Recent studies by N.T. Annan and co-authors add new data to antiretrovirals findings
2009 JUL 13 - (NewsRx.com) -- "We wished to determine the efficacy of nonnucleoside reverse transcriptase inhibitor (NNRTI)-based regimens in antiretroviral-naive patients commencing highly active antiretroviral therapy (HAART) and to evaluate the effect of calendar year, nucleoside analogue reverse trapscriptase inhibitor (NRTI) backbone, sex, and ethnicity on treatment outcome. Antiretroviral-naive individuals commencing efavirenz or nevirapine with dual-nucleoside analogue backbones were identified from a prospective database," scientists in London, the United Kingdom report. "Virological success was defined as HIV viral load <500 copies per milliliter. Treatment failure was defined as a switch or discontinuation of NNRTI or documented virological failure (2 measurements with viral load >500 copies/mL). From a cohort of 994 individuals, 73% commenced efavirenz- and 27% nevirapine-containing regimens. We found no differences between the 2 treatment groups for the time to virological success (proportion with virological success: efavirenz 71%, nevirapine 72%, P = 0.77) or treatment failure (proportion failing treatment: efavirenz 23%, nevirapine 26%, P = 0.58). There was a significant difference in the calendar year for commencing HAART for the time to virological success and treatment failure (P < 0.001). In the multivariable model, the likelihood of virological success for stavudine/lamivudine was 52% [relative hazard (RH) 1.52, 95% confidence interval (CI) 1.17 to 1.97, P = 0.002]. The nonthymidine analogue backbones as a group seemed to be least likely associated with virological success (RH 0.62, 95% CI 0.48 to 0.80, P< 0.001). This was however largely driven by tenofovir/didanosine being significantly associated with treatment failure (RH 6.48, 95% CI 3.81 to 11.0, P< 0.001). Sex and ethnicity were not associated with treatment outcome. We found no significant differences between nevirapine and efavirenz for the time to virological success or treatment failure. Calendar year of commencing HAART and NRTI backbones were significant predictors of virological success and treatment failure, explaining differences in data to the 2NN study," wrote N.T. Annan and colleagues. The researchers concluded: "The weaker the NNRTI (or the weaker the protease inhibitor) the more important the NRTI backbone becomes.." Annan and colleagues published their study in Jaids - Journal of Acquired Immune Deficiency Syndromes (The Nucleoside Backbone Affects Durability of Efavirenz- or Nevirapine-Based Highly Active Antiretroviral Therapy in Antiretroviral-Naive Individuals. Jaids - Journal of Acquired Immune Deficiency Syndromes, 2009;51(2):140-146). For more information, contact J. Stebbing, Imperial College Healthcare NHS Trust, Fulham Palace Rd., London W6 8RF, UK. Publisher contact information for the Jaids - Journal of Acquired Immune Deficiency Syndromes is: Lippincott Williams & Wilkins, 530 Walnut St., Philadelphia, PA 19106-3621, USA. Keywords: United Kingdom, London, Antiretrovirals, AIDS, Acquired Immune Deficiency Syndrome, Acquired Immunodeficiency Syndrome, Antivirals, Drugs, Efavirenz, Enzyme Research, Enzymes, Enzymology, HAART, HIV, Human Immunodeficiency Virus, Immunology, Nevirapine, Nonnucleoside Reverse Transcriptase Inhibitor, Nucleoside Analog, Nucleoside Reverse Transcriptase Inhibitor, Pharmaceuticals, Protease Inhibitor, Proteins, Proteomics, Sexually Transmitted Disease, Therapy, Treatment, Viral Load, Virology. This article was prepared by AIDS Weekly editors from staff and other reports. Copyright 2009, AIDS Weekly via NewsRx.com.
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