2006, Number 1
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Med Int Mex 2006; 22 (1)
Switch from protease inhibitor to efavirenz. Efficacy and tolerance
Ayala GJJ, Zapata de la GER, Valdovinos CSB, González MPM
Language: Spanish
References: 21
Page: 10-15
PDF size: 205.75 Kb.
ABSTRACT
Objective: To compare the two-year response from a group of patients with antiretroviral therapy that was switched from indinavir to efavirenz with those that continued the original regimen.
Patients and method: A cohort of 53 adult HIV-infected patients with antiretroviral therapy based on indinavir, which were sustaining undetectable viral load at least for one year were studied. Thirty-three of these patients changed to efavirenz as base and the remaining subjects with the protease inhibitor based scheme continued as control.
Results: There were no differences as for the initial viral load or in the length of time with protease inhibitor before switching (28.75 months in the protease inhibitor group, and 30.64 months in the switch group). During the first year a patient with protease inhibitor left the control (IT = 95%), and none of the switch group did (IT = 100%). At the end of the follow-up two more patients from the group of protease inhibitor quit (IT = 85%) and one from the switchers did (IT = 97%); there was no signifi cant difference. There were no treatment failures due to severe adverse events. At week 96 CD4 counts increased progressively but without signifi cant differences among both groups, with a mean increase of CD4 count of 77.47 ± 129.7 cells/mm
3 in patients with protease inhibitor and of 88.34 ± 280 in the switch group. No patient experienced illness progression, new AIDS defining condition or death.
Conclusions: Switching protease inhibitors to efavirenz in patients sustaining undetectable viral load for a year or more seems to be both immunologically and virologically safe, and favors better adherence to therapy.
REFERENCES
D’Arminio Monforte A, Lepri AC , Rezza G, Pezzotti P, et al. Insights into reasons for discontinuation of the first highly active antiretroviral therapy (HAART ) regimen in a cohort of antiretroviral naive patients. ICONA Study Group. Italian cohort of antiretroviral naive patients. AI DS 2000;14:499-507.
M urphy RL , Smith WJ. Switch studies: a review. HIV Med 2002;3:146-55.
M allon PW. Switch therapy studies: a review. J HIV Ther 2001;2:45-48.
Youle M. Strategies of HIV management-when to switch. AI DS 2002;16:S151-S5.
L een CL . Perspectives on HAART : switch maintenance therapy. Int J ST D AI DS 2003;14:577-82.
A yala-Gaytán JJ, Zapata de la Garza ER , Chávez-García M, Valdovinos-Chávez S, Pérez-Cristóbal M. Experiencia con indinavir en la práctica clínica. Med Int Mex 2003;19:197-201.
P hillips AN , Walker AS . Drug switching and virologic-based endpoints in trials of antiretroviral drugs for HIV infection. AI DS 2004;18:365-70.
S taszewski S, Morales-Ramírez J, Tashima K, Rachlis A, et al. Efavirenz plus zidovudine and lamivudine, efavirenz plus indinavir, and indinavir plus zidovudine and lamivudine in the treatment of HIV infection in adults. N Engl J Med 1999;341:1865-73.
DHHS panel on clinical practices for treatment of HIV infection. Guidelines for the use of antiretroviral agents in HIV-infected adults and adolescents. 2005.
DHHS panel on clinical practices for treatment of HIV infection. Guidelines for use of antiretroviral agents in HIV-infected adults and adolescents. 2001.
Drechsler H, Powderly WG. Switching effective antiretroviral therapy: a review. Clin Infect Dis 2002;35:1219-30.
R ey D, Schmitt MP , Partisani M, Hess-Kempf G, et al. Efavirenz as a substitute for protease inhibitors in HIV-1-infected patients with undetectable plasma viral load on HAART : a median follow-up of 64 weeks. J Acquir Immune Defic Syndr 2001;27:459-62.
E strada V, de Villar NGP, Martinez MTL , González AL , et al. Long-term metabolic consequences of switching from protease inhibitors to efavirenz in therapy for human immunodeficiency virus-infected patients with lipoatrophy. Clin Infect Dis 2002;35:69-76.
Hirschel B, Flepp M, Bucher HC, Zellweger C, et al. Switching from protease inhibitors to efavirenz. Differences in efficacy and tolerance among risk groups: a case-control study from the Swiss HIV Cohort. AI DS 2002;16:381-5.
M aggiolo F, Ripamonti D, Ravasio L, Gregis G, et al. Outcome of simplification strategies for the treatment of human immunodeficiency virus type 1 infection. Clin Infect Dis 2003;37:41-49.
M artinez E, Arnaiz JA, Podzamczer D, Dalmau D, et al. Substitution of nevirapine, efavirenz, or abacavir for protease inhibitors in patients with human immunodeficiency virus infection. N Engl J Med 2003;349:1036-46.
R affi F, Bonnet B, Ferré V, Esnault JL, et al. Substitution of a nonnucleoside reverse transcriptase inhibitor for a protease inhibitor in the treatment of patients with undetectable plasma human immunodeficiency virus type 1 RNA . Clin Infect Dis 2000;31:1274-8.
M iller LG, Golin CE , Hays RD, Liu H, et al. Impact of antiretroviral regimen switches on adherence. HIV Clin Trials 2002;3:355-60.
Barreiro P, Garcia-Benayas T, Soriano V, Gallant J. Simplification of antiretroviral treatment-how to sustain success, reduce toxicity and ensure adherence avoiding PI use. AI DS Rev 2002;4:233-41.
Hansen BR, Haugaard SB, Iversen J, Nielsen JO, Andersen O. Impact of switching antiretroviral therapy on lipodystrophy and other metabolic complications: a review. Scand J infect Dis 2004;35:244-53.
M olina JM, Journot V, Morand-Joubert L, Yeni P, et al. Simplification therapy with once-daily emtricitabine, didanosine, and efavirenz in HIV-1-infected adults with viral suppression receiving a protease inhibitor-based regimen: a randomized trial. J Infect Dis 2005;19:830-9.
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