Abacavir/Lamivudine Versus Tenofovir/Emtricitabine in Virologically Suppressed Patients Switching from Ritonavir-Boosted Protease Inhibitors to Raltegravir

Abstract

There are few clinical data on the combination abacavir/lamivudine plus raltegravir. We compared the outcomes of patients from the SPIRAL trial receiving either abacavir/lamivudine or tenofovir/emtricitabine at baseline who had taken at least one dose of either raltegravir or ritonavir-boosted protease inhibitors. For the purpose of this analysis, treatment failure was defined as virological failure (confirmed HIV-1 RNA ‡ 50 copies/ ml) or discontinuation of abacavir/lamivudine or tenofovir/emtricitabine because of adverse events, consent withdrawal, or lost to follow-up. There were 143 (72.59%) patients with tenofovir/emtricitabine and 54 (27.41%) with abacavir/lamivudine. In the raltegravir group, there were three (11.11%) treatment failures with abacavir/ lamivudine and eight (10.96%) with tenofovir/emtricitabine (estimated difference 0.15%; 95% CI -17.90 to 11.6). In the ritonavir-boosted protease inhibitor group, there were four (14.81%) treatment failures with abacavir/ lamivudine and 12 (17.14%) with tenofovir/emtricitabine (estimated difference -2.33%; 95% CI -16.10 to 16.70). Triglycerides decreased and HDL cholesterol increased through the study more pronouncedly with abacavir/lamivudine than with tenofovir/emtricitabine and differences in the total-to-HDL cholesterol ratio between both combinations of nucleoside reverse transcriptase inhibitors (NRTIs) tended to be higher in the raltegravir group, although differences at 48 weeks were not significant. While no patient discontinued abacavir/lamivudine due to adverse events, four (2.80%) patients (all in the ritonavir-boosted protease inhibitor group) discontinued tenofovir/emtricitabine because of adverse events ( p = 0.2744). The results of this analysis do not suggest that outcomes of abacavir/lamivudine are worse than those of tenofovir/emtricitabine when combined with raltegravir in virologically suppressed HIV-infected adults.

Adverse effects of chronic treatment with the Main subclasses of highly active antiretroviral therapy: a systematic review

“…Two studies did not report any biochemical changes . Moreover, two studies described lipidaemic changes .…”

“…A total of 21 articles were included in this study: 10 observational cohort studies , six clinical trials , two cross‐sectional studies , one experimental study , one observational prospective study and one case report .…”

Risk of Cardiovascular Disease in an Aging HIV Population: Where Are We Now?

“…However, decreases in TG and increases in HDL-C were greater with abacavir/ lamivudine than with tenofovir/emtricitabine when combined with raltegravir [82]. Altered platelet reactivity has been described in HIVinfected patients.…”

Dyslipidemia and Cardiovascular Risk in Human Immunodeficiency Virus Infection

“…9,39,52–61 Replacement of NRTIs such as stavudine with tenofovir is a strategy to reduce the cardiovascular risk and improve the lipid profile of patients with dyslipidemia. 9,39 Currently, the association between abacavir and excess CVD risk remains controversial.…”