Tenofovir Disoproxil Fumarate, Emtricitabine, and Efavirenz Compared With Zidovudine/Lamivudine and Efavirenz in Treatment-Naive Patients

Arribas, José Ramón; Pozniak, Anton; Gallant, Joel E.; DeJesus, Edwin; Gazzard, Brian; Campo, Rafael; Chen, Shan Shan; McColl, Damian J.; Holmes, Charles B.; Enejosa, Jeffrey; Toole, John J.; Cheng, Andrew

doi:10.1097/qai.0b013e31815acab8

Cited by 211 publications

(159 citation statements)

References 7 publications

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“…At the 144-week analysis of the cohort, 64% of patients maintained viral suppression in the TDF-FTC-EFV arm compared to 56% of the ZDV-3TC-EFV (P = 0.08). 23 These results remained robust at 5 years of follow-up. 24 Since then this combination has been the standard against which all other regimens have been compared.…”

Section: Efficacysupporting

confidence: 65%

Issues in resistance, adherence, and comparative efficacy of the single-tablet regimen combination of tenofovir, emtricitabine, and efavirenz in the management of HIV-1 infection

Rebick¹,

Walmsley²

2012

VAAT

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Abstract:Atripla is the first once-daily, single-tablet, triple-combination antiretroviral therapy. It is recommended for the initial treatment of the naïve patient with human immunodeficiency virus-1 (HIV-1) infection in all current guidelines, based on its proven efficacy in numerous head-to-head randomized clinical trials. Not only has it proven efficacy, but the fixed-dose combination, Atripla, has resulted in an improvement in adherence, quality of life, and satisfaction among naïve as well as virally suppressed patients switching from another regimen. Despite the advantages, tolerability issues can arise that are related primarily to the efavirenz component, which is known to cause central nervous side effects such as dizziness, abnormal dreams, and anxiety. Although generally self-limited, these side-effects can lead to treatment discontinuation in the short-or long-term. Based on the observation of neural tube defects in macaque models, and isolated case reports in human fetuses with first trimester exposure, it is rated as Food and Drug Administration pregnancy category D, and considered as contraindicated in the first trimester of pregnancy where alternatives are available. Given the low genetic barrier of each of the individual components, resistance remains an important issue for patients with poor adherence, but is balanced in part by the long half-life of the drugs. Transmitted resistance is described in up to 16% of newly infected patients in population surveys, and is particularly prevalent in men who have sex with men. Minority variants that may impart resistant to efavirenz are not detected with currently used HIV-1 genotype assays, but nonetheless may also be implicated in patients who fail initial treatment. Several single-tablet regimens are recently licensed or in development that will challenge Atripla as the single-tablet first-line option, but none have shown superior efficacy to date.

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Section: Efficacysupporting

confidence: 65%

Issues in resistance, adherence, and comparative efficacy of the single-tablet regimen combination of tenofovir, emtricitabine, and efavirenz in the management of HIV-1 infection

Rebick¹,

Walmsley²

2012

VAAT

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“…Tenofovir disoproxil fumarate (TDF), the prodrug for the nucleotide reverse transcriptase inhibitor tenofovir (TFV), has proved highly effective in the treatment of antiretroviralnaïve and antiretroviral-experienced HIV-infected patients when combined in regimens containing nonnucleoside reverse transcriptase inhibitors (NNRTIs) or protease inhibitors (PIs) [1][2][3][4][5][6][7][8]. At the time at which TDF was developed, TDF-PI drug-drug interactions were not expected because TFV is eliminated renally by glomerular filtration and active tubular secretion, whereas PIs are hepatically metabolized [9].…”

Section: Introductionmentioning

confidence: 99%

Steady‐state amprenavir and tenofovir pharmacokinetics after coadministration of unboosted or ritonavir‐boosted fosamprenavir with tenofovir disoproxil fumarate in healthy volunteers

et al. 2010

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ObjectiveAn open-label, three-period pharmacokinetic study was conducted to investigate the drug interaction potential between fosamprenavir (FPV) and tenofovir disoproxil fumarate (TDF). MethodsThirty-six healthy subjects received TDF 300 mg once daily (qd) for 7 days (period 1), and then were randomized to 14 days of either FPV 1400 mg twice daily (bid) or FPV/ritonavir (RTV) 700/100 mg bid alone or with TDF (period 2). Subjects continued their randomized dose of FPV for 14 more days, adding or removing TDF based upon its receipt in period 2 (period 3). Twenty-four-hour pharmacokinetic sampling was carried out on day 7 of period 1 and on day 14 of periods 2 and 3. Steady-state plasma amprenavir (APV) and tenofovir (TFV) pharmacokinetics were assessed by noncompartmental analysis and parameter values observed with each regimen were compared using geometric mean ratios with 90% confidence intervals. ResultsAfter TDF coadministration, APV geometric mean minimum concentration (C min ), maximum concentration (C max ), and area under the plasma concentration-time curve (AUC) increased by 31, 3 and 7% above values observed with unboosted FPV alone; they also increased by 31, 4 and 16% above values observed with FPV/RTV alone. TFV C min , C max and AUC decreased by 12, 25 and 15% after FPV coadministration and by 9, 18 and 7% after FPV/RTV coadministration. No significant changes in RTV pharmacokinetics were observed. No differences were noted in adverse events among dosing periods. ConclusionsIn this evaluation of the interaction between FPV and TDF, increases in APV exposures and modest decreases in TFV exposures were observed. These were unlikely to be clinically significant.Keywords: drug interaction, fosamprenavir, tenofovir IntroductionTenofovir disoproxil fumarate (TDF), the prodrug for the nucleotide reverse transcriptase inhibitor tenofovir (TFV), has proved highly effective in the treatment of antiretroviralnaïve and antiretroviral-experienced HIV-infected patients when combined in regimens containing nonnucleoside reverse transcriptase inhibitors (NNRTIs) or protease inhibitors (PIs) [1][2][3][4][5][6][7][8]. At the time at which TDF was developed, TDF-PI drug-drug interactions were not expected because TFV is eliminated renally by glomerular filtration and active tubular secretion, whereas PIs are hepatically metabolized [9]. However, drug interaction studies showed that the area under the plasma concentration-time curve (AUC; exposure) DOI: 10.1111DOI: 10. /j.1468DOI: 10. -1293DOI: 10. .2009 (2010), 11, 193-199 193 for TFV increased by 22-32% when TDF was combined with unboosted atazanavir (ATV), ATV boosted by ritonavir (ATV/ RTV), lopinavir (LPV)/RTV, or darunavir (DRV)/RTV, accompanied by 15-20% decreases in ATV and LPV AUCs and a 21% increase in the DRV AUC [10][11][12][13][14]. Although the combination of TDF with fosamprenavir (FPV), the phosphate ester prodrug of the PI amprenavir (APV), has been reported to be effective and well tolerated in HIV-infected patients [4,[15][16][17][18][19], a fo...

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“…The prevalent combination of Tenofovir-based NRTI backbones with EFV or boosted PIs used in recent years had greater antiviral activity and better tolerability than first generation HAART combinations in many studies as in ours [36,37]; modification rates of first-line HAART regimens were significantly more frequent in 1998, in line with many other observations, even after adjusting for adherence and the proportion of drug addicts (data not shown) [6,7,16,18,19,35,38]. In our study, however, the incidence of toxic events in the sample years was surprisingly similar, differing from those of previous studies [35,39] and in line with another recent report [19].…”

Section: Or (95% CImentioning

confidence: 96%

Efficacy of 1998 Vs 2006 First-Line Antiretroviral Regimens for HIV Infection: An Ordinary Clinics Retrospective Investigation

Parruti

Polilli

Socio³

et al. 2012

J Antivir Antiretrovir

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Purpose: The evidence suggesting increased HAART efficacy over time comes from randomized trials or cohort studies. This retrospective multicenter survey aimed to assess the variation over time in the efficacy and tolerability of first-line HAART regimens in unselected patients treated in ordinary clinical settings. HAART modification (20.1% vs 29.2%; p=0.02); HAART interruption (7.3% vs 14.6%; p=0.01); proportion reporting optimal adherence (92.2% vs 82.7%, p=0.03). No differences were observed in the prevalence of grade 3-4 WHO toxicities (26.4% vs 26.6%; p=0.9). Multivariate logistic regression showed that being treated in 1998 remained an independent predictor of virological failure after several adjustments, including adherence. Methods Conclusions:Our data from patients not included in clinical trials or cohort studies provide an additional line of evidence that the effectiveness of HAART significantly improved in 2006. Treated patients, however, were significantly older and more frequently late HIV presenters in 2006 than in 1998.

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Tenofovir Disoproxil Fumarate, Emtricitabine, and Efavirenz Compared With Zidovudine/Lamivudine and Efavirenz in Treatment-Naive Patients

Abstract: Cumulative results from 3 years of follow-up suggest that a regimen of TDF/FTC and EFV demonstrates superior durability of viral load suppression and an improved safety and morphologic profile compared with ZDV/3TC and EFV.

Cited by 211 publications

References 7 publications

Issues in resistance, adherence, and comparative efficacy of the single-tablet regimen combination of tenofovir, emtricitabine, and efavirenz in the management of HIV-1 infection

Issues in resistance, adherence, and comparative efficacy of the single-tablet regimen combination of tenofovir, emtricitabine, and efavirenz in the management of HIV-1 infection

Steady‐state amprenavir and tenofovir pharmacokinetics after coadministration of unboosted or ritonavir‐boosted fosamprenavir with tenofovir disoproxil fumarate in healthy volunteers

Efficacy of 1998 Vs 2006 First-Line Antiretroviral Regimens for HIV Infection: An Ordinary Clinics Retrospective Investigation

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