dc.contributor |
Universitat de Vic - Universitat Central de Catalunya. Càtedra de la Sida i Malalties Relacionades |
dc.contributor.author |
Llibre, Josep M. |
dc.contributor.author |
Bravo, Isabel |
dc.contributor.author |
Ornelas, Arelly |
dc.contributor.author |
Santos, José R. |
dc.contributor.author |
Puig, Jordi |
dc.contributor.author |
Martín Iguacel, Raquel |
dc.contributor.author |
Paredes, Roger |
dc.contributor.author |
Clotet, Bonaventura |
dc.date |
2015 |
dc.identifier |
Llibre, J. M., Bravo, I., Ornelas, A., Santos, J. R., Puig, J., Martin-Iguacel, R., et al. (2015). Effectiveness of a treatment switch to nevirapine plus tenofovir and emtricitabine (or lamivudine) in adults with HIV-1 suppressed viremia. Plos One, 10(6), e0128131. |
dc.identifier |
1932-6203 |
dc.identifier |
http://hdl.handle.net/10854/4225 |
dc.identifier |
https://doi.org/10.1371/journal.pone.0128131 |
dc.identifier.uri |
http://hdl.handle.net/10854/4225 |
dc.description |
Background
Switching subjects with persistently undetectable HIV-1 viremia under antiretroviral treatment
(ART) to once-daily tenofovir/emtricitabine (or lamivudine) + nevirapine is a cost-effective
and well-tolerated strategy. However, the effectiveness of this approach has not been
established.
Methods
We performed a retrospective study evaluating the rates of treatment failure, virological failure
(VF), and variables associated, in all subjects initiating this switch combination in our
clinic since 2001. Analyses were performed by a modified intention to treat, where switch
due to toxicity equalled failure. The main endpoint was plasma HIV-RNA < 50 copies/mL.
Results
341 patients were treated for a median of 176 (57; 308) weeks. At week 48, 306 (89.7%)
subjects had HIV-1 RNA <50 copies/mL, 10 (2.9%) experienced VF, and 25 (7.4%) discontinued
the treatment due to toxicity. During the whole follow-up 23 (6.7%) individuals (17 on
lamivudine, 6 on emtricitabine; p = 0.034) developed VF and treatment modification due to
toxicity occurred in 36 (10.7%). Factors independently associated with VF in a multivariate
analysis were: intravenous drug use (HR 1.51; 95%CI 1.12, 2.04), time with undetectable
viral load before the switch (HR 0.98; 0.97, 0.99), number of prior NRTIs (HR 1.49; 1.15,
1.93) or NNRTIs (HR 3.22; 1.64, 6.25), and previous NVP (HR 1.54; 1.10, 2.17) or efavirenz
(HR 5.76; 1.11, 29.87) unscheduled interruptions. VF was associated with emergence of
usual nevirapine mutations (Y181C/I/D, K103N and V106A/I), M184V (n = 16; 12 with lamivudine
vs. 4 with emtricitabine, p = 0.04), and K65R (n = 7).Conclusions
The rates of treatment failure at 48 weeks, or long-term toxicity or VF with this switch regimen
are low and no unexpected mutations or patterns of mutations were selected in subjects
with treatment failure. |
dc.format |
application/pdf |
dc.language |
eng |
dc.publisher |
Plos One |
dc.rights |
Aquest document està subjecte a aquesta llicència Creative Commons |
dc.rights |
http://creativecommons.org/licenses/by-nc/3.0/es/ |
dc.rights |
info:eu-repo/semantics/openAccess |
dc.subject |
Sida -- Tractament |
dc.title |
Effectiveness of a Treatment Switch to Nevirapine plus Tenofovir and Emtricitabine (or Lamivudine) in Adults with HIV-1 Suppressed Viremia |
dc.type |
info:eu-repo/semantics/article |
dc.type |
info:eu-repo/publishedVersion |