Early virological failure with a combination of tenofovir, didanosine and efavirenz

Daniel Podzamczer*, Elena Ferrer, Josep Maria Gatell, Jordi Niubo, David Dalmau, Agathe Leon, Hernando Knobel, Carolina Polo, Daniel Iniguez, Isaac Ruiz

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review

50 Citations (Scopus)

Abstract

Objective: To describe the occurrence of a high early virological failure (VF) rate and development of resistance mutations in antiretroviral-naive patients receiving tenofovir, didanosine and efavirenz. Methods: HIV-infected antiretroviral-naive patients with viral load ≥30 000 copies/ml were enrolled in a pilot randomized trial of tenofovir/didanosine (250 mg)/ efavirenz with (arm A) or without (arm B) lopinavir/r for the first 12 weeks. As six cases of early VF (a drop of <2 log at month 3, or a rebound of >1 log from the nadir) were detected (five in arm B and one in arm A who had previously stopped lopinavir/r) an unplanned interim analysis was performed. Results: A total of 29 out of 36 enrolled patients completed at least 3 months of follow-up and were included in the interim analysis. An intent-to-treat analysis showed treatment failure in 7/15 (46.7%) patients in arm B (five VF, one lost, one switched) versus 2/14 (14.3%) in arm A (one lost, one switched) (P=0.109). The patient in arm A who interrupted lopinavir/r at day 3 and continued with tenofovir/didanosine/efavirenz later developed VF. At baseline, 6/6 VF patients had VL >100 000 copies/ml and an advanced stage of disease (CD4 <200 plus CDC stage C or B3) versus 0/8 non-VF patients taking the triple drug regimen (P<0.001). At failure, G190S/E alone or associated with K103N and K101R mutations was detected in five patients, and K103N/L100I/V108I in the sixth patient. Additionally, L74V/I and K65R were detected in four and two patients, respectively. Conclusions: A high early virological failure rate and the occurrence of resistance mutations were detected in a group of antiretroviral-naive patients treated with tenofovir/didanosine/efavirenz.

Original languageAmerican English
Pages (from-to)171-177
Number of pages7
JournalAntiviral Therapy
Volume10
Issue number1
Publication statusPublished - 2005

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