title: Efavirenz as a substitute for protease inhibitors in HIV-1-infected patients with undetectable plasma viral load on HAART: a median follow-up of 64 weeks.
abstract: We investigated, in a prospective cohort follow-up study, whether substituting efavirenz (EFV) for protease inhibitors (PIs) could be safe in HIV-infected patients with optimal viral suppression achieved on PI-containing regimens. In patients with undetectable plasma viral load (pVL) <50 copies/ml who were naive to therapy with nonnucleoside reverse transcriptase inhibitors (NNRTIs), PIs were replaced by EFV whereas associated nucleoside analogs (NAs) were retained. 62 patients were enrolled. Median follow-up on EFV was 64 weeks (2-88 weeks). Side effects due to EFV occurred in 48 patients. Two patients experienced a high level viral rebound due to diminished compliance; 55 (88.7%) maintained a pVL <50 copies/ml; 3 showed one episode of viremia (52-89 copies/ml); 2 stopped EFV before any VL control. Mean CD4 cell count did not change significantly. One AIDS patient experienced a single cutaneous recurrence of Kaposi's sarcoma after 40 weeks on EFV. Replacing PI with EFV in patients with optimal pVL suppression appears to be safe both virologically and immunologically.
authors.affiliation: Centre d'Informations et de Soins de l'Immunodéficience Humaine, Clinique Médicale A, Hôpitaux Universitaires, 1 place de l'Hôpital, 67091 Strasbourg Cedex, France. david.rey@chru-strasbourg.fr
authors.forename: D
authors.initials: D
authors.lastname: Rey
authors.forename: M P
authors.initials: MP
authors.lastname: Schmitt
authors.forename: M
authors.initials: M
authors.lastname: Partisani
authors.forename: G
authors.initials: G
authors.lastname: Hess-Kempf
authors.forename: V
authors.initials: V
authors.lastname: Krantz
authors.forename: E
authors.initials: E
authors.lastname: de Mautort
authors.forename: C
authors.initials: C
authors.lastname: Bernard-Henry
authors.forename: M
authors.initials: M
authors.lastname: Priester
authors.forename: C
authors.initials: C
authors.lastname: Cheneau
authors.forename: J M
authors.initials: JM
authors.lastname: Lang
mesh_terms: D000328:Adult; D000480:Alkynes; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D048588:Benzoxazines; D015331:Cohort Studies; D003521:Cyclopropanes; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D017320:HIV Protease Inhibitors / Q000627:therapeutic use*; D015497:HIV-1 / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010078:Oxazines / Q000627:therapeutic use*; D012367:RNA, Viral / Q000097:blood*; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*; D019562:Viral Load; D014766:Viremia / Q000188:drug therapy / Q000821:virology
chemical_list: D000480:Alkynes; D019380:Anti-HIV Agents; D048588:Benzoxazines; D003521:Cyclopropanes; D017320:HIV Protease Inhibitors; D010078:Oxazines; D012367:RNA, Viral; D018894:Reverse Transcriptase Inhibitors; C098320:efavirenz