Document Detail


Comparison of antiviral activity of regimens containing nucleos(t)ide (NUC) Pairs in HIV-Infected Patients Initiating REScue therapy (The NUCREST Study).
MedLine Citation:
PMID:  21126959     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: recycling nucleos(t)ides (NUCs) is useful in regions where new antiretrovirals are not available. This study compares the effectiveness of NUC-containing regimens as rescue therapy in routine care.
METHODS: retrospective, multicentre cohort study (January 2001 to June 2006) of patients with ≥ 1 virological failure who started therapy with 2 NUCs and 1 non-nucleoside reverse transcriptase inhibitor (NNRTI) or a protease inhibitor (PI). The primary endpoint was the rate of treatment response at 6 months (intention-to-treat [ITT] analysis).
RESULTS: we included 719 patients (average of 4 prior regimens over a median 6.1 years). The most frequent NUC pairs were tenofovir plus lamivudine (TDF+3TC; 25%), tenofovir plus stavudine (TDF+d4T; 23%), and stavudine plus didanosine (d4T+ddI; 15%). A boosted PI was used in 68% of total cases. Resistance to both NUCs was more frequent in zidovudine plus lamivudine (AZT+3TC; 22.0%), abacavir plus lamivudine (ABC+3TC; 35.5%), and stavudine plus lamivudine (d4T+3TC; 31.2%). No significant differences were observed in treatment response (overall 65%, P = .67); ddI+3TC (71%) and d4T+3TC (53%) had the highest and lowest response rates, respectively. Median time to failure was shorter with d4T+3TC, d4T+ddI, and ABC+3TC (48, 51, and 58 weeks, respectively; P = .0012). Lower response rates associated with an increasing number of thymidine analog mutations (TAMs) were observed for ABC+3TC (P = .027).
CONCLUSION: the clinical utility of NUCs for rescue therapy is limited and selection should be individualized. Specific combinations (d4T+3TC and d4T+ddI) might be less efficacious.
Authors:
J A Pérez-Molina; O Serrano; A Milinkovic; P Domingo; A Currán; H Knobel; G Gaspar; A Rodrigo; M J Jiménez-Expósito; B Hernández-Novoa; S Moreno; The NUCREST Study
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  HIV clinical trials     Volume:  11     ISSN:  1528-4336     ISO Abbreviation:  HIV Clin Trials     Publication Date:    2010 Sep-Oct
Date Detail:
Created Date:  2010-12-03     Completed Date:  2011-01-06     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100936377     Medline TA:  HIV Clin Trials     Country:  United States    
Other Details:
Languages:  eng     Pagination:  294-302     Citation Subset:  IM    
Affiliation:
Infectious Diseases, Hospital Ramón y Cajal, Madrid, Spain. jose.perezmolina@gmail.com
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MeSH Terms
Descriptor/Qualifier:
Adult
Cohort Studies
Female
HIV*
HIV Infections / blood,  drug therapy*,  immunology,  virology
Humans
Male
RNA, Viral / blood
Retrospective Studies
Reverse Transcriptase Inhibitors / administration & dosage*
Chemical
Reg. No./Substance:
0/RNA, Viral; 0/Reverse Transcriptase Inhibitors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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