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HIV regimens for treatment-naive patients compared

Treatment regimens

Patients received either efavirenz (Sustiva) 600mg plus tenofovir disoproxil (Viread) 300mg and emtricitabine (Emtriva) 200mg once daily, or efavirenz 600mg once daily plus a fixed dose of zidovudine 300mg and lamivudine 150mg twice daily (Combivir).

After comparing two regimens for treatment-naive HIV patients, researchers suggest that a tenofovir-emtricitabine regimen is better than a zidovudine-lamivudine regimen in terms of lowering viral levels and increasing CD4 count (New England Journal of Medicine 2006;354:251).

An open-label study involving 517 patients compared two regimens (see Panel). The primary outcome measure was the proportion of patients with HIV RNA levels of less than 400 copies/ml at week 48.

The researchers found that more patients in the tenofovir-emtricitabine group reached the primary endpoint than in the zidovudine-lamivudine group (84 per cent versus 73 per cent, 95 per cent confidence interval for the difference 4–19; P=0.002). This difference not only indicates that tenofovir-emtricitabine is not inferior to zidovudine-lamivudine but shows a superior response, say the researchers.

They also observed that more patients in the tenofovir-emtricitabine group maintained HIV RNA levels of less than 50 copies/ml (P=0.02). CD4 counts were also higher in this group and adverse events resulting in drug discontinuation were lower.

“These findings have important implications for the choice of an initial nucleoside-analogue backbone in the treatment of such patients,” the researchers conclude.

Citation: The Pharmaceutical Journal URI: 10020835

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