Molecular Evaluation of HIV-1 HAART Efficacy, Comparison of TDF+3TC+EFV and AZT+3TC+NVP Regimens

Abstract

Context: The UNAIDS goal of ending the HIV epidemic by 2030 will be achieved primarily through the success of the three “95s” by 2030, and in particular the third “95 », which consists of achieving an undetectable viral load thanks to effective antiretroviral treatment. Achieving and maintaining viral suppression is the goal of ART and a good knowledge of the effectiveness of triple ARV therapies can help national HIV programs. Thus, the objective of this study was to evaluate and compare the effectiveness of the two ARTs, Tenovofir + Lamivudine +Efavirenz (TDF+3TC+EFV) and Zidovudine+Lamivudine+ Efavirenz (AZT+3TC+NVP) in their abilities to make the plasma viral load of HIV+ patients under treatment undetectable. 
 
 Material and method: This is a retrospective study of the management of HIV-1 seropositive patients, followed at the Military Hospital of Ouakam (HMO) Molecular Biology laboratory from 2014 to 2021. The main criterion for evaluating the effectiveness of the treatment was the proportions of patients whose Viral load values were undetectable, VL< 50 copies/ml depending on duration of antiretroviral therapy (ART). Plasma viral load tests were carried out on Abbott Real Time HIV-1® (m2000sp/rt) and COBAS®AmpliPrep/COBAS®TaqMan® (Roche) version 2.0. Variables with p<0.05 were considered statistically significant for all comparisons between groups.
 
 Results: 3,335 patients met the inclusion criteria, including 2,078 on TDF+3TC+EFV, 445 on AZT+3TC+NVP and 812 were excluded due to death, transfer or loss to follow-up. At 6 months of ART, VL was undetectable in 7.3% of patients on TDF+3TC+EFV and 6.7% of patients on AZT+3TC+NVP (P=0.67). 78.2% versus 73.4% of patients had an undetectable VL respectively for TDF+3TC+EFV and AZT+3TC+NVP at 12 months of ART (p=0.03). TDF+3TC+EFV had significantly higher virological success rates than AZT+3TC+NVP (85.7% versus 80.2%) and virological failure (VL>1000 copies/ml) was significantly greater in patients taking AZT+3TC+NVP (13% versus 7.2%) after 18 months (P=0.001). Gender and age had a significant relationship in treatment success.
 
 Conclusion: TDF+3TC+EFV was superior in terms of virological suppression at the end of the study period. These results support the WHO recommendation to use TDF+3TD+EFV as an alternative first-line regimen.