Effectiveness of a Treatment Switch to Nevirapine plus Tenofovir and Emtricitabine (or Lamivudine) in Adults with HIV-1 Suppressed Viremia
Llibre Codina, Josep Maria (Institut Germans Trias i Pujol. Institut de Recerca de la Sida IrsiCaixa)
Bravo, Isabel (Institut Germans Trias i Pujol. Fundació de Lluita Contra la Sida)
Ornelas Vargas, Arelly (Universitat de Barcelona. Departament d'Econometria, Estadística i Economia Aplicada)
Santos Fernández, José Ramón (Institut Germans Trias i Pujol. Fundació de Lluita Contra la Sida)
Puig, Jordi (Institut Germans Trias i Pujol. Fundació de Lluita Contra la Sida)
Martín Iguacel, Raquel (Odense University Hospital (Dinamarca))
Paredes, Roger (Institut Germans Trias i Pujol. Fundació de Lluita Contra la Sida)
Clotet Sala, Bonaventura (Institut Germans Trias i Pujol. Fundació de Lluita Contra la Sida)
Universitat Autònoma de Barcelona

Fecha:	2015
Resumen:	BACKGROUND: Switching subjects with persistently undetectable HIV-1 viremia under antiretroviral treatment (ART) to once-daily tenofovir/emtricitabine (or lamivudine) + nevirapine is a cost-effective and well-tolerated strategy. However, the effectiveness of this approach has not been established. METHODS:We performed a retrospective study evaluating the rates of treatment failure, virological failure (VF), and variables associated, in all subjects initiating this switch combination in our clinic since 2001. Analyses were performed by a modified intention to treat, where switch due to toxicity equalled failure. The main endpoint was plasma HIV-RNA < 50 copies/mL. RESULTS: 341 patients were treated for a median of 176 (57; 308) weeks. At week 48, 306 (89. 7%) subjects had HIV-1 RNA <50 copies/mL, 10 (2. 9%) experienced VF, and 25 (7. 4%) discontinued the treatment due to toxicity. During the whole follow-up 23 (6. 7%) individuals (17 on lamivudine, 6 on emtricitabine; p = 0. 034) developed VF and treatment modification due to toxicity occurred in 36 (10. 7%). Factors independently associated with VF in a multivariate analysis were: intravenous drug use (HR 1. 51; 95%CI 1. 12, 2. 04), time with undetectable viral load before the switch (HR 0. 98; 0. 97, 0. 99), number of prior NRTIs (HR 1. 49; 1. 15, 1. 93) or NNRTIs (HR 3. 22; 1. 64, 6. 25), and previous NVP (HR 1. 54; 1. 10, 2. 17) or efavirenz (HR 5. 76; 1. 11, 29. 87) unscheduled interruptions. VF was associated with emergence of usual nevirapine mutations (Y181C/I/D, K103N and V106A/I), M184V (n = 16; 12 with lamivudine vs. 4 with emtricitabine, p = 0. 04), and K65R (n = 7). CONCLUSIONS: The rates of treatment failure at 48 weeks, or long-term toxicity or VF with this switch regimen are low and no unexpected mutations or patterns of mutations were selected in subjects with treatment failure.
Nota:	Ajuts: CHAIN, Collaborative HIV and Anti-HIV Drug Resistance Network (Integrated Project no. 223131, funded by the European Commission Framework 7 Program) i Gala contra la Sida Barcelona 2011
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Publicado en:	PloS one, Vol. 10 Núm. 6 (June 2015) , ISSN 1932-6203

DOI: 10.1371/journal.pone.0128131
PMID: 26107265

14 p, 455.3 KB

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