Comparative biological and clinical outcomes after a switch from a virologically unsuccessful first protease inhibitor-containing antiretroviral combination to a 3-drug regimen containing efavirenz, nevirapine, or abacavir.
BACKGROUND
Incomplete adherence is the main cause of antiretroviral therapy failure during initial combination antiretroviral therapy (cART). A switch to a protease inhibitor-sparing cART may be useful when a patient does not tolerate a first protease inhibitor-containing cART regimen.


METHODS
To compare the biological and clinical outcomes of patients in whom a first protease inhibitor-containing cART regimen failed to control viral replication and whose treatment was switched to cART containing efavirenz, nevirapine, or abacavir, we studied 1440 patients from the French Hospital Database on HIV whose treatment was changed from a first protease inhibitor-containing cART to a 3-drug regimen with either efavirenz, nevirapine, or abacavir while their plasma viral load was detectable.


RESULTS
Kaplan-Meier 12-month probabilities of virological suppression were 73.6%, 53.9%, and 66.1% among patients whose treatment was switched to efavirenz-cART, nevirapine-cART, and abacavir-cART, respectively. Factors associated with a lower likelihood of virological suppression were antiretroviral exposure before the first cART, higher plasma viral load values at the treatment switch, a stavudine-lamivudine backbone after the switch (instead of a zidovudine-lamivudine backbone), and a switch to nevirapine (adjusted hazard ratio, 0.63 [95% CI, 0.54-0.74], compared with efavirenz) or abacavir (adjusted hazard ratio, 0.84 [95% CI, 0.68-1.04] compared with efavirenz). There was no difference among the 3 groups with regard to immunological gain (>50 CD4+ T cells/mm3) or clinical outcome.


CONCLUSIONS
When virological rebound occurs from receipt of protease inhibitor-containing cART, virological suppression can be obtained after a switch to a protease inhibitor-free cART--efavirenz-cART yielding the highest rate of virological suppression.
Abgrall
Sophie
S
Institut National de la Santé et de la Recherche Médicale U720, Université Pierre et Marie Curie-Paris 6, Paris, 75625, France. sophie.abgrall@ccde.chups.jussieu.fr
Yeni
Patrick G
PG
Bouchaud
Olivier
O
Costagliola
Dominique
D
D000328:Adult; D000480:Alkynes; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D048588:Benzoxazines; D003521:Cyclopropanes; D015224:Dideoxynucleosides / Q000008:administration & dosage / Q000627:therapeutic use; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D015497:HIV-1 / Q000187:drug effects / Q000502:physiology*; D006801:Humans; D008297:Male; D019829:Nevirapine / Q000008:administration & dosage / Q000627:therapeutic use; D010078:Oxazines / Q000008:administration & dosage / Q000627:therapeutic use; D011480:Protease Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D018894:Reverse Transcriptase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome; D019562:Viral Load; D014779:Virus Replication; D000099227:Abacavir
D000480:Alkynes; D019380:Anti-HIV Agents; D048588:Benzoxazines; D003521:Cyclopropanes; D015224:Dideoxynucleosides; D019829:Nevirapine; D010078:Oxazines; D011480:Protease Inhibitors; D018894:Reverse Transcriptase Inhibitors; D000099227:Abacavir; C098320:efavirenz