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Abstract
Efficacy of subsequent efavirenz-based regimen in HIV-infected patients with preceding discontinuation of nevirapine
W. Manosuthi1, S. Chimsuntorn1, S. Sungkanuparph2
Background: Simultaneous discontinuation of all drugs in a regimen of stavudine (d4T) or zidovudine (ZDV) plus lamivudine (3TC) and nevirapine (NVP) results in functional monotherapy with NVP. Continuation of d4T/3TC or ZDV/3TC for a period of time is rational. Nonetheless, the data regarding subsequent efficacy of efavirenz (EFV)-based regimen in this situation is limited.
Methods: An observational cohort study was conducted in all HIV-infected patients who had discontinued of d4T/3TC/NVP or ZDV/3TC/NVP and continued the NRTI backbone for 7-14 days and subsequently received EFV-based regimen between January 2005 and December 2006. CD4 counts and plasma HIV-1 RNA were assessed at baseline, and every 12 weeks through 48 weeks of EFV-based regimen.
Results: A total of 45 patients were eligible into the study. Mean±SD age was 37±11 years; 60% were males. Mean±SD baseline body weight was 53.3±9.8 kgs. Median (IQR) baseline CD4 was 43 (19-150) cells/mm3 and median (IQR) plasma HIV-1 RNA was 5.7 (5.3-5.9) log copies/mL. Forty (88.9%) and 5 (11.1%) patients received d4T/3TC and ZDV/3TC, respectively. Of all, 35 (77.8%), 5 (11.1%) and 5 (11.1%) patients discontinued NVP due to skin rashes grade II-III, hepatitis, and both, respectively. Median (IQR) duration from stopping NVP to initiate EFV was 13 (7-18) days. At 48 week, 33 of 45 (73.3%) patients achieved plasma HIV-1 RNA <50 copies/mL. The other 12 patients were lost to follow-up (5), having virological failure (3), transferred care (2), having EFV-related skin reaction (1) and EFV-related neurological event (1). At week 12, 24, 36 and 48, median CD4 counts were 193, 238, 270 and 268 cells/mm3, respectively. By repeated measurement analysis, there were difference from baseline (P <0.05).
Conclusions: Efficacy of subsequent EFV-based regimen in patients who continued 7-14 days of NRTI backbone after discontinuation of NVP is favorable. The strategy of extended short half-life NRTIs in the regimen after discontinuation of NVP is justified.
AIDS 2008 - XVII International AIDS Conference
Abstract no.
THPE0206
Suggested Citation
"W.Manosuthi, et al.
Efficacy of subsequent efavirenz-based regimen in HIV-infected patients with preceding discontinuation of nevirapine.
:
AIDS 2008 - XVII International AIDS Conference:
Abstract no.
THPE0206"
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