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Effectiveness of a Treatment Switch to Nevirapine plus Tenofovir and Emtricitabine (or Lamivudine) in Adults with HIV-1 Suppressed Viremia

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dc.contributor Universitat de Vic - Universitat Central de Catalunya. Càtedra de la Sida i Malalties Relacionades
dc.contributor.author Llibre, Josep M.
dc.contributor.author Bravo, Isabel
dc.contributor.author Ornelas, Arelly
dc.contributor.author Santos, José R.
dc.contributor.author Puig, Jordi
dc.contributor.author Martín Iguacel, Raquel
dc.contributor.author Paredes, Roger
dc.contributor.author Clotet, Bonaventura
dc.date.accessioned 2015-09-28T11:02:47Z
dc.date.available 2015-09-28T11:02:47Z
dc.date.created 2015
dc.date.issued 2015
dc.identifier.citation Llibre, J. M., Bravo, I., Ornelas, A., Santos, J. R., Puig, J., Martin-Iguacel, R., et al. (2015). Effectiveness of a treatment switch to nevirapine plus tenofovir and emtricitabine (or lamivudine) in adults with HIV-1 suppressed viremia. Plos One, 10(6), e0128131. ca_ES
dc.identifier.issn 1932-6203
dc.identifier.uri http://hdl.handle.net/10854/4225
dc.description.abstract Background Switching subjects with persistently undetectable HIV-1 viremia under antiretroviral treatment (ART) to once-daily tenofovir/emtricitabine (or lamivudine) + nevirapine is a cost-effective and well-tolerated strategy. However, the effectiveness of this approach has not been established. Methods We performed a retrospective study evaluating the rates of treatment failure, virological failure (VF), and variables associated, in all subjects initiating this switch combination in our clinic since 2001. Analyses were performed by a modified intention to treat, where switch due to toxicity equalled failure. The main endpoint was plasma HIV-RNA < 50 copies/mL. Results 341 patients were treated for a median of 176 (57; 308) weeks. At week 48, 306 (89.7%) subjects had HIV-1 RNA <50 copies/mL, 10 (2.9%) experienced VF, and 25 (7.4%) discontinued the treatment due to toxicity. During the whole follow-up 23 (6.7%) individuals (17 on lamivudine, 6 on emtricitabine; p = 0.034) developed VF and treatment modification due to toxicity occurred in 36 (10.7%). Factors independently associated with VF in a multivariate analysis were: intravenous drug use (HR 1.51; 95%CI 1.12, 2.04), time with undetectable viral load before the switch (HR 0.98; 0.97, 0.99), number of prior NRTIs (HR 1.49; 1.15, 1.93) or NNRTIs (HR 3.22; 1.64, 6.25), and previous NVP (HR 1.54; 1.10, 2.17) or efavirenz (HR 5.76; 1.11, 29.87) unscheduled interruptions. VF was associated with emergence of usual nevirapine mutations (Y181C/I/D, K103N and V106A/I), M184V (n = 16; 12 with lamivudine vs. 4 with emtricitabine, p = 0.04), and K65R (n = 7).Conclusions The rates of treatment failure at 48 weeks, or long-term toxicity or VF with this switch regimen are low and no unexpected mutations or patterns of mutations were selected in subjects with treatment failure. en
dc.format application/pdf
dc.format.extent 14 p.
dc.language.iso eng
dc.publisher Plos One ca_ES
dc.rights Aquest document està subjecte a aquesta llicència Creative Commons ca_ES
dc.rights.uri http://creativecommons.org/licenses/by-nc/3.0/es/ ca_ES
dc.subject.other Sida -- Tractament ca_ES
dc.title Effectiveness of a Treatment Switch to Nevirapine plus Tenofovir and Emtricitabine (or Lamivudine) in Adults with HIV-1 Suppressed Viremia en
dc.type info:eu-repo/semantics/article ca_ES
dc.identifier.doi https://doi.org/10.1371/journal.pone.0128131
dc.rights.accesRights info:eu-repo/semantics/openAccess ca_ES
dc.type.version info:eu-repo/publishedVersion ca_ES
dc.indexacio Indexat a WOS/JCR ca_ES

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