Simplification with abacavir-based triple nucleoside therapy versus continued protease inhibitor-based highly active antiretroviral therapy in HIV-1-infected patients with undetectable plasma HIV-1 RNA
作者:
Nathan Clumeck,
Frank Goebel,
Willy Rozenbaum,
Jan Gerstoft,
Schlomo Staszewski,
Julio Montaner,
Margaret Johnson,
Brian Gazzard,
Chris Stone,
Rayma Athisegaran,
Sarah Moore,
期刊:
AIDS
(OVID Available online 2001)
卷期:
Volume 15,
issue 12
页码: 1517-1526
ISSN:0269-9370
年代: 2001
出版商: OVID
关键词: Abacavir 1592U89;combination therapy;highly active antiretroviral therapy;protease inhibitor-sparing
数据来源: OVID
摘要:
ObjectiveTo assess the antiviral efficacy, safety and adherence in patients switched to an abacavir-containing nucleoside reverse transcriptase inhibitor (NRTI) regimen after long-term HIV-1 RNA suppression with a dual NRTI/protease inhibitor (PI) combination.MethodsIn an open-label, multicentre study, patients receiving 2NRTI plus PI for at least 6 months, with a history of undetectable plasma HIV-1 RNA since the initiation of therapy and plasma HIV-1 RNA < 50 copies/ml at screening, were randomly assigned to replace the PI with abacavir (n = 105) or continue the same treatment (n = 106). Clinical assessments included plasma HIV-1 RNA, chemistry, haematology, lymphocyte counts, and adverse event reports. Adherence to treatment was assessed by patient self-report.ResultsA significantly longer time to treatment failure was demonstrated in the abacavir arm compared with the PI arm (P= 0.03) while treatment failure was experienced by significantly more patients in the PI arm: 24 (23%) versus 12 (12%) (P= 0.03). Therapy-limiting toxicity led to treatment failure in eight versus 14 cases in the abacavir and PI arms, respectively, whereas virological rebound was the cause in four versus two cases. Significant reductions in cholesterol and non-fasting triglyceride plasma levels at 48 weeks were observed in the abacavir arm (P< 0.001 andP= 0.035, respectively). The number of patients reporting no difficulty in taking their therapy showed a marked increase from baseline in the abacavir arm.ConclusionThe replacement of PI by abacavir in a triple combination regimen following prolonged suppression of plasma HIV-1 RNA provides continued virological suppression, significant improvements in lipid abnormalities and enhanced ease of dosing.
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