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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Efficacy of tenofovir and efavirenz in combination with lamivudine or emtricitabine in antiretroviral-naive patients in Europe
Journal of Antimicrobial Chemotherapy, Volume 70, No. 6, Year 2014
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Description
Background: The combination of tenofovir and efavirenz with either lamivudine or emtricitabine (TELE) has proved to be highly effective in clinical trials for first-line treatment of HIV-1 infection. However, limited data are available on its efficacy in routine clinical practice. Methods: A multicentre cohort study was performed in therapy-naive patients initiating ART with TELE before July 2009. Efficacy was studied using ITT (missing or switch=failure) and on-treatment (OT) analyses. Genotypic susceptibility scores (GSSs) were determined using the Stanford HIVdb algorithm. Results: Efficacy analysis of 1608 patients showed virological suppression to <50 copies/mL at 48 weeks in 91.5% (OT) and 70.6%(ITT). Almost a quarter of all patients (22.9%) had discontinued TELE atweek 48,mainly due to CNS toxicity. Virological failure within 48 weeks was rarely observed (3.3%, n=53). In multilevel, multivariate analysis, infection with subtype B (P=0.011), baseline CD4 count<200 cells/mm3 (P<0.001), GSS<3 (P=0.002) and use of lamivudine (P<0.001) were associated with a higher risk of virological failure. After exclusion of patients using co-formulated compounds, virological failure was still more often observed with lamivudine. Following virological failure, three-quarters of patients switched to a PI-based regimenwith GSS <3. After 1 year of second-line therapy, viral load was suppressed to <50 copies/mL in 73.5% (OT). Conclusions: In clinical practice, treatment failure on TELE regimens is relatively frequent due to toxicity. Virological failure is rare and more often observed with lamivudine than with emtricitabine. Following virological failure on TELE, PI-based second-line therapy was often successful despite GSS <3. © The Author 2015. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.
Authors & Co-Authors
Vandekerckhove, Linos P.R.
Belgium, Ghent
Universiteit Gent
Ammerlaan, Heidi S.M.
Netherlands, Eindhoven
Catharina Ziekenhuis
Begovac, J.
Croatia, Zagreb
University Hospital for Infectious Diseases dr Fran Mihaljevic
Boucher, Charles A.B.
Netherlands, Rotterdam
Erasmus Mc
van der Ende, Marchina Elisabeth
Netherlands, Rotterdam
Erasmus Mc
Grossman, Zehava
Israel, Tel Aviv-yafo
Tel Aviv University
Kaiser, Rolf
Germany, Koln
Universität zu Köln
Levy, Itzchak
Israel, Tel Aviv-yafo
Tel Aviv University
Mudrikova, Tania
Netherlands, Utrecht
University Medical Center Utrecht
Paredes, Roger
Spain, Badalona
Hospital Universitari Germans Trias I Pujol
Perez-Bercoff, Danielle
Luxembourg, Strassen
Luxembourg Institute of Health
Richter, Clemens
Netherlands, Arnhem
Rijnstate Hospital
Schmit, Jean Claude
Luxembourg, Strassen
Luxembourg Institute of Health
Luxembourg, Luxembourg
Centre Hospitalier de Luxembourg
Vercauteren, Jurgen
Belgium, Leuven
Ku Leuven
Zazzi, Maurizio
Italy, Siena
Università Degli Studi Di Siena
De Luca, Andrea
Italy, Rome
Università Cattolica Del Sacro Cuore, Campus Di Roma
Italy, Siena
Azienda Ospedaliera Universitaria Senese
Wensing, Annemarie Marie J.
Netherlands, Utrecht
University Medical Center Utrecht
Statistics
Citations: 14
Authors: 17
Affiliations: 16
Identifiers
Doi:
10.1093/jac/dkv033
ISSN:
03057453
Research Areas
Cancer
Infectious Diseases
Study Design
Cohort Study
Study Approach
Quantitative