Plasma HIV-1 RNA dynamics in antiretroviral-naive subjects receiving either triple-nucleoside or efavirenz-containing regimens: ACTG A5166s.

TitlePlasma HIV-1 RNA dynamics in antiretroviral-naive subjects receiving either triple-nucleoside or efavirenz-containing regimens: ACTG A5166s.
Publication TypeJournal Article
Year of Publication2007
AuthorsKuritzkes DR, Ribaudo HJ, Squires KE, Koletar SL, Santana J, Riddler SA, Reichman R, Shikuma C, Meyer WA, Klingman KL, Gulick RM
Corporate AuthorsACTG A5166s Protocol Team
JournalJ Infect Dis
Volume195
Issue8
Pagination1169-76
Date Published2007 Apr 15
ISSN0022-1899
KeywordsAnti-HIV Agents, Benzoxazines, Dideoxynucleosides, Drug Therapy, Combination, Female, HIV Infections, HIV-1, Humans, Lamivudine, Male, Prospective Studies, Regression Analysis, RNA, Viral, Time Factors, Zidovudine
Abstract

OBJECTIVE: We sought to compare clearance rates of plasma human immunodeficiency virus type 1 (HIV-1) RNA in men and women starting triple-nucleoside-based versus efavirenz (EFV)-based regimens.

METHODS: First- and second-phase decay rates of plasma HIV-1 were compared in men and women initiating a triple nucleoside reverse-transcriptase inhibitor (NRTI) regimen versus regimens that included EFV plus an NRTI. Subjects (n=64) were randomized to receive zidovudine/lamivudine/abacavir (triple-nucleoside regimen), zidovudine/lamivudine plus EFV (3-drug EFV regimen) or zidovudine/lamivudine/abacavir plus EFV (4-drug EFV regimen). Plasma HIV-1 RNA levels were fitted to a biexponential viral-dynamics model using a nonlinear mixed-effects model. Nonparametric Wilcoxon tests compared empirical Bayes estimates of first- and second-phase viral decay rates between treatment arms and sex.

RESULTS: Median first-phase viral decay rates were significantly faster in subjects receiving the 3-drug EFV regimen (0.67/day), compared with those receiving the triple-nucleoside regimen (0.56/day; P=.02). The second-phase viral decay rate was also faster in the 3-drug EFV group than in the triple-nucleoside group (P=.09). Decay rates in the 4-drug EFV group were intermediate. Viral decay rates were not significantly different in men and women. CONCLUSIONS Faster initial viral decay in subjects randomized to a 3-drug EFV-based regimen corresponded to the overall superior efficacy of that regimen. Viral decay rates did not differ by sex.

DOI10.1086/512619
Alternate JournalJ. Infect. Dis.
PubMed ID17357053
Grant ListUL1 TR000005 / TR / NCATS NIH HHS / United States