K, Paredes R. Long-term effectiveness of unboosted atazanavir plus abacavir/lamivudine in subjects with virological suppression: A prospective cohort study. Medicine (Baltimore) 2016; 95:e5020. [PMID: 27749561 PMCID: PMC5059063 DOI: 10.1097/md.0000000000005020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Effectiveness data of an unboosted atazanavir (ATV) with abacavir/lamivudine (ABC/3TC) switch strategy in clinical routine are scant.We evaluated treatment outcomes of ATV + ABC/3TC in pretreated subjects in the EuroSIDA cohort when started with undetectable plasma HIV-1 viral load (pVL), performing a time to loss of virological response (TLOVR <50 copies/mL) and a snapshot analysis at 48, 96, and 144 weeks. Virological failure (VF) was defined as confirmed pVL >50 copies/mL.We included 285 subjects, 67% male, with median baseline CD4 530 cells, and 44 months with pVL ≤50 copies/mL. The third drug in the previous regimen was ritonavir-boosted atazanavir (ATV/r) in 79 (28%), and another ritonavir-boosted protease inhibitor (PI/r) in 29 (10%). Ninety (32%) had previously failed with a PI. Proportions of people with virological success at 48/96/144 weeks were 90%/87%/88% (TLOVR) and 74%/67%/59% (snapshot analysis), respectively. The rates of VF were 8%/8%/6%. Rates of adverse events leading to study discontinuation were 0.4%/1%/2%. The multivariable adjusted analysis showed an association between VF and nadir CD4+ (hazard ratio [HR] 0.63 [95% confidence interval [CI]: 0.42-0.93] per 100 cells higher), time with pVL ≤50 copies/mL (HR 0.87 [95% CI: 0.79-0.96] per 6 months longer), and previous failure with a PI (HR 2.78 [95% CI: 1.28-6.04]). Resistance selection at failure was uncommon.A switch to ATV + ABC/3TC in selected subjects with suppressed viremia was associated with low rates of VF and discontinuation due to adverse events, even in subjects not receiving ATV/r. The strategy might be considered in those with long-term suppression and no prior PI failure.
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Affiliation(s)
- Josep M. Llibre
- Infectious Diseases and “Lluita contra la SIDA” Foundation, University Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Correspondence: Josep M. Llibre, HIV Unit, Hospital Universitari Germans Trias i Pujol, Ctra de Canyet, s/n, 08916 Badalona, Barcelona, Spain (e-mail: )
| | - Alessandro Cozzi-Lepri
- Research Department of Infection and Population Health, University College London, London, UK
| | - Court Pedersen
- Odense University Hospital, Department of Infectious Diseases, Odense, Denmark
| | - Matti Ristola
- Helsinki University Hospital, Department of Infectious Diseases, Helsinki, Finland
| | - Marcelo Losso
- Hospital General de Agudos JM Ramos Mejía, Department of Infectious Diseases, Buenos Aires, Argentina
| | - Amanda Mocroft
- Department of Epidemiology and Medical Statistics, University College London, London, UK
| | - Viktar Mitsura
- Department of Infectious Diseases, Gomel State Medical University, Gomel, Belarus
| | | | - Fernando Maltez
- Curry Cabral Hospital, Department of Infectious Diseases, Lisbon, Portugal
| | - Marek Beniowski
- Specialistic Hospital, Outpatient Clinic for AIDS Diagnostics and Therapy, Chorzów, Poland
| | | | | | - Elena Kuzovatova
- Nizhny Novgorod Scientific and Research Institute of Epidemiology and Microbiology named after Academician I.N. Blokhina, Russia
| | | | | | | | - Claudine Duvivier
- Infectious Diseases Center Necker-Pasteur, APHP-Hôpital Necker-Enfants Malades, Paris, France
| | | | - Kamilla Laut
- Centre for Health & Infectious Diseases Research (CHIP), Department of Infectious Diseases, Section 2100, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Roger Paredes
- Infectious Diseases and “Lluita contra la SIDA” Foundation, University Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
- Irsi-Caixa AIDS Research Institute, Badalona, Spain
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Liu Y, Park ES, Gibbons AT, Shide ED, Divi RL, Woodward RA, Poirier MC. Mitochondrial compromise in 3-year old patas monkeys exposed in utero to human-equivalent antiretroviral therapies. Environ Mol Mutagen 2016; 57:526-34. [PMID: 27452341 PMCID: PMC4980240 DOI: 10.1002/em.22033] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 06/21/2016] [Indexed: 05/25/2023]
Abstract
Antiretroviral (ARV) drug therapy, given during pregnancy for prevention of mother-to-child transmission of human immunodeficiency virus 1 (HIV-1), induces fetal mitochondrial dysfunction in some children. However, the persistence/reversibility of that dysfunction is unclear. Here we have followed Erythrocebus patas (patas) monkey offspring for up to 3 years of age (similar in development to a 15-year old human) after exposure of the dams to human-equivalent in utero ARV exposure protocols. Pregnant patas dams (3-5/exposure group) were given ARV drug combinations that included zidovudine (AZT)/lamivudine (3TC)/abacavir (ABC), or AZT/3TC/nevirapine (NVP), for the last 10 weeks (50%) of gestation. Infants kept for 1 and 3 years also received drug for the first 6 weeks of life. In offpsring at birth, 1 and 3 years of age mitochondrial morphology, examined by electron microscopy (EM), was compromised compared to the unexposed controls. Mitochondrial DNA (mtDNA), measured by hybrid capture chemiluminescence assay (HCCA) was depleted in hearts of patas exposed to AZT/3TC/NVP at all ages (P < 0.05), but not in those exposed to AZT/3TC/ABC at any age. Compared to unexposed controls, mitochondrial reserve capacity oxygen consumption rate (OCR by Seahorse) in cultured bone marrow mesenchymal fibroblasts from 3-year-old patas offspring was ∼50% reduced in AZT/3TC/ABC-exposed patas (P < 0.01), but not in AZT/3TC/NVP-exposed patas. Overall the data show that 3-year-old patas sustain persistent mitochondrial dysfunction as a result of perinatal ARV drug exposure. Environ. Mol. Mutagen. 57:526-534, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Yongmin Liu
- Carcinogen-DNA Interactions Section, Laboratory of Cancer Biology and Genetics, CCR, National Cancer Institute, NIH, Bethesda, MD
| | - Eunwoo Shim Park
- Carcinogen-DNA Interactions Section, Laboratory of Cancer Biology and Genetics, CCR, National Cancer Institute, NIH, Bethesda, MD
| | - Alexander T. Gibbons
- Carcinogen-DNA Interactions Section, Laboratory of Cancer Biology and Genetics, CCR, National Cancer Institute, NIH, Bethesda, MD
| | - Eric D. Shide
- Carcinogen-DNA Interactions Section, Laboratory of Cancer Biology and Genetics, CCR, National Cancer Institute, NIH, Bethesda, MD
| | - Rao L. Divi
- Methods and Technologies Branch, DCPC, National Cancer Institute, NIH, Bethesda, MD
| | | | - Miriam C. Poirier
- Carcinogen-DNA Interactions Section, Laboratory of Cancer Biology and Genetics, CCR, National Cancer Institute, NIH, Bethesda, MD
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M. Llibre J, Raffi F, Moyle G, Behrens G, Bouee S, Reilly G, Borg P, Piontkowsky D, Rogatto F. An Indirect Comparison of Efficacy and Safety of Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Disoproxil Fumarate and Abacavir/Lamivudine + Dolutegravir in Initial Therapy. PLoS One 2016; 11:e0155406. [PMID: 27196332 PMCID: PMC4872996 DOI: 10.1371/journal.pone.0155406] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 04/28/2016] [Indexed: 11/19/2022] Open
Abstract
Objectives The objective of this analysis is to perform an indirect comparison of elvitegravir, cobicistat, emtricitabine and tenofovir DF (E/C/F/TDF) to abacavir/lamivudine and dolutegravir (ABC/3TC + DTG) by using 2 trials evaluating each of these regimens in comparison to efavirenz, emtricitabine and tenofovir DF (EFV/FTC/TDF). Methods An indirect comparison was performed by using a generalization of Bucher's methodology to calculate risk differences. Two phase III clinical trials (GS-US-236-0102 and SINGLE—described above) were used. Results Results of the indirect comparison showed no statistically significant risk difference of the efficacy endpoint of achieving HIV RNA < 50 copies/mL between E/C/F/TDF and ABC/3TC + DTG for the ITT population at weeks 48, 96 and 144: respectively -3.7% (CI95% = [-10.8%; 3.4%]), -5.2% (CI95% = [-13.2%; 2.8%]) and -3.1% (CI95% = [-12.0%; 5.7%]). There was no statistically significant differences in the risk difference for serious adverse events (5.7% (CI95% = [-2.2%; 12.3%])), drug related adverse event (2.7% (CI95% = [-7.0%;12.4%])), drug related serious adverse event (0.8% (CI95% = [-1.6%;3.2%])) and death (0.5% (CI95% = [-0.8%;1.8%])), respectively, between E/C/F/TDF and ABC/3TC + DTG. A significant difference was found for discontinuation due to adverse events with a higher rate for E/C/F/TDF (difference = 8.6% (CI95% = [3.3%; 13.9%])). There was also no statistically significant risk difference of the viral resistance of 1.2% (CI95% = [-1.2; 3.7]) between E/C/F/TDF and ABC/3TC + DTG at week 48, 1.7% at week 96 (CI95% = [-1.1; 4.5]) and 2.2% (CI95% = [-1.0; 5.4]) at week 144.
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Affiliation(s)
| | | | - Graeme Moyle
- Chelsea and Westminster Hospital, London, United Kingdom
| | | | | | | | - Peter Borg
- Gilead Sciences, Stockley Park, United Kingdom
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Fukutake K. [Companion Diagnostics for Selecting Antiretroviral Drugs against HIV-1]. Rinsho Byori 2015; 63:1323-1327. [PMID: 26995879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Currently, the treatment of human immunodeficiency virus involves combination therapy, as antiretroviral therapy(ART). The treatment has improved steadily since the advent of potent combination therapy in 1996. New drugs that offer new mechanisms of action, improvements in potency and activity even against multidrug-resistant viruses, dosing convenience, and tolerability have been approved. Among ART with useful drugs, there are two important examinations before starting the treatment using the two kinds of drug. CCR5 co-receptor antagonists, maraviroc, prevent HIV entry into target cells by binding to CCR5 receptors. Genotypic assays have been developed that can determine or predict the co-receptor tropism(i.e., CCR5, CXCR4, or both) of the patient's dominant virus population. The assay for HIV-1 co-receptor usage should be performed whenever the use of a CCR5 antagonist is being considered. One of the nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs), abacavir, is an important agent to develop recommended regimens for antiretroviral therapy. Serious and sometimes fatal hypersensitivity reactions have been associated with abacavir-containing products, ZIAGEN, Epzicom, and Triumeq. Patients who carry the HLA-B*5701 allele are at high-risk of a hypersensitivity reaction to abacavir. Prior to initiating therapy with abacavir, performing a screening test for the HLA-B*5701 allele is recommended. [Review].
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Fantauzzi A, Floridia M, Falasca F, Spanedda P, Turriziani O, Vullo V, Mezzaroma I. Backbone switch to abacavir/lamivudine fixed-dose combination: implications for antiretroviral therapy optimization. New Microbiol 2015; 38:531-540. [PMID: 26485011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 08/23/2015] [Indexed: 06/05/2023]
Abstract
Current guidelines recommend treatment optimization in virologically suppressed patients through switching/ simplification strategies to minimize long-term toxicities and improve adherence. The assessment of inflammation/ coagulation profiles may support therapeutic decisions. We undertook a prospective, non-randomized study to evaluate the efficacy and safety of switching to ABC/3TC from ZDV/3TC or TDF/FTC backbones, in 40 HIV-1 infected patients with HIV-RNA levels <37 copies/mL (>24 months). Main endpoints were viral load levels, CD4+ T cells and toxicities after 48 weeks. Serum inflammation/coagulation markers (ESR, CRP, D-dimer and fibrinogen) and pro-inflammatory cytokines (IL-6, TNF-α, adiponectin, resistin) were evaluated. Baseline characteristics were similar in the two arms, with significantly lower values of e-GFR in patients on TDF/FTC. Markers of inflammation/ coagulation and cytokine profile were also similar, except for higher values of resistin in patients on TDF/ FTC. During follow up, CD4+ T cells increased and viral load remained undetectable in both groups. Patient from ZDV/3TC had significantly greater changes in total cholesterol and serum creatinine. Markers of inflammation/ coagulation remained unchanged. Adiponectin significantly increased in patients from ZDV/3TC. Switching to ABC/3TC was effective and safe. Inflammatory markers remained low in both groups. Some changes in metabolic, kidney and cytokine profiles were apparently specific for baseline cART treatment.
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Affiliation(s)
| | - Marco Floridia
- Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanità (ISS), Rome, Italy
| | - Francesca Falasca
- Department of Molecular Medicine, Sapienza, University of Rome, Rome, Italy
| | - Pierpaolo Spanedda
- Department of Experimental Medicine, Sapienza, University of Rome, Rome, Italy
| | | | - Vincenzo Vullo
- Department of Public Health and Infectious Diseases, Sapienza, University of Rome, Rome, Italy
| | - Ivano Mezzaroma
- Department of Clinical Medicine, Sapienza, University of Rome, Rome, Italy
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Wilson B, Paladugu L, Priyadarshini SRB, Jenita JJL. Development of albumin-based nanoparticles for the delivery of abacavir. Int J Biol Macromol 2015; 81:763-7. [PMID: 26365020 DOI: 10.1016/j.ijbiomac.2015.09.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 09/05/2015] [Accepted: 09/07/2015] [Indexed: 12/14/2022]
Abstract
The study was designed to prepare and evaluate albumin nanoparticles containing antiviral drug abacavir sulphate. Various batches of albumin nanoparticles containing abacavir sulphate were prepared by desolvation method. The abacavir loaded particles were characterized for their yield, percentage of drug loading, surface morphology, particle size, surface charge, pattern of in vitro drug release and release mechanism studies. Drug loading ranged from 1.2 to 5.9%w/w. The mean particle size and the surface charge were 418.2nm and -40.8mV respectively. The in vitro drug release varied between 38.73 and 51.36%w/w for 24h. The n value for Korsmeyer-Peppas was 0.425 indicating Fickian type drug release. The preliminary findings indicated that albumin nanoparticles of abacavir can be prepared by desolvation method with good yield, high drug loading and sustained release.
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Affiliation(s)
- Barnabas Wilson
- Department of Pharmaceutics, Dayananda Sagar College of Pharmacy, Kumaraswamy Layout, Bangalore, Karnataka 560078, India.
| | - Latishkumar Paladugu
- Department of Pharmaceutics, Dayananda Sagar College of Pharmacy, Kumaraswamy Layout, Bangalore, Karnataka 560078, India
| | - S R Brahmani Priyadarshini
- Department of Pharmaceutics, Dayananda Sagar College of Pharmacy, Kumaraswamy Layout, Bangalore, Karnataka 560078, India
| | - J Josephine Leno Jenita
- Department of Pharmaceutics, Dayananda Sagar College of Pharmacy, Kumaraswamy Layout, Bangalore, Karnataka 560078, India
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De Spiegelaere W, Philippé J, Vervisch K, Verhofstede C, Malatinkova E, Kiselinova M, Trypsteen W, Bonczkowski P, Vogelaers D, Callens S, Ruelle J, Kabeya K, De Wit S, Van Acker P, Van Sandt V, Emonds MP, Coucke P, Sermijn E, Vandekerckhove L. Comparison of methods for in-house screening of HLA-B*57:01 to prevent abacavir hypersensitivity in HIV-1 care. PLoS One 2015; 10:e0123525. [PMID: 25874872 PMCID: PMC4398410 DOI: 10.1371/journal.pone.0123525] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 03/04/2015] [Indexed: 12/27/2022] Open
Abstract
Abacavir is a nucleoside reverse transcriptase inhibitor used as part of combination antiretroviral therapy in HIV-1-infected patients. Because this drug can cause a hypersensitivity reaction that is correlated with the presence of the HLA-B*57:01 allotype, screening for the presence of HLA-B*57:01 is recommended before abacavir initiation. Different genetic assays have been developed for HLA-B*57:01 screening, each with specific sensitivity, turnaround time and assay costs. Here, a new real-time PCR (qPCR) based analysis is described and compared to sequence specific primer PCR with capillary electrophoresis (SSP PCR CE) on 149 patient-derived samples, using sequence specific oligonucleotide hybridization combined with high resolution SSP PCR as gold standard. In addition to these PCR based methods, a complementary approach was developed using flow cytometry with an HLA-B17 specific monoclonal antibody as a pre-screening assay to diminish the number of samples for genetic testing. All three assays had a maximum sensitivity of >99. However, differences in specificity were recorded, i.e. 84.3%, 97.2% and >99% for flow cytometry, qPCR and SSP PCR CE respectively. Our data indicate that the most specific and sensitive of the compared methods is the SSP PCR CE. Flow cytometry pre-screening can substantially decrease the number of genetic tests for HLA-B*57:01 typing in a clinical setting.
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Affiliation(s)
| | - Jan Philippé
- Ghent University, Department of Clinical Chemistry, Microbiology and Immunology, Ghent, Belgium
| | - Karen Vervisch
- Ghent University, Department of Internal Medicine, Ghent, Belgium
| | - Chris Verhofstede
- Ghent University, Department of Clinical Chemistry, Microbiology and Immunology, Ghent, Belgium
| | - Eva Malatinkova
- Ghent University, Department of Internal Medicine, Ghent, Belgium
| | - Maja Kiselinova
- Ghent University, Department of Internal Medicine, Ghent, Belgium
| | - Wim Trypsteen
- Ghent University, Department of Internal Medicine, Ghent, Belgium
| | | | - Dirk Vogelaers
- Ghent University, Department of Internal Medicine, Ghent, Belgium
| | - Steven Callens
- Ghent University, Department of Internal Medicine, Ghent, Belgium
| | - Jean Ruelle
- Université Catholique de Louvain, IREC, AIDS Reference Laboratory, Brussels, Belgium
| | - Kabamba Kabeya
- Saint-Pierre University Hospital, Department of Infectious Diseases, Bruxelles, Belgium
| | - Stephane De Wit
- Saint-Pierre University Hospital, Department of Infectious Diseases, Bruxelles, Belgium
| | - Petra Van Acker
- Ghent University, Center for Medical Genetics, Ghent, Belgium
| | - Vicky Van Sandt
- HILA, Laboratory for Histocompatibility & Immunogenetics Red Cross Flanders, Mechelen, Belgium
| | - Marie-Paule Emonds
- HILA, Laboratory for Histocompatibility & Immunogenetics Red Cross Flanders, Mechelen, Belgium
| | - Paul Coucke
- Ghent University, Center for Medical Genetics, Ghent, Belgium
| | - Erica Sermijn
- Ghent University, Department of Internal Medicine, Ghent, Belgium
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Grant PM, Kitch D, McComsey GA, Tierney C, Ha B, Brown TT. Differential skeletal impact of tenofovir disoproxil fumarate in young versus old HIV-infected adults. HIV Clin Trials 2015; 16:66-71. [PMID: 25872972 DOI: 10.1179/1528433614z.0000000010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Lower peak bone mass in early adulthood predicts subsequent fragility fractures. Antiretroviral toxicity could contribute to young HIV-infected individuals not achieving adequate peak bone mass. OBJECTIVE To determine if tenofovir disoproxil fumarate's (TDF) effect on bone mineral density (BMD) differs by age. METHODS We examined BMD data at the lumbar spine and hip from AIDS Clinical Trials Group (ACTG) A5224s and ASSERT and randomized treatment-naive studies comparing TDF/emtricitabine versus abacavir/lamivudine (with efavirenz or atazanavir/ritonavir). In this post hoc analysis, we defined the TDF effect as the difference between mean 48-week BMD per cent changes for lumbar spine and hip in individuals randomized to TDF versus abacavir. We used multivariable linear regression to compare the TDF effect in individuals younger and older than 30 years. If TDF effect by age did not differ significantly between studies, we pooled study populations. Otherwise, analyses were conducted separately within each study population. RESULTS Among 652 subjects, 21% were below age 30 years. The relationship between age and TDF effect significantly differed between A5224s and ASSERT (P = 0.008 for lumbar spine; P = 0.007 for hip). In A5224s, there was more bone loss with TDF at lumbar spine and hip in subjects under 30 years old versus in older subjects ( - 4.5% vs - 1.4%; P = 0.045; - 4.3% vs - 1.6%; P = 0.026, respectively). There was no significant evidence for this age-associated TDF effect in ASSERT. CONCLUSIONS There was heterogeneity in the observed effect of TDF on bone density in young adults compared to older adults, suggesting that further investigation is required to understand the impact of age on BMD decline with TDF.
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Li RWS, Yang C, Chan SW, Hoi MPM, Lee SMY, Kwan YW, Leung GPH. Relaxation effect of abacavir on rat basilar arteries. PLoS One 2015; 10:e0123043. [PMID: 25853881 PMCID: PMC4390379 DOI: 10.1371/journal.pone.0123043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 02/25/2015] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND The use of abacavir has been linked with increased cardiovascular risk in patients with human immunodeficiency virus infection; however, the mechanism involved remains unclear. We hypothesize that abacavir may impair endothelial function. In addition, based on the structural similarity between abacavir and adenosine, we propose that abacavir may affect vascular contractility through endogenous adenosine release or adenosine receptors in blood vessels. METHODS The relaxation effect of abacavir on rat basilar arteries was studied using the myograph technique. Cyclic GMP and AMP levels were measured by immunoassay. The effects of abacavir on nucleoside transporters were studied using radiolabeled nucleoside uptake experiments. Ecto-5' nucleotidase activity was determined by measuring the generation of inorganic phosphate using adenosine monophosphate as the substrate. RESULTS Abacavir induced the relaxation of rat basilar arteries in a concentration-dependent manner. This relaxation was abolished when endothelium was removed. In addition, the relaxation was diminished by the nitric oxide synthase inhibitor, L-NAME, the guanylyl cyclase inhibitor, ODQ, and the protein kinase G inhibitor, KT5820. Abacavir also increased the cGMP level in rat basilar arteries. Abacavir-induced relaxation was also abolished by adenosine A2 receptor blockers. However, abacavir had no effect on ecto-5' nucleotidase and nucleoside transporters. Short-term and long-term treatment of abacavir did not affect acetylcholine-induced relaxation in rat basilar arteries. CONCLUSION Abacavir induces acute endothelium-dependent relaxation of rat basilar arteries, probably through the activation of adenosine A2 receptors in endothelial cells, which subsequently leads to the release of nitric oxide, resulting in activation of the cyclic guanosine monophosphate/protein kinase G-dependent pathway in vascular smooth muscle cells. It is speculated that abacavir-induced cardiovascular risk may not be related to endothelial dysfunction as abacavir does not impair relaxation of blood vessels. The most likely explanation of increased cardiovascular risk may be increased platelet aggregation as suggested by other studies.
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Affiliation(s)
- Rachel Wai Sum Li
- Department of Pharmacology and Pharmacy, Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Cui Yang
- Key Laboratory of Ethnic Medicine Resource Chemistry (Yunnan University of Nationalities), State Ethnic Affairs Commission & Ministry of Education, School of Chemistry & Biotechnology, Yunnan University of Nationalities, Kunming, China
| | - Shun Wan Chan
- State Key Laboratory of Chinese Medicine and Molecular Pharmacology, Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Hong Kong, China
| | - Maggie Pui Man Hoi
- Institute of Chinese Medical Sciences, University of Macau, Macao, China
| | | | - Yiu Wa Kwan
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - George Pak Heng Leung
- Department of Pharmacology and Pharmacy, Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- * E-mail:
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MacArthur RD, Chen L, Peng G, Novak RM, van den Berg-Wolf M, Kozal M, Besch L, Yurik T, Schmetter B, Henley C, Dehlinger M. Efficacy and Safety of Abacavir Plus Lamivudine Versus Didanosine Plus Stavudine When Combined with a Protease Inhibitor, a Nonnucleoside Reverse Transcriptase Inhibitor, or Both in HIV-1 Positive Antiretroviral-Naive Persons. HIV Clinical Trials 2015; 5:361-70. [PMID: 15682349 DOI: 10.1310/weqg-qthl-dl3x-ftxc] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE The combination of abacavir + lamivudine (ABC+3TC) versus didanosine + stavudine (ddI+d4T), each combined with other classes of antiretrovirals (ARVs) in ARV-naive patients, was compared for the combined endpoint of time to plasma HIV RNA >50 copies/mL (at or after the 8-month visit) or death (primary endpoint) in a nested substudy of an ongoing multicenter randomized trial. METHOD The substudy enrolled 182 patients; mean HIV RNA and CD4+ cell counts at baseline were 5.1 log10 copies/mL and 212 cells/mm3, respectively. RESULTS After a median follow-up of 28 months, rates of primary endpoint were 57.2 and 67.8 per 100 person-years for the ABC+3TC and ddI+d4T groups (hazard ratio [HR]=0.81, 95% confidence interval [CI] 0.58-1.14, p=.23). CONCLUSION There was a trend for treatments containing ABC+3TC to be better than treatments containing ddI+d4T with respect to HIV RNA decreases, CD4+ cell count increases, and tolerability.
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Affiliation(s)
- R D MacArthur
- Department of Medicine, Division of Infectious Diseases, Wayne State University, Detroit, Michigan 48201, USA.
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Abstract
A randomized controlled study exploring an induction-maintenance strategy was performed with a quadruple-drug regimen: zidovudine/lamivudine/abacavir/nevirapine. The study was prematurely interrupted due to the high proportion of adverse events. The median time on protocol-defined therapy was 110 days; 13/28 (46%) patients interrupted therapy and 2/6 tested patients selected praecox viral mutants. Despite this, we observed a significant (p </= .001) increment of CD4. The theoretical advantages of induction-maintenance strategies are tempered by an increased risk of adverse experiences.
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Affiliation(s)
- Franco Maggiolo
- Division of Infectious Diseases, Antiviral Therapy Unit, Ospedali Riuniti di Bergamo, Italy.
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de Truchis P, Mathez D, Force G, Rouveix E, Khuong MA, Chemlal K, Thiaux C, Leibowitch J. Letter to the Editor: Long-Term Control of Viral Residual Replication Under Maintenance Therapy with Trizivir After a Quadruple Induction Regimen in HIV-1-Infected Adults (Suburbs Trial). HIV Clinical Trials 2015; 8:102-4. [PMID: 17507326 DOI: 10.1310/hct0802-102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Elion R, Cohen C, DeJesus E, Redfield R, Gathe J, Hsu R, Yau L, Ross L, Ha B, Lanier RE, Scott T. Once-Daily Abacavir/Lamivudine/Zidovudine plus Tenofovir for the Treatment of HIV-1 Infection in Antiretroviral-NaïveSubjects: A 48-Week Pilot Study. HIV Clinical Trials 2015; 7:324-33. [PMID: 17208898 DOI: 10.1310/hct0706-324] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To assess the safety and efficacy of a 4-drug, 3-tablet, once-daily (qd) regimen consisting of abacavir/lamivudine/zidovudine (ABC/3TC/ZDV; 2 tablets) and tenofovir (TDF) in antiretroviral-naïve patients with plasma HIV-1 RNA 30,000 copies/mL at 48 weeks. METHOD All participants received ABC/3TC/ZDV (300/150/300 mg) and TDF (300 mg) qd in this pilot, open-label, multicenter study. Intent-to-treat (ITT) analyses were conducted to evaluate virologic and immunologic efficacy. RESULTS Of the 123 participants enrolled, 52 (42%) prematurely discontinued study for adverse events (14), were lost to follow-up (13), had virologic nonresponse (12), and withdrew for other reasons (13). At week 48, by ITT missing=failure analysis, 41% (51/123) and 51% (63/123) of participants had plasma HIV-1 RNA <50 copies/mL and <400 copies/mL, respectively; by ITT-observed analysis, 75% (51/68) and 93% (63/68) had plasma HIV-1 RNA <50 copies/mL and <400 copies/mL, respectively; 11% (14/123) met virologic nonresponse criteria. Median week 48 change in CD4+ cell count from baseline was +127 cells/mm3. Median week 48 changes from baseline for fasting lipids were as follows: cholesterol (-9 mg/dL), HDL (+1 mg/dL), LDL (-9 mg/dL), and triglycerides (-4 mg/dL). CONCLUSION A high rate of premature discontinuations contributed to the overall suboptimal virologic response to ABC/3TC/ZDV+TDF qd; however, the regimen was not associated with high rates of virologic failure previously observed with TDF+ABC/3TC.
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Triumeq--a 3-drug combination for HIV. Med Lett Drugs Ther 2015; 57:7-8. [PMID: 25555073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Vázquez E. A NEW TRIPLE THREAT AGAINST THE VIRUS. Posit Aware 2014; 26:37-39. [PMID: 26292381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Patel DA, Snedecor SJ, Tang WY, Sudharshan L, Lim JW, Cuffe R, Pulgar S, Gilchrist KA, Camejo RR, Stephens J, Nichols G. 48-week efficacy and safety of dolutegravir relative to commonly used third agents in treatment-naive HIV-1-infected patients: a systematic review and network meta-analysis. PLoS One 2014; 9:e105653. [PMID: 25188312 PMCID: PMC4154896 DOI: 10.1371/journal.pone.0105653] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 07/22/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND A network meta-analysis can provide estimates of relative efficacy for treatments not directly studied in head-to-head randomized controlled trials. We estimated the relative efficacy and safety of dolutegravir (DTG) versus third agents currently recommended by guidelines, including ritonavir-boosted atazanavir (ATV/r), ritonavir-boosted darunavir (DRV/r), efavirenz (EFV), cobicistat-boosted elvitegravir (EVG/c), ritonavir-boosted lopinavir (LPV/r), raltegravir (RAL), and rilpivirine (RPV), in treatment-naive HIV-1-infected patients. METHODS A systematic review of published literature was conducted to identify phase 3/4 randomized controlled clinical trials (up to August 2013) including at least one third agent of interest in combination with a backbone nucleoside reverse transcriptase inhibitor (NRTI) regimen. Bayesian fixed-effect network meta-analysis models adjusting for the type of nucleoside reverse transcriptase inhibitor backbone (tenofovir disoproxil fumarate/emtricitabine [TDF/FTC] or abacavir/lamivudine [ABC/3TC]) were used to evaluate week 48 efficacy (HIV-RNA suppression to <50 copies/mL and change in CD4+ cells/µL) and safety (lipid changes, adverse events, and discontinuations due to adverse events) of DTG relative to all other treatments. Sensitivity analyses assessing the impact of NRTI treatment adjustment and random-effects models were performed. RESULTS Thirty-one studies including 17,000 patients were combined in the analysis. Adjusting for the effect of NRTI backbone, treatment with DTG resulted in significantly higher odds of virologic suppression (HIV RNA<50 copies/mL) and increase in CD4+ cells/µL versus ATV/r, DRV/r, EFV, LPV/r, and RPV. Dolutegravir had better or equivalent changes in total cholesterol, LDL, triglycerides, and lower odds of adverse events and discontinuation due to adverse events compared to all treatments. Random-effects and unadjusted models resulted in similar conclusions. CONCLUSION Three clinical trials of DTG have demonstrated comparable or superior efficacy and safety to DRV, RAL, and EFV in HIV-1-infected treatment-naive patients. This network meta-analysis suggests DTG is also favorable or comparable to other commonly used third agents (ATV/r, LPV/r, RPV, and EVG/c).
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Affiliation(s)
- Dipen A. Patel
- Pharmerit International, Bethesda, Maryland, United States of America
| | - Sonya J. Snedecor
- Pharmerit International, Bethesda, Maryland, United States of America
| | - Wing Yu Tang
- Pharmerit International, Bethesda, Maryland, United States of America
| | | | | | | | - Sonia Pulgar
- GlaxoSmithKline, Research Triangle Park, North Carolina, United States of America
| | - Kim A. Gilchrist
- GlaxoSmithKline, Renaissance, Pennsylvania, United States of America
| | | | - Jennifer Stephens
- Pharmerit International, Bethesda, Maryland, United States of America
| | - Garrett Nichols
- GlaxoSmithKline, Research Triangle Park, North Carolina, United States of America
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Ghosal K, Ranjan A, Bhowmik BB. A novel vaginal drug delivery system: anti-HIV bioadhesive film containing abacavir. J Mater Sci Mater Med 2014; 25:1679-1689. [PMID: 24699799 DOI: 10.1007/s10856-014-5204-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Accepted: 03/24/2014] [Indexed: 06/03/2023]
Abstract
Women are very much susceptible for acquired immunodeficiency syndrome (AIDS) and other sexually transmitted diseases (STDs), mainly due to unprotected heterosexual vaginal intercourse and for some other social and economical disadvantages. Our aim was to formulate and optimize vaginal film of abacavir, a potent nucleoside reverse transcriptase inhibitor, for the treatment of AIDS and HIV. Abacavir films were prepared by solvent evaporation method using sodium alginate (Na-alginate) as the main polymer, Hydroxypropyl Methylcellulose E 15 (HPMC E 15) as the copolymer and glycerol as a humectant. Abacavir sulphate (ABC) was used here as a drug. Films were optimized for various physicochemical parameters such as tensile strength, % elongation at break, swelling capacity, drug content (mg/cm(2)), thickness, folding endurance, bioadhesion, pH, moisture content and SEM. Drug polymer interaction was studied by FTIR Spectra. The drug release study was accomplished in dissolution apparatus. In vivo study was also carried out. This newly formed film was one kind of sustain release type and can be considered as a novel drug carrier system for the treatment of AIDS and other STDs. It was suitable for local as well as systemic effect. The films showed good physicochemical property with good aesthetic appeal.
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Affiliation(s)
- Kajal Ghosal
- Dr. B.C. Roy College of Pharmacy and Allied Health Science, Bidhan Nagar, Durgapur, 713206, West Bengal, India,
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Casado JL, Bañón S. Recent advances in rilpivirine: new data and promising treatment option. AIDS Rev 2014; 16:172-181. [PMID: 25221991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The usefulness of every antiretroviral drug in the clinical setting should be continuously evaluated, since registration studies may not adequately reflect real-world patient populations. Rilpivirine was developed in an effort to generate patient-tailored drugs with high convenience and minimal side effects. By now, rilpivirine is currently licensed for use with other antiretroviral agents, and as a single agent or a single-tablet regimen with tenofovir and emtricitabine , in antiretroviral-naive, HIV-1-infected adults with < 100,000 HIV-1 RNA copies/ml because of a higher rate of virological failure above this level. However, after its introduction several questions remained to be elucidated, such as the efficacy of rilpivirine with abacavir/lamivudine, or its use in switching strategies, a useful alternative for patients with toxicity or intolerance. Cumulative data suggest the efficacy and safety of the combination of abacavir/lamivudine plus rilpivirine in the clinical setting, and an increasing number of patients received rilpivirine after protease inhibitor, efavirenz, or nevirapine-based therapy without compromising rilpivirine exposure after the change. Moreover, rilpivirine is a substrate and weak inducer of the CYP3A4, but there are no significant pharmacokinetic interactions with new anti-hepatitis C compounds such as telaprevir, simeprevir, daclatasvir, ledipasvir, and sofosbuvir, an important issue for a drug with low risk of hepatoxicity. As a new and promising strategy, rilpivirine has been evaluated with darunavir and dolutegravir in dual therapies, without need of dose adjustment and with adequate preliminary data. Therefore, to date, new data on rilpivirine confirm the good results observed in the clinical trials.
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Affiliation(s)
- José Luis Casado
- Dept of Infectious Diseases, Ramon y Cajal Hospital, Madrid, Spain
| | - Sara Bañón
- Dept of Infectious Diseases, Ramon y Cajal Hospital, Madrid, Spain
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Achhra AC, Boyd MA, Law MG, Matthews GV, Kelleher AD, Cooper DA. Moving away from Ritonavir, Abacavir, Tenofovir, and Efavirenz (RATE)--agents that concern prescribers and patients: a feasibility study and call for a trial. PLoS One 2014; 9:e99530. [PMID: 24968324 PMCID: PMC4072535 DOI: 10.1371/journal.pone.0099530] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 05/15/2014] [Indexed: 11/19/2022] Open
Abstract
Objectives Regimens sparing RATE (ritonavir, abacavir, tenofovir, efavirienz) agents might have better long-term safety. We conducted a feasibility exercise to assess the potential for a randomised trial evaluating RATE-sparing regimens. Design Observational. Methods We first calculated RATE-sparing options available to an average patient receiving RATE agents. We reviewed treatment history and all resistance assays from patients attending the St. Vincent’s Hospital (Sydney) clinic and receiving ≥2 RATE agents (n = 120). A viable RATE-sparing regimen with 2 or 3 fully-active agents was constructed from the following six ‘safer’ agents: rilpivirine or etravirine; atazanavir; raltegravir; maraviroc; and lamivudine. Activity for each drug was predicted as 1 (full-activity), 0.5 or 0 (no activity) using the Stanford mutation database. The utility of maraviroc was calculated assuming both maraviroc activity and inactivity where unknown. The analysis was restricted to regimens for which supporting evidence was identified in the literature or conference proceedings. Finally, we calculated the proportion of patients in the nationally representative Australian HIV Observational Database (AHOD) cohort receiving ≥2 RATE agents (n = 1473) to measure the potential population-level uptake of RATE-sparing agents. Results Assuming full maraviroc activity, 117(97.5%) and 107(89.2%) individuals had at least one option with 2 or 3 active RATE-sparing agents, respectively. Assuming no maraviroc activity this decreased to 113(94.2%) and 104(86.7%), respectively. In AHOD, 837(56.8%) patients were receiving ≥2 RATE agents. Conclusion Feasible treatment switch options sparing RATE agents exist for the majority of patients. Understanding the pros and cons of switching stable patients onto new RATE-sparing regimens requires evidence derived from randomised controlled trials.
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Affiliation(s)
- Amit C. Achhra
- The Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia
- * E-mail:
| | - Mark A. Boyd
- The Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia
| | - Matthew G. Law
- The Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia
| | - Gail V. Matthews
- The Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia
| | | | - David A. Cooper
- The Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia
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Abstract
The fixed dose combination of abacavir with lamivudine represents a new treatment option for patients infected with HIV. Fixed dose combination abacavir/lamivudine has the convenience of one pill and once-daily dosing. It achieves comparable suppression of plasma HIV RNA with the pill's individual components dosed twice daily and with thymidine analogs combined with lamivudine. The combination is well tolerated, with the potential advantages of less lipoatrophy and fewer metabolic perturbations. However, the abacavir component may cause hypersensitivity reactions, which are reported in up to 8% of patients, and are potentially life threatening. Fixed dose combination abacavir/lamivudine should be considered as a viable treatment option for HIV-infected patients, particularly for those who have otherwise limited nucleoside reverse transcriptase inhibitor choices.
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Affiliation(s)
- Albert M L Anderson
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA.
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Mushiroda T. [Future direction of pharmacogenomics: identification of genes associated with risk of adverse drug reactions using genome-wide association study]. Rinsho Byori 2014; 62:83-88. [PMID: 24724431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Drug-induced skin rash characterized by an acute inflammatory reaction of skin and mucous membranes is dose-independent, unpredictable, and sometimes life-threatening. In recent years, the U.S. Food and Drug Administration (FDA) has recommended genotyping of polymorphisms in the human leukocyte antigen (HLA) prior to drug administration for the avoidance of severe skin rash induced by drugs, such as abacavir and carbamazepine. A genome-wide association study (GWAS) is useful for the identification of genomic biomarkers that can predict the efficacy or risk of toxicity of various drugs. We identified novel susceptibility loci associated with the risk of a skin rash induced by nevirapine and carbamazepine in Thai and Japanese populations, respectively, through case-control GWAS with high-throughput single-nucleotide polymorphism (SNP) genotyping technology. In order to apply the genomic biomarkers to clinical therapeutics, prospective clinical trials will be necessary for the evaluation of an intervention based on genetic tests.
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Kravchenko AV, Zimina VN, Popova AA, Deulina MO, Kanestri VG, Ivanova ES, Yakovlev AA, Pokrovsky VV. [The efficacy and safety of a therapy regimen including raltegravir and a fixed dose combination of lamivudine and abacavir in previously rifabutin-treated patients with tuberculosis and HIV infection]. TERAPEVT ARKH 2014; 86:34-41. [PMID: 25715485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIM To evaluate the efficiency and safety of using raltegravir (RAL) twice daily in conjunction with a once-daily fixed dose combination of abacavir (ABC)/lamivudine (3TC) in patients with HIV infection and active tuberculosis who have not previously received antiretroviral therapy (ART) and have taken rifabutin as antituberculosis therapy (ATT). SUBJECTS AND METHODS The efficiency of ART was evaluated in 28 patients from a change in HIV RNA levels and from an increase in CD4+ lymphocyte counts during 48-week treatment that had been completed by 15 (53.6%) patients. The main reason for therapy discontinuation was that the patients returned to the use psychoactive agents. RESULTS After 24 and 48 weeks of ART, the level of HIV RNA reached the undetectable values (less than 50 copies/ml) in 81.25 and 75% of the patients, respectively (according to an analysis including the patients who had completed the study in conformity with the requirements of the protocol). In only 2 patients, the virological therapy proved to be ineffective, which was likely to be associated with noncompliance with drug therapy. Following 24- and 48-week therapy, the increase in median CD4+ lymphocyte counts was 70 and 208.5 per μl, respectively. The concurrent use of ART and ATT caused positive changes in the lung skiagraphic pattern in 92.9% of the patients and complete resolution of lung tissue infiltration in 71.4%. Mixed infection ended in a fatal outcome caused by a progressive tuberculous process in 3 (10.7%) patients, in 2 of them within the first 8 weeks of treatment. The concomitant use of ATT including rifabutin and an ART (RAL + ABC/3TC) regimen was safe since one patient was noted to have a RAL-related adverse event (AE) (an allergic reaction) and caused the patient to discontinue therapy. ATT was not discontinued because of AE in any case. CONCLUSION The ART regimen containing RAL and a fixed dose combination of ABC/3TC for adult patients with tuberculosis concurrent with HIV infection who are on combined therapy using rifabutin for tuberculosis may be recommended for the treatment of this category of patients.
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Gupta RK, Goodall RL, Ranopa M, Kityo C, Munderi P, Lyagoba F, Mugarura L, Gilks CF, Kaleebu P, Pillay D. High rate of HIV resuppression after viral failure on first-line antiretroviral therapy in the absence of switch to second-line therapy. Clin Infect Dis 2013; 58:1023-6. [PMID: 24352348 PMCID: PMC3952602 DOI: 10.1093/cid/cit933] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
In a randomized comparison of nevirapine or abacavir with zidovudine plus lamivudine, routine viral load monitoring was not performed, yet 27% of individuals with viral failure at week 48 experienced resuppression by week 96 without switching. This supports World Health Organization recommendations that suspected viral failure should trigger adherence counseling and repeat measurement before a treatment switch is considered.
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Pammi M, Arumainayagam J, Kumari B, Ahmed-Jushuf I, Carlin EM, Chandramani S, Riddell L, Ghanem M, Das S. Safety and efficacy of tenofovir/emtricitabine or abacavir/lamivudine in combination with efavirenz in treatment naïve HIV patients: a 5 year retrospective observational cohort study. (the TOKEN Study). Int J Clin Pract 2013; 67:922-3. [PMID: 23952469 DOI: 10.1111/ijcp.12233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Accepted: 06/19/2013] [Indexed: 11/28/2022] Open
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Fuchs K, Kukuk D, Mahling M, Quintanilla-Martinez L, Reischl G, Reutershan J, Lang F, Röcken M, Pichler BJ, Kneilling M. Impact of anesthetics on 3'-[18F]fluoro-3'-deoxythymidine ([18F]FLT) uptake in animal models of cancer and inflammation. Mol Imaging 2013; 12:277-287. [PMID: 23759369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
The aim of this study was to evaluate the impact of different anesthetics on 3'-[18F]fluoro-3'-deoxythymidine ([18F]FLT) uptake in carcinomas and arthritic ankles. To determine the amount of [18F]FLT uptake in subcutaneous CT26 colon carcinomas or arthritic ankles, spontaneously room air/medical air-breathing mice were anesthetized with isoflurane, a combination of medetomidine/midazolam, or ketamine/xylazine. Mice were kept conscious or anesthetized during [18F]FLT uptake before the 10-minute static positron emission tomographic (PET) investigations. [18F]FLT uptake in CT26 colon carcinomas and arthritic ankles was calculated by drawing regions of interest. We detected a significantly reduced (4.4 ± 0.9 %ID/cm3) [18F]FLT uptake in the carcinomas of ketamine/xylazine-anesthetized mice compared to the [18F]FLT-uptake in carcinomas of medetomidine/midazolam- (7.0 ± 1.5 %ID/cm3) or isoflurane-anesthetized mice (6.4 ± 1.5 %ID/cm3), whereas no significant differences were observed in arthritic ankles regardless of whether mice were anesthetized or conscious during tracer uptake. The time-activity curves of carcinomas and arthritic ankles yielded diverse [18F]FLT accumulation related to the used anesthetics. [18F]FLT uptake dynamics are different in arthritic ankles and carcinoma, and the magnitude and pharmacokinetics of [18F]FLT uptake are sensitive to anesthetics. Thus, for preclinical in vivo [18F]FLT PET studies in experimental tumor or inflammation models, we recommend the use of isoflurane anesthesia as it yields a stable tracer uptake and is easy to handle.
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Affiliation(s)
- Kerstin Fuchs
- Laboratory for Preclinical Imaging and Imaging Technology of the Werner Siemens-Foundation, Department of Preclinical Imaging and Radiopharmacy
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Campo R, DeJesus E, Bredeek UF, Henry K, Khanlou H, Logue K, Brinson C, Benson P, Dau L, Wang H, White K, Flaherty J, Fralich T, Guyer B, Piontkowsky D. SWIFT: prospective 48-week study to evaluate efficacy and safety of switching to emtricitabine/tenofovir from lamivudine/abacavir in virologically suppressed HIV-1 infected patients on a boosted protease inhibitor containing antiretroviral regimen. Clin Infect Dis 2013; 56:1637-45. [PMID: 23362296 PMCID: PMC3641864 DOI: 10.1093/cid/cis1203] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 12/07/2012] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND In the United States, emtricitabine/tenofovir disoproxil fumarate (FTC/TDF) is a preferred nucleoside reverse transcriptase inhibitor (NRTI) backbone with lamivudine/abacavir (3TC/ABC) as a commonly used alternative. For patients infected with human immunodeficiency virus (HIV-1) virologically suppressed on a boosted protease inhibitor (PI) + 3TC/ABC regimen, the merits of switching to FTC/TDF as the NRTI backbone are unknown. METHODS SWIFT was a prospective, randomized, open-label 48-week study to evaluate efficacy and safety of switching to FTC/TDF. Subjects receiving 3TC/ABC + PI + ritonavir (RTV) with HIV-1 RNA < 200 c/mL ≥3 months were randomized to continue 3TC/ABC or switch to FTC/TDF. The primary endpoint was time to loss of virologic response (TLOVR) with noninferiority measured by delta of 12%. Virologic failure (VF) was defined as confirmed rebound or the last HIV-1 RNA measurement on study drug ≥200 c/mL. RESULTS In total, 311 subjects were treated in this study (155 to PI + RTV + FTC/TDF, 156 to PI + RTV + 3TC/ABC). Baseline characteristics were similar between the arms: 85% male, 28% black, median age, 46 years; and median CD4 532 cells/mm(3). By TLOVR through week 48, switching to FTC/TDF was noninferior compared to continued 3TC/ABC (86.4% vs 83.3%, treatment difference 3.0% (95% confidence interval, -5.1% to 11.2%). Fewer subjects on FTC/TDF experienced VF (3 vs 11; P = .034). FTC/TDF showed greater declines in fasting low-density lipoproteins (LDL), total cholesterol (TC), and triglycerides (TG) with significant declines in LDL and TC beginning at week 12 with no TC/HDL ratio change. Switching to FTC/TDF showed improved NCEP thresholds for TC and TG and improved 10-year Framingham TC calculated scores. Decreased estimated glomerular filtration rate [corrected] (eGFR) was observed in both arms with a larger decrease in the FTC/TDF arm. CONCLUSIONS Switching to FTC/TDF from 3TC/ABC maintained virologic suppression, had fewer VFs, improved lipid parameters and Framingham scores but decreased eGFR. CLINICALTRIALS.GOV IDENTIFIER: NCT00724711.
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Affiliation(s)
- R Campo
- Department of Infectious Diseases, University of Miami School of Medicine, Miami, FL 33136, USA.
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Jullien V, Urien S, Chappuy H, Dimet J, Rey E, Pons G, Blanche S, Tréluyer JM. Abacavir Pharmacokinetics in Human Immunodeficiency Virus-Infected Children Ranging in Age From 1 Month to 16 Years: A Population Analysis. J Clin Pharmacol 2013; 45:257-64. [PMID: 15703361 DOI: 10.1177/0091270004272215] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abacavir pharmacokinetics was studied in 105 children by a population approach performed with NONMEM. A 1-compartment open model with linear absorption and elimination adequately described the data. Typical population estimates (percent interindividual variability) of absorption rate constant, apparent distribution volume, and apparent plasma clearance were 1.79 h(-1) (58%), 42.9 L (53%), and 24.3 L/h (30%), respectively. Apparent plasma clearance was positively related to body weight. Individual Bayesian estimates of apparent plasma clearance were used to calculate individual abacavir area under the concentration curve (AUC). For the current weight-based regimen, abacavir exposure was found to be constant throughout the age range of the study, with an overall mean AUC value of 8.5 +/- 2.5 mg x h/L, which is slightly greater than the mean AUC value reported in adults. This study confirms the relevance of the current weight-based abacavir dosage regimen in pediatric patients.
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Affiliation(s)
- Vincent Jullien
- Pharmacologie Clinique, Université René Descartes, Groupe Hospitalier Cochin-Saint-Vincent-de-Paul, Assistance Publique-Hôpitaux de Paris, 82 Avenue Denfert-Rochereau, 75674 Paris Cedex 14, France
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Cohan D, Mwesigwa J, Natureeba P, Aliba Luwedde F, Ades V, Plenty A, Kakuru A, Achan J, Clark T, Osterbauer B, Kamya M, Havlir D. WHO option B+: early experience of antiretroviral therapy sequencing after cessation of breastfeeding and risk of dermatologic toxicity. J Acquir Immune Defic Syndr 2013; 62:e101-3. [PMID: 23924639 PMCID: PMC3738916 DOI: 10.1097/qai.0b013e31828011ca] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Nishijima T, Takano M, Ishisaka M, Komatsu H, Gatanaga H, Kikuchi Y, Endo T, Horiba M, Kaneda S, Uchiumi H, Koibuchi T, Naito T, Yoshida M, Tachikawa N, Ueda M, Yokomaku Y, Fujii T, Higasa S, Takada K, Yamamoto M, Matsushita S, Tateyama M, Tanabe Y, Mitsuya H, Oka S. Abacavir/lamivudine versus tenofovir/emtricitabine with atazanavir/ritonavir for treatment-naive Japanese patients with HIV-1 infection: a randomized multicenter trial. Intern Med 2013; 52:735-44. [PMID: 23545667 DOI: 10.2169/internalmedicine.52.9155] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To compare the efficacy and safety of fixed-dose abacavir/lamivudine (ABC/3TC) and tenofovir/emtricitabine (TDF/FTC) with ritonavir-boosted atazanavir (ATV/r) in treatment-naïve Japanese patients with HIV-1 infection. METHODS A 96-week multicenter, randomized, open-label, parallel group pilot study was conducted. The endpoints were times to virologic failure, safety event and regimen modification. RESULTS 109 patients were enrolled and randomly allocated (54 patients received ABC/3TC and 55 patients received TDF/FTC). All randomized subjects were analyzed. The time to virologic failure was not significantly different between the two arms by 96 weeks (HR, 2.09; 95% CI, 0.72-6.13; p=0.178). Both regimens showed favorable viral efficacy, as in the intention-to-treat population, 72.2% (ABC/3TC) and 78.2% (TDF/FTC) of the patients had an HIV-1 viral load <50 copies/mL at 96 weeks. The time to the first grade 3 or 4 adverse event and the time to the first regimen modification were not significantly different between the two arms (adverse event: HR 0.66; 95% CI, 0.25-1.75, p=0.407) (regimen modification: HR 1.03; 95% CI, 0.33-3.19, p=0.964). Both regimens were also well-tolerated, as only 11.1% (ABC/3TC) and 10.9% (TDF/FTC) of the patients discontinued the allocated regimen by 96 weeks. Clinically suspected abacavir-associated hypersensitivity reactions occurred in only one (1.9%) patient in the ABC/3TC arm. CONCLUSION Although insufficiently powered to show non-inferiority of viral efficacy of ABC/3TC relative to TDF/FTC, this pilot trial suggested that ABC/3TC with ATV/r is a safe and efficacious initial regimen for HLA-B*5701-negative patients, such as the Japanese population.
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Affiliation(s)
- Takeshi Nishijima
- AIDS Clinical Center, National Center for Global Health and Medicine, Japan
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MacLeod IJ, Rowley CF, Lockman S, Ogwu A, Moyo S, van Widenfelt E, Mmalane M, Makhema J, Essex M, Shapiro RL. Abacavir alters the transcription of inflammatory cytokines in virologically suppressed, HIV-infected women. J Int AIDS Soc 2012; 15:17393. [PMID: 22789611 PMCID: PMC3499794 DOI: 10.7448/ias.15.2.17393] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Revised: 03/09/2012] [Accepted: 04/18/2012] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Abacavir (ABC) may be associated with a small, increased risk of myocardial infarction in HIV-infected adults, possibly related to cytokine-mediated inflammation. METHODS To evaluate the induction of inflammatory cytokine transcription by ABC, we used samples from women randomized to receive zidovudine/lamivudine/ABC (Trizivir) or lopinavir/ritonavir and zidovudine/lamividine (Kaletra/Combivir) from the third trimester through six-months postpartum for the prevention of mother-to-child transmission (PMTCT). Women were matched by CD4 count and baseline HIV RNA. All women attained viral suppression (<50 copies/ml) by the time of sampling. RESULTS Four cytokines showed a difference in expression between the treatment arms, all in a proinflammatory direction for the ABC arm: CD40LG 1.82-fold, (p=.027); IL-8 3.16-fold (p=.020); LTA 2.82-fold, (p=.008); and CCL5 -1.67-fold, (p=.035). At 12-months postpartum, 6-months after antiretroviral discontinuation, cytokine expression was similar by treatment arm. CONCLUSIONS We conclude that ABC may upregulate proinflammatory cytokines at the transcriptional level in this population.
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Affiliation(s)
- Iain J MacLeod
- Harvard School of Public Health AIDS Initiative, Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, MA, USA
- Botswana–Harvard AIDS Institute, Gaborone, Botswana
| | - Christopher F Rowley
- Harvard School of Public Health AIDS Initiative, Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, MA, USA
- Botswana–Harvard AIDS Institute, Gaborone, Botswana
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Lowry Building Boston, MA, USA
| | - Shahin Lockman
- Harvard School of Public Health AIDS Initiative, Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, MA, USA
- Botswana–Harvard AIDS Institute, Gaborone, Botswana
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA
| | - Anthony Ogwu
- Botswana–Harvard AIDS Institute, Gaborone, Botswana
| | | | | | | | | | - M Essex
- Harvard School of Public Health AIDS Initiative, Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, MA, USA
- Botswana–Harvard AIDS Institute, Gaborone, Botswana
| | - Roger L Shapiro
- Harvard School of Public Health AIDS Initiative, Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, MA, USA
- Botswana–Harvard AIDS Institute, Gaborone, Botswana
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Lowry Building Boston, MA, USA
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Melikian GL, Rhee SY, Taylor J, Fessel WJ, Kaufman D, Towner W, Troia-Cancio PV, Zolopa A, Robbins GK, Kagan R, Israelski D, Shafer RW. Standardized comparison of the relative impacts of HIV-1 reverse transcriptase (RT) mutations on nucleoside RT inhibitor susceptibility. Antimicrob Agents Chemother 2012; 56:2305-13. [PMID: 22330916 PMCID: PMC3346663 DOI: 10.1128/aac.05487-11] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Accepted: 02/03/2012] [Indexed: 11/20/2022] Open
Abstract
Determining the phenotypic impacts of reverse transcriptase (RT) mutations on individual nucleoside RT inhibitors (NRTIs) has remained a statistical challenge because clinical NRTI-resistant HIV-1 isolates usually contain multiple mutations, often in complex patterns, complicating the task of determining the relative contribution of each mutation to HIV drug resistance. Furthermore, the NRTIs have highly variable dynamic susceptibility ranges, making it difficult to determine the relative effect of an RT mutation on susceptibility to different NRTIs. In this study, we analyzed 1,273 genotyped HIV-1 isolates for which phenotypic results were obtained using the PhenoSense assay (Monogram, South San Francisco, CA). We used a parsimonious feature selection algorithm, LASSO, to assess the possible contributions of 177 mutations that occurred in 10 or more isolates in our data set. We then used least-squares regression to quantify the impact of each LASSO-selected mutation on each NRTI. Our study provides a comprehensive view of the most common NRTI resistance mutations. Because our results were standardized, the study provides the first analysis that quantifies the relative phenotypic effects of NRTI resistance mutations on each of the NRTIs. In addition, the study contains new findings on the relative impacts of thymidine analog mutations (TAMs) on susceptibility to abacavir and tenofovir; the impacts of several known but incompletely characterized mutations, including E40F, V75T, Y115F, and K219R; and a tentative role in reduced NRTI susceptibility for K64H, a novel NRTI resistance mutation.
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Affiliation(s)
- George L Melikian
- Division of Infectious Diseases, Department of Medicine, Stanford University, Stanford, California, USA.
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