Adherence to trizivir and tenofovir as a simplified salvage regimen is associated with suppression of viraemia and a decreased cholesterol.
BACKGROUND
Treatment failure during highly active antiretroviral therapy (HAART) is ultimately common and associated with the development of resistance mutations. Trizivir (zidovudine/lamivudine/abacavir) and tenofovir disoproxil fumarate may improve adherence and enhance virological suppression in individuals who have failed previous regimens.


METHODS
Individuals were identified who had failed previous HAART and who were then prescribed trizivir and tenofovir. Viral load and genotypic information were obtained to assess virological response.


RESULTS
One hundred and twenty-two individuals were identified from a database containing 5883 patients. In a last observation carried forward intention to treat analysis, 34% of individuals achieved an undetectable viral load of <50 copies/mL at 1 year. Of those who were able to remain on treatment for 1 year, 65% achieved undetectability. We observed no effect regarding previous regimens on viral outcome. Accumulation of TAMs (thymidine analogue mutations) was associated with a decrease in the number of patients achieving an undetectable viral load (with <2 TAMs present 38% of patients developed undetectable viral loads, > or =1;2 TAMs 17% undetectable; P = 0.03). Using the mean cell volume as a measure of compliance, those with higher values were more likely to achieve a viral load <50 copies/mL (P = 0.04). A beneficial effect on cholesterol was noted regardless of virological outcome.


CONCLUSIONS
In compliant heavily pre-treated individuals with less than 2 TAMs, salvage therapy with trizivir and tenofovir is associated with suppression of viraemia and an improved lipid profile.
Latham
Victoria
V
The St Stephen's Centre, The Chelsea and Westminster Hospital, London, UK.
Stebbing
Justin
J
Mandalia
Sundhiya
S
Michailidis
Christos
C
Davies
Elizabeth
E
Bower
Mark
M
Gazzard
Brian
B
Nelson
Mark
M
D000163:Acquired Immunodeficiency Syndrome / Q000097:blood / Q000188:drug therapy* / Q000276:immunology; D000225:Adenine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D002784:Cholesterol / Q000097:blood*; D015224:Dideoxynucleosides / Q000627:therapeutic use*; D004338:Drug Combinations; D004909:Erythrocyte Indices; D006801:Humans; D019259:Lamivudine / Q000627:therapeutic use*; D063065:Organophosphonates / Q000627:therapeutic use*; D010349:Patient Compliance; D016879:Salvage Therapy; D000068698:Tenofovir; D019562:Viral Load; D014766:Viremia / Q000188:drug therapy*; D015215:Zidovudine / Q000627:therapeutic use*; D000099227:Abacavir
D000225:Adenine; D019380:Anti-HIV Agents; D002784:Cholesterol; D015224:Dideoxynucleosides; D004338:Drug Combinations; D019259:Lamivudine; D063065:Organophosphonates; D000068698:Tenofovir; D015215:Zidovudine; C418262:abacavir, lamivudine, and zidovudine drug combination; D000099227:Abacavir