Simplified therapy with zidovudine, lamivudine, and abacavir for very nonadherent, treatment-failing patients.
OBJECTIVE
To assess the effectiveness of a simplified therapy for very nonadherent patients who had previously failed with HAART.


METHODS
We performed a prospective open-label study of antiretroviral-experienced patients. Dosing schedule comprised (co-formulated) zidovudine, lamivudine, and abacavir bid. Eligible patients had to have plasma HIV RNA >5000 copies/mL, previous therapy, and very poor adherence to the medication regimen.


RESULTS
Eighty-five patients were included (mean viral load, 4.4 log/mL; mean CD4, 240 cells/mL; IDUs, 78%; methadone maintenance program, 42%; AIDS, 28%). Number of previous therapies: one, 53%; two, 28%; three or more, 19%. In the intent-to-treat analysis at 1 year, 38 patients (44.7%) achieved viral load below 500 copies/mL. Adherence greater than 90% of prescribed drugs was reported in 49% of patients, adverse events were reported in 17.6%, mortality in 6%, and lost to follow-up in 26%. The factors associated with virologic failure were nonadherence (odds ratio [OR], 4.4; 95% CI 1.5-12.3), baseline CD4 cell count <200 cells/mL (OR, 3.4; 95% CI 1.3-8.9; p =.01), and more than one previous treatment (OR, 2.7; 95% CI 1.1-6.9).


CONCLUSIONS
Regarding previously very nonadherent patients, this simplified combination therapy containing three NRTIs obtained satisfactory results in ART-experienced patients. However, more aggressive interventions to enhance adherence are needed to improve results.
Knobel
Hernando
H
Department of Internal Medicine-Infectious Diseases, Hospital del Mar, Barcelona, Spain. hknobel@imas.imim.es
Vallecillo
Gabriel
G
Guelar
Ana
A
Pedrol
Enric
E
Soler
Ana
A
Carmona
Alexia
A
Saballs
Pere
P
Gonzalez
Alicia
A
Gimeno
Juan Luis
JL
Colomés
José Luis López
JL
D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015224:Dideoxynucleosides / Q000008:administration & dosage; D004334:Drug Administration Schedule; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D019259:Lamivudine / Q000008:administration & dosage; D008297:Male; D011446:Prospective Studies; D018894:Reverse Transcriptase Inhibitors / Q000008:administration & dosage*; D013030:Spain; D017211:Treatment Failure; D016896:Treatment Outcome; D016312:Treatment Refusal; D019562:Viral Load; D015215:Zidovudine / Q000008:administration & dosage; D000099227:Abacavir
D019380:Anti-HIV Agents; D015224:Dideoxynucleosides; D019259:Lamivudine; D018894:Reverse Transcriptase Inhibitors; D015215:Zidovudine; D000099227:Abacavir