Effectiveness of a treatment switch to nevirapine plus tenofovir and emtricitabine (or lamivudine) in adults with HIV-1 suppressed viremia

Josep M. Llibre, Isabel Bravo, Arelly Ornelas, José R. Santos, Jordi Puig, Raquel Martin-Iguacel, Roger Paredes, Bonaventura Clotet

Research output: Contribution to journalArticleResearchpeer-review

6 Citations (Scopus)

Abstract

© 2015 Llibre et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. 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.
Original languageEnglish
Article numbere0128131
JournalPLoS ONE
Volume10
Issue number6
DOIs
Publication statusPublished - 24 Jun 2015

Fingerprint

Dive into the research topics of 'Effectiveness of a treatment switch to nevirapine plus tenofovir and emtricitabine (or lamivudine) in adults with HIV-1 suppressed viremia'. Together they form a unique fingerprint.

Cite this