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JAC Advance Access published online on May 23, 2005
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dki170
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© The Author 2005. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oupjournals.org
Received January 5, 2005
Revised April 2, 2005
Accepted April 19, 2005

Original article

Adherence to trizivir and tenofovir as a simplified salvage regimen is associated with suppression of viraemia and a decreased cholesterol

Victoria Latham 1, Justin Stebbing 1, Sundhiya Mandalia 1, Christos Michailidis 1, Elizabeth Davies 1, Mark Bower 1, Brian Gazzard 1, and Mark Nelson 1*

1 The St Stephen's Centre, The Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK

* To whom correspondence should be addressed.
Mark Nelson, E-mail: mark.nelson{at}chelwest.nhs.uk


  Abstract

Background: Treatment failure during highly active antiretroviral therapy (HAART) is ultimately common and associated with the development of resistance mutations. Trizivir (zidovudine/lamivudine/abacavir) and tenofovir disoproxil fumarate may improve adherence and enhance virological suppression in individuals who have failed previous regimens.

Methods: Individuals were identified who had failed previous HAART and who were then prescribed trizivir and tenofovir. Viral load and genotypic information were obtained to assess virological response.

Results: One hundred and twenty-two individuals were identified from a database containing 5883 patients. In a last observation carried forward intention to treat analysis, 34% of individuals achieved an undetectable viral load of <50 copies/mL at 1 year. Of those who were able to remain on treatment for 1 year, 65% achieved undetectability. We observed no effect regarding previous regimens on viral outcome. Accumulation of TAMs (thymidine analogue mutations) was associated with a decrease in the number of patients achieving an undetectable viral load (with <2 TAMs present 38% of patients developed undetectable viral loads, ≥2 TAMs 17% undetectable; P = 0.03). Using the mean cell volume as a measure of compliance, those with higher values were more likely to achieve a viral load <50 copies/mL (P = 0.04). A beneficial effect on cholesterol was noted regardless of virological outcome.

Conclusions: In compliant heavily pre-treated individuals with less than 2 TAMs, salvage therapy with trizivir and tenofovir is associated with suppression of viraemia and an improved lipid profile.

Keywords: HAART; HIV/AIDS; thymidine analogue mutations; cholesterol.
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