title: High rate of early virological failure with the once-daily tenofovir/lamivudine/nevirapine combination in naive HIV-1-infected patients.
abstract: BACKGROUND
  The combination of one non-nucleoside reverse transcriptase inhibitor (NNRTI) with two nucleoside reverse transcriptase inhibitors is a validated first-line antiretroviral (ARV) therapy. The once-daily combination of lamivudine, tenofovirDF and nevirapine has not been evaluated in a clinical trial.
  
  
  METHODS
  Randomized, open-label, multicentre, non-inferiority trial comparing lamivudine, tenofovirDF and nevirapine once daily (Group 2) with zidovudine/lamivudine and nevirapine twice daily (Group 1), in naive HIV-1-infected patients with a CD4 count <350/mm(3). We planned to enroll 250 patients.
  
  
  RESULTS
  As of May 2006, 71 patients had been enrolled (35 in Group 1 and 36 in Group 2) and an unplanned interim analysis was done. The groups were comparable at baseline: median CD4 count was 195 and 191/mm(3) and median plasma viral load was 4.9 log(10) and 5.01 log(10), respectively, in Groups 1 and 2. Eight early non-responses (22.2%) were observed, all in Group 2, while two later viral rebounds occurred. Resistance genotypes for the nine Group 2 failing patients showed the mutations M184V/I (n = 3), K65R (n = 6), one or more NNRTI resistance mutations in all cases. At baseline, the nine Group 2 patients who failed had higher median plasma viral load (5.4 log(10)) and lower median CD4 count (110/mm(3)) than the other Group 2 patients (4.7 log(10), P = 0.002 and 223/mm(3), P = 0.004). Nevirapine trough concentrations were not different between the two groups, nor between patients with full viral suppression or those who failed in Group 2. Due to slow recruitment, and those results, the steering committee decided to stop the trial at 12 months.
  
  
  CONCLUSIONS
  In ARV-naive HIV-1-infected patients, the once-daily lamivudine, tenofovirDF and nevirapine regimen resulted in a high rate of early virological failures. The reasons for the failures remain unclear.
authors.affiliation: COREVIH, Hôpitaux Universitaires, Strasbourg, France. david.rey@chru-strasbourg.fr
authors.forename: D
authors.initials: D
authors.lastname: Rey
authors.forename: B
authors.initials: B
authors.lastname: Hoen
authors.forename: P
authors.initials: P
authors.lastname: Chavanet
authors.forename: M P
authors.initials: MP
authors.lastname: Schmitt
authors.forename: G
authors.initials: G
authors.lastname: Hoizey
authors.forename: P
authors.initials: P
authors.lastname: Meyer
authors.forename: G
authors.initials: G
authors.lastname: Peytavin
authors.forename: B
authors.initials: B
authors.lastname: Spire
authors.forename: C
authors.initials: C
authors.lastname: Allavena
authors.forename: M
authors.initials: M
authors.lastname: Diemer
authors.forename: T
authors.initials: T
authors.lastname: May
authors.forename: J L
authors.initials: JL
authors.lastname: Schmit
authors.forename: M
authors.initials: M
authors.lastname: Duong
authors.forename: V
authors.initials: V
authors.lastname: Calvez
authors.forename: J M
authors.initials: JM
authors.lastname: Lang
mesh_terms: D000225:Adenine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000328:Adult; D019943:Amino Acid Substitution / Q000235:genetics; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D024882:Drug Resistance, Viral; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D015497:HIV-1 / Q000187:drug effects*; D006801:Humans; D019259:Lamivudine / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D020125:Mutation, Missense; D019829:Nevirapine / Q000008:administration & dosage / Q000627:therapeutic use*; D063065:Organophosphonates / Q000008:administration & dosage / Q000627:therapeutic use*; D000068698:Tenofovir; D016896:Treatment Outcome; D019562:Viral Load; D014764:Viral Proteins / Q000235:genetics
chemical_list: D019380:Anti-HIV Agents; D063065:Organophosphonates; D014764:Viral Proteins; D019259:Lamivudine; D019829:Nevirapine; D000068698:Tenofovir; D000225:Adenine