title: Efficacy and safety of adefovir dipivoxil with antiretroviral therapy: a randomized controlled trial.
abstract: BACKGROUND
  Adefovir dipivoxil is a nucleotide analog that has demonstrated effective antiretroviral activity against human immunodeficiency virus (HIV) with once-daily administration.
  
  
  OBJECTIVE
  To determine if adefovir confers antiretroviral or immunologic benefit when added to stable antiretroviral therapy.
  
  
  METHODS
  Multicenter, 24-week, randomized, double-blind, placebo-controlled study. Enrollment was conducted from June 3, 1996, through May 6, 1997.
  
  
  METHODS
  Thirty-three US HIV treatment centers.
  
  
  METHODS
  Of 1171 patients screened, 442 patients infected with HIV receiving stable antiretroviral therapy for at least 8 weeks with plasma HIV RNA greater than 2500 copies/mL and CD4+ cell count above 0.20 x 10(9)/L were randomized.
  
  
  METHODS
  Patients were randomized to receive either a single 120-mg/d dose of adefovir dipivoxil (n = 219) or an indistinguishable placebo (n = 223). All patients received L-carnitine, 500 mg/d. Open-label adefovir was offered after 24 weeks and was continued until the end of the study.
  
  
  METHODS
  Changes in HIV RNA from baseline, based on area under the curve and CD4+ cell levels, adverse events, and effect of baseline genotypic resistance on response to adefovir.
  
  
  RESULTS
  Patients assigned to adefovir demonstrated a 0.4-log10 decline from baseline in HIV RNA compared with no change in the placebo group (P<.001), which continued through 48 weeks. CD4+ cell counts did not change. During the initial 24 weeks, elevated hepatic enzyme levels (P<.001), gastrointestinal tract complaints (P<.001), and weight loss (P<.001) were associated with use of adefovir. Between 24 weeks and 48 weeks elevations in serum creatinine occurred in 60% of patients, usually returning to baseline after discontinuation of adefovir. Patients with lamivudine or lamivudine and zidovudine resistance mutations demonstrated anti-HIV effects with adefovir (P< or =.01 vs placebo group).
  
  
  CONCLUSIONS
  This study suggests that once-daily adefovir therapy reduces HIV RNA and is active against isolates resistant to lamivudine or lamivudine and zidovudine. Nephrotoxicity occurred when treatment extended beyond 24 weeks but was reversible.
authors.affiliation: Positive Health Program University of California San Francisco, San Francisco General Hospital, 94110, USA. jkahn@php.ucsf.edu
authors.forename: J
authors.initials: J
authors.lastname: Kahn
authors.forename: S
authors.initials: S
authors.lastname: Lagakos
authors.forename: M
authors.initials: M
authors.lastname: Wulfsohn
authors.forename: D
authors.initials: D
authors.lastname: Cherng
authors.forename: M
authors.initials: M
authors.lastname: Miller
authors.forename: J
authors.initials: J
authors.lastname: Cherrington
authors.forename: D
authors.initials: D
authors.lastname: Hardy
authors.forename: G
authors.initials: G
authors.lastname: Beall
authors.forename: R
authors.initials: R
authors.lastname: Cooper
authors.forename: R
authors.initials: R
authors.lastname: Murphy
authors.forename: N
authors.initials: N
authors.lastname: Basgoz
authors.forename: E
authors.initials: E
authors.lastname: Ng
authors.forename: S
authors.initials: S
authors.lastname: Deeks
authors.forename: D
authors.initials: D
authors.lastname: Winslow
authors.forename: J J
authors.initials: JJ
authors.lastname: Toole
authors.forename: D
authors.initials: D
authors.lastname: Coakley
mesh_terms: D000225:Adenine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000328:Adult; D019380:Anti-HIV Agents / Q000494:pharmacology / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D004311:Double-Blind Method; D004352:Drug Resistance, Microbial; D004359:Drug Therapy, Combination; D005260:Female; D005838:Genotype; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D015497:HIV-1 / Q000187:drug effects / Q000235:genetics; D006801:Humans; D019259:Lamivudine / Q000494:pharmacology; D008297:Male; D063065:Organophosphonates; D012367:RNA, Viral; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*; D019562:Viral Load; D015215:Zidovudine / Q000494:pharmacology
chemical_list: D019380:Anti-HIV Agents; D063065:Organophosphonates; D012367:RNA, Viral; D018894:Reverse Transcriptase Inhibitors; D019259:Lamivudine; D015215:Zidovudine; D000225:Adenine; C106812:adefovir dipivoxil