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Combination antiretroviral therapy without a nucleoside reverse transcriptase inhibitor: experience from 334 patients in three cohorts.
HIV Med. 2007 Apr; 8(3):171-80.HM

Abstract

BACKGROUND

Toxicity and resistance may limit the use of HIV nucleoside reverse transcriptase inhibitors (NRTIs). We assessed the safety and activity of regimens that did not include an NRTI.

METHOD AND PATIENTS

We analysed NRTI-sparing regimens using pooled data from three cohorts in Australia and France where HIV RNA viral load, CD4 lymphocyte count and metabolic parameters are assessed prospectively. The inclusion criterion was the commencement of any antiretroviral combination excluding NRTIs.

RESULTS

A total of 334 (3.9%) of 8477 patients were included in the present study for a median follow-up time of 105 weeks. Therapeutic combinations were one nonnucleoside reverse transcriptase inhibitor (NNRTI) plus one protease inhibitor (PI) (58%), two PIs (26%), one PI (16%), and one NNRTI plus two PIs (8%). At baseline, the median CD4 lymphocyte count was 264 cells/muL (interquartile range 164-446 cells/muL) and 25% of patients had plasma HIV RNA below 500 HIV-1 RNA copies/mL. In intent-to-treat analysis, 64% of patients had HIV RNA <500 copies/mL at 6 months and 68% at 24 months. The mean CD4 lymphocyte count increase was 60 cells/microL (95% confidence interval 41-76 cells/microL) at 6 months and 111 cells/microL (95% confidence interval 82-140 cells/microL) at 24 months. Prognostic factors for having HIV RNA <500 copies/mL at 6 months included independently having undetectable HIV RNA at baseline and being naïve for NNRTIs. The proportion of patients with triglycerides >2.3 mmol/L increased from 32% to 63% at 6 months and to 62% at 24 months (P-trend=0.002), and those with total cholesterol >6.2 mmol/L increased from 18% to 38% at 6 months and to 44% at 24 months (P-trend <0.001), with an increased risk for patients treated with NNRTI+PIs. Forty-one per cent of patients discontinued their NRTI-sparing regimen.

CONCLUSION

In these antiretroviral-experienced patients, NRTI-sparing therapy appeared to have satisfactory virological and immunological efficacy. However, hyperlipidaemia was frequent and requires monitoring of cardiovascular risk factors.

Authors+Show Affiliations

HIV Immunology and Infectious Diseases Clinical Services Unit, St Vincent's Hospital, Sydney, Australia. acalmy@stvincents.com.auNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

17461861

Citation

Calmy, A, et al. "Combination Antiretroviral Therapy Without a Nucleoside Reverse Transcriptase Inhibitor: Experience From 334 Patients in Three Cohorts." HIV Medicine, vol. 8, no. 3, 2007, pp. 171-80.
Calmy A, Petoumenos K, Lewden C, et al. Combination antiretroviral therapy without a nucleoside reverse transcriptase inhibitor: experience from 334 patients in three cohorts. HIV Med. 2007;8(3):171-80.
Calmy, A., Petoumenos, K., Lewden, C., Law, M., Bocquentin, F., Hesse, K., Cooper, D., Carr, A., & Bonnet, F. (2007). Combination antiretroviral therapy without a nucleoside reverse transcriptase inhibitor: experience from 334 patients in three cohorts. HIV Medicine, 8(3), 171-80.
Calmy A, et al. Combination Antiretroviral Therapy Without a Nucleoside Reverse Transcriptase Inhibitor: Experience From 334 Patients in Three Cohorts. HIV Med. 2007;8(3):171-80. PubMed PMID: 17461861.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Combination antiretroviral therapy without a nucleoside reverse transcriptase inhibitor: experience from 334 patients in three cohorts. AU - Calmy,A, AU - Petoumenos,K, AU - Lewden,C, AU - Law,M, AU - Bocquentin,F, AU - Hesse,K, AU - Cooper,D, AU - Carr,A, AU - Bonnet,F, AU - ,, PY - 2007/4/28/pubmed PY - 2007/12/21/medline PY - 2007/4/28/entrez SP - 171 EP - 80 JF - HIV medicine JO - HIV Med VL - 8 IS - 3 N2 - BACKGROUND: Toxicity and resistance may limit the use of HIV nucleoside reverse transcriptase inhibitors (NRTIs). We assessed the safety and activity of regimens that did not include an NRTI. METHOD AND PATIENTS: We analysed NRTI-sparing regimens using pooled data from three cohorts in Australia and France where HIV RNA viral load, CD4 lymphocyte count and metabolic parameters are assessed prospectively. The inclusion criterion was the commencement of any antiretroviral combination excluding NRTIs. RESULTS: A total of 334 (3.9%) of 8477 patients were included in the present study for a median follow-up time of 105 weeks. Therapeutic combinations were one nonnucleoside reverse transcriptase inhibitor (NNRTI) plus one protease inhibitor (PI) (58%), two PIs (26%), one PI (16%), and one NNRTI plus two PIs (8%). At baseline, the median CD4 lymphocyte count was 264 cells/muL (interquartile range 164-446 cells/muL) and 25% of patients had plasma HIV RNA below 500 HIV-1 RNA copies/mL. In intent-to-treat analysis, 64% of patients had HIV RNA <500 copies/mL at 6 months and 68% at 24 months. The mean CD4 lymphocyte count increase was 60 cells/microL (95% confidence interval 41-76 cells/microL) at 6 months and 111 cells/microL (95% confidence interval 82-140 cells/microL) at 24 months. Prognostic factors for having HIV RNA <500 copies/mL at 6 months included independently having undetectable HIV RNA at baseline and being naïve for NNRTIs. The proportion of patients with triglycerides >2.3 mmol/L increased from 32% to 63% at 6 months and to 62% at 24 months (P-trend=0.002), and those with total cholesterol >6.2 mmol/L increased from 18% to 38% at 6 months and to 44% at 24 months (P-trend <0.001), with an increased risk for patients treated with NNRTI+PIs. Forty-one per cent of patients discontinued their NRTI-sparing regimen. CONCLUSION: In these antiretroviral-experienced patients, NRTI-sparing therapy appeared to have satisfactory virological and immunological efficacy. However, hyperlipidaemia was frequent and requires monitoring of cardiovascular risk factors. SN - 1464-2662 UR - https://www.unboundmedicine.com/medline/citation/17461861/Combination_antiretroviral_therapy_without_a_nucleoside_reverse_transcriptase_inhibitor:_experience_from_334_patients_in_three_cohorts_ L2 - https://doi.org/10.1111/j.1468-1293.2007.00448.x DB - PRIME DP - Unbound Medicine ER -