A Comparison between Abacavir and Efavirenz as the Third Drug Used in Combination with a Background Therapy Regimen of 2 Nucleoside Reverse‐Transcriptase Inhibitors in Patients with Initially Suppressed Viral Loads
Background.
Our objective was to compare the rate of viral rebound and therapy failure in patients receiving abacavir or efavirenz as the third drug (in addition to 2 non‐abacavir nucleosides) in combination antiretroviral therapy (cART) and to compare the rate of metabolic alteration associated with these regimens.
Methods.We conducted a multicohort prospective observational study of human immunodeficiency virus–infected patients who had attained viral loads 
80 copies/mL while receiving cART, without having previously received antiretrovirals. The rates of virological rebound, therapy failure, and lipid‐level alteration during follow‐up were calculated as the number of events divided by person‐years of follow‐up (PYFU). A multivariable analysis was performed using a Poisson regression model.
Results.We studied a total of 744 patients; the median age was 37 years, 27% of the patients were female, and 41% were heterosexual. There was a total of 854 PYFU spent receiving efavirenz and 285 spent receiving abacavir. The nucleoside reverse‐transcriptase inhibitor pairs most frequently used were zidovudine/lamivudine (66% of PYFU), stavudine/lamivudine (17.6%), and stavudine/didanosine (5.4%). The adjusted relative rates of virological failure and therapy failure for abacavir, compared with those for efavirenz, were 2.17 (95% confidence interval [CI], 1.12–4.18; 
) and 1.41 (95% CI, 1.01–2.01; 
), respectively.
Conclusions.Patients with virological suppression while receiving regimens containing abacavir appear more likely to experience virological and therapy failure than those receiving efavirenz as their third drug. Although this is a selected group of adherent patients, bias cannot be ruled out, because this is a nonrandomized comparison.
Received 3 October 2005; accepted 30 January 2006; electronically published 16 May 2006.
Cited by
Online publication date: 1-Nov-2007.
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Online publication date: 1-Nov-2006.
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Online publication date: 1-Feb-2006.
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Presented in part: 10th European AIDS Conference/European AIDS Clinical Society, Dublin, 17–20 November 2005 (abstract PE7.4/8).
Potential conflicts of interest: Over the past few years, some of the authors have received reimbursement, fees, and/or funding for attending symposia, speaking, advisory board membership, organizing educational activities, consulting, and/or research from Abbott (A.N.P. and A.D.L.), Boeringher Ingelheim (A.N.P.), Bristol‐Myers Squibb (A.N.P.), Gilead Sciences (A.N.P.), GlaxoSmithKline (A.C.‐L., A.D.L., A.N.P., M.B., S.D.G., M.M., M.C.M., M.A., L.S., P.N., M.L., R.C., and A.d.A.M.), Pfizer Pharmaceutical (A.N.P.), Roche (A.C.‐L., A.d.A.M., and A.P.), and Tibotec (A.N.P.). None of the authors holds any shares in any of the companies.
Financial support: European AIDS Clinical Society Medical Exchange Program for Young Physicians (grant to M.B.).
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Author affiliations and study group members are listed after the text.