Safety and efficacy of Tenofovir/Emtricitabine or Abacavir/Lamivudine in combination with Efavirenz in Treatment Na?ve HIV patients: A 5 year retrospective observational cohort study. (The TOKEN Study)

摘要

Dear Editor: The management of HIV has made tremendous advance with the advent of anti-retroviral therapy, transforming HIV from a 'killer disease' to a 'chronic immune mediated disease'. Our multicentre retrospective study observed therapy-naive, HLA-B5701 negative, predominantly Black-African patients receiving TDF-FTC (tenofovir-emtricitabine) or ABC-3TC (abacavir-lamivudine) as backbone, administered with efavirenz for 260 weeks. The objectives were to compare the immu-nologic and virologic response and difference in lipid profiles, cardiovascular risk and markers of renal function. At baseline 178 treatment naive patients initiated therapy between January 2006 and December 2006. Final analysis was restricted to 146 patients, 71 patients were in the TDF-FTC arm and 75 in the ABC-3TC arm after exclusions due to transfer of care, pregnancy, recruitment to another trial, treatment switch or loss to follow up. Mean age at the beginning of the study period was 41 (SD ± 8.9 years). 73% of patients were from Black African ethnicity, 43% were women. Mean baseline viral load was 5.4 (±4.6) log copies/ml and was higher in the TDF-FTC arm (p = 0.01). CD4 count was similar in both the arms. All the patients were followed-up every 3 months as part of their routine care. At 260 weeks, viral load below 200 copies/ ml in TDF-FTC arm versus ABC-3TC arm were 78.8% and 80.0% (p = 0.1) and below 40 copies/ml in 70.4% and 74.6% (p = 0.6) respectively (Figure 1A). 58 patients in the TDF-FTC arm and 47 patients in the ABC-3TC arm had baseline viral load above 100,000 copies/ml and the percentage of patients with virological suppression to less than 40 copies/ ml was similar (89% and 86% respectively).