Abstract
The development and widespread clinical use of coformulated abacavir/lamivudine/zidovudine (ABC/3TC/ZDV) as Trizivir represented an important advance in the management of HIV-infected patients, especially those with adherence challenges. With a low pill burden, no food restrictions, limited drug-drug interactions, and a favorable resistance profile, ABC/3TC/ZDV remains an alternative option in the US Department of Health and Human Services Consensus Panel Guidelines as initial treatment in antiretroviral-naive patients. Recent data have shown ABC/3TC/ZDV to be less efficacious in suppressing and/or maintaining suppression of virologic replication compared with efavirenz-containing antiretroviral therapy. Although triple-nucleoside/nucleotide reverse transcriptase inhibitor (t-NRTI) combinations that do not contain a thymidine analog (ZDV or stavudine) have recently shown high virologic failure rates in clinical trials and clinical practice, t-NRTI regimens containing a thymidine analog have consistently been shown to be efficacious.
Highlights
The development and widespread clinical use of coformulated abacavir/lamivudine/zidovudine (ABC/3TC/ZDV) as Trizivir represented an important advance in the management of HIV-infected patients, especially those with adherence challenges
Recent data from clinical trials and clinical practice showing high virologic failure rates from a number of other triple-nucleoside/ nucleotide reverse transcriptase inhibitor (t-NRTI) combinations[3,4,5,6,7,8] have led some clinicians to conclude that tNRTI-based antiretroviral therapy (ART) has a limited role, if any, in clinical practice
ZDV or d4T + ABC and 3TC as Initial ART: Discussion data show that ABC may be equivalent to NFV and APV/r, and potentially superior to IDV, when combined with d4T or ZDV + 3TC, the overall response rates are lower than those seen in clinical trials comparing these t-NRTI regimens with EFV-containing ART, which is recommended as a preferred initial option in combination with 2 NRTIs by the Department of Health and Human Services (DHHS) guidelines.[1]
Summary
The development and widespread clinical use of coformulated abacavir/lamivudine/zidovudine (ABC/3TC/ZDV) as Trizivir represented an important advance in the management of HIV-infected patients, especially those with adherence challenges. Simplification With t-NRTI: Discussion The use of t-NRTIs as switch therapy for patients receiving stable ART for simplification and/or improvement in lipid abnormalities has proven effective for patients who initiated a PI- or NNRTI-based regimen with at least 3 agents, regardless of baseline viral load This strategy should be used in patients with little to no prior treatment with mono- or dual-NRTI therapies, as these patients are more likely to experience virologic breakthrough following the switch. SUBURBS was a small open-label pilot study that evaluated the quadruple-based regimen of ABC/3TC/ZDV + EFV as initial ART for treatment-naive patients.[26] Following 48 weeks of treatment, patients with HIV RNA < 50 copies/mL and CD4+ cell counts > 100 cells/mcL (n = 20) were switched to ABC/3TC/ZDV alone. More information will be available in the near future when the maintenance phase of ESS40013 is completed and the data are reported
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