Document Detail


High virological failure rate in HIV patients after switching to a regimen with two nucleoside reverse transcriptase inhibitors plus tenofovir.
MedLine Citation:
PMID:  15821395     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Regimens with two nucleoside analogue reverse transcriptase inhibitors (NRTI) plus tenofovir DF have been associated with a high failure rate when administered as first line therapy. Little is known about patients with undetectable viral loads who are switched to these regimens. METHODS: A post-hoc review of the virological outcomes at 24 weeks of patients who switched from a successful (< 50 copies/ml) highly active antiretroviral therapy regimen to a tenofovir plus two NRTI combination. RESULTS: Fifty-five patients started a two NRTI plus tenofovir regimen mostly because of previous toxicity/intolerance of the original drugs (74%). After 24 weeks, only 17 patients (31%) remained virologically suppressed. Patients with a regimen including a didanosine plus tenofovir-based regimen had significantly poorer outcomes than those on other combinations (success rate 5 versus 47.1%, P = 0.001). In contrast, patients on a regimen including zidovudine plus tenofovir showed a trend towards a better outcome (75 versus 27%, P = 0.083). Multivariate analysis confirmed the combination of didanosine plus tenofovir as the only variable associated with a higher rate of failure (odds ratio 17.7; 95% confidence interval 2.1-147; P = 0.007). Patients with previous reverse transcriptase mutations presented virological failure in all cases. At failure a new pattern, including the K65R mutation with M184V or thymidine analogue mutations, was observed. CONCLUSIONS: Even in patients with suppressed viraemia, a two NRTI plus tenofovir regimen is associated with a high virological failure rate, but significant variations are found depending on the nucleosides included.
Authors:
Maria Jesús Pérez-Elías; Santiago Moreno; Carolina Gutiérrez; Dolores López; Victor Abraira; Ana Moreno; Fernando Dronda; Jóse Luis Casado; Antonio Antela; Miguel Angel Rodríguez
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Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  AIDS (London, England)     Volume:  19     ISSN:  0269-9370     ISO Abbreviation:  AIDS     Publication Date:  2005 Apr 
Date Detail:
Created Date:  2005-04-11     Completed Date:  2005-09-20     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8710219     Medline TA:  AIDS     Country:  England    
Other Details:
Languages:  eng     Pagination:  695-8     Citation Subset:  IM; X    
Affiliation:
Infectious Diseases Unit, Hospital Ramón y Cajal, Madrid, Spain. mjperez@telefonica.net
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MeSH Terms
Descriptor/Qualifier:
Acquired Immunodeficiency Syndrome / drug therapy*,  virology
Adenine / analogs & derivatives*,  therapeutic use
Adult
Anti-HIV Agents / therapeutic use
Antiretroviral Therapy, Highly Active
Didanosine / therapeutic use*
Drug Resistance, Multiple, Viral
Female
Follow-Up Studies
HIV-1* / genetics
Humans
Male
Middle Aged
Multivariate Analysis
Phosphonic Acids / therapeutic use*
RNA, Viral / analysis
Reverse Transcriptase Inhibitors / therapeutic use*
Treatment Failure
Viral Load
Zidovudine / therapeutic use
Chemical
Reg. No./Substance:
0/Anti-HIV Agents; 0/Phosphonic Acids; 0/RNA, Viral; 0/Reverse Transcriptase Inhibitors; 107021-12-5/tenofovir; 30516-87-1/Zidovudine; 69655-05-6/Didanosine; 73-24-5/Adenine

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


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