Revista de SIDA e investigación clínica

Long-Term Efficacy of Nevirapine Plus Co-Formulated Abacavir/Lamividune as Simplification Therapy in HIV-Infected Patients with Undetectable Viral Load

Abstract

Alfonso Cabello, José Casas, Juan Alfredo López, Rosa García Delgado, Manuel L. Fernández Guerrero and Miguel Górgolas

Background: The long-term efficacy of NVP+ABC+3TC as a simplification strategy for the treatment of HIV-1 infected patients with undetectable viral load has not been properly assessed in randomized trials. This low-cost treatment with limited renal and bone side effects must be of particular interest in this era of cost-containment urgency and also in limited resource settings.

Methods: Observational study of 232 HIV1-infected patients with undetectable viral load who initiated nevirapine (NVP) + abacavir (ABC) + lamivudine (3TC). Reasons for the switching were treatment simplification (56%), renal problems (6%), osteopenia/osteoporosis (7%), hyperlipidemia (11%) and others (20%). HIV-1 viral load, CD4 cell count and fasting biochemistry profiles were determined on a routine clinical practice. The aim of the study was to evaluate long-term efficacy of this combination and its effect on renal function and lipid metabolism.

Results: 232 patients had a mean follow-up of 4 years (712 patients-year). The mean increment of CD4 after 4 years was 83 cells/μL (13% from baseline). Viral load remained undetectable in all but 14 patients (6%). Triglycerides levels decreased by 10% overtime (p < 0,05). 25 patients (10,7%) stopped therapy due to NVP associated side effects; no ABC associated side-effects were observed. No changes were found in renal function or bone mineral density.

Conclusions: The combination of NVP+ABC+3TC is a safe option for maintaining longterm viral suppression and immunological control, preserving renal function and improving hypertriglyceridemia.