Comparative risk of failure of ABC/3TC or TDF/FTC based first-line regimens in patients with a high viral load.
OBJECTIVE
To compare the efficacy, in current clinical practice, of first regimens containing abacavir with lamivudine (ABC/3TC) or tenofovir with emtricitabine (TDF/FTC) in patients with baseline viral load ≥100,000 HIV-1 RNA copies/mL.


METHODS
Using a prospective cohort, we selected all patients starting a first HIV regimen based either on ABC/3TC or on TDF/FTC. The propensity score (PS) method was used to limit the indication bias due to the observational nature of the data. Adjusting and weighting methods via PS were used to compare the effectiveness of a first regimen containing ABC/3TC or TDF/FTC. The primary outcome was treatment failure by month 12 (M12).


RESULTS
Overall, 2781 patients started an antiretroviral (ARV) regimen with ABC/3TC or TDF/FTC each in combination with efavirenz, boosted atazanavir or boosted darunavir. Among the 2472 uncensored patients before M12, 962 (39%) had a baseline viral load ≥100,000 copies/mL of whom 294 were in treatment failure at or before M12. Our analyses showed no difference between ABC/3TC and TDF/FTC in the risk of treatment failure at M12 in patients starting an ARV regimen with a high viral load (≥100,000 copies/mL).


CONCLUSIONS
Using a large prospectively collected cohort of patients seeking care in France, we found no evidence that ABC/3TC based regimens led to more failures than TDF/FTC based ones in patients with high baseline viral loads.
INSERM, UMR-S 1136, Paris, France.|Pierre Louis Institute of Epidemiology and Public Health, Sorbonne Universities, UPMC Université de Paris 06, Paris, France.
P
P
Flandre
Infectious Diseases Department, CHU Archet, Nice, France.
P
P
Pugliese
Infectious Diseases Department, CHU Hotel Dieu, Nantes, France.
C
C
Allavena
Pierre Louis Institute of Epidemiology and Public Health, Sorbonne University, UPMC Université de Paris 06, UMR_S 1136, Paris, France.|AP-HP, Groupe hospitalier Pitié Salpêtrière, Service des Maladies Infectieuses, Paris, France.
C
C
Katlama
Infectious Diseases Department, Hospices Civils de Lyon, Lyon, France.|INSERM U1052, Lyon, France.
L
L
Cotte
EA 3620, Université Paris-Descartes, Sorbonne Paris Cité, Paris, France.|Infectious Diseases Department, Tourcoing Genral Hospital, Tourcoing, France.
A
A
Cheret
Infectious Diseases Department, CHU de Martinique, Fort de France, France.|Université Antilles Guyane EA 4537, CHU de Martinique, Pointe à Pitre, France.
A
A
Cabié
Le Trait d'Union, HIV Care Center, CHU Strasbourg, Strasbourg, France.
D
D
Rey
UMR CNRS 6249 Chrono-Environnement, Université de Franche-Comté, CHRU Besançon, Besançon, France.|Service de maladies infectieuses, CHRU Besançon, Besançon, France.
C
C
Chirouze
Reims Champagne-Ardenne University, Faculté de médecine, EA-4684/SFR CAP-SANTE, Reims, France.|Tropical and Infectious Diseases, CHU Reims, Hôpital Robert Debré, Reims, France.
F
F
Bani-Sadr
Regional Center for HIV Care and Coordination, INSERM UMR1027, Toulouse 3 University, Toulouse, France.
L
L
Cuzin
D015224:Dideoxynucleosides / Q000494:pharmacology / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D000068679:Emtricitabine / Q000494:pharmacology / Q000627:therapeutic use*; D005260:Female; D005602:France; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D019259:Lamivudine / Q000494:pharmacology / Q000627:therapeutic use*; D008297:Male; D057216:Propensity Score; D011446:Prospective Studies; D018570:Risk Assessment; D000068698:Tenofovir / Q000627:therapeutic use*; D017211:Treatment Failure; D019562:Viral Load / Q000187:drug effects*; D000099227:Abacavir
D015224:Dideoxynucleosides; D000068679:Emtricitabine; D019259:Lamivudine; D000068698:Tenofovir; D000099227:Abacavir
abacavir; baseline viral load; efficacy; propensity scores; tenofovir