Presentation Abstract

Session: 099-Antiretroviral Therapy of HIV-1 Infection
Sunday, Sep 18, 2011, 11:15 AM - 1:15 PM
Presentation Title: H2-783 - Discontinuation of Tenofovir, Emtricitabine and Efavirenz as a Single Table Regime in HIV-1 Infected Individuals Naïve to Antiretroviral Therapy
Location: Exhibit Hall F1
Poster Board Number: 270
Presentation Number: H2-783
Pres. Time: Sunday, Sep 18, 2011, 11:15 AM - 1:15 PM
Category: H2
Keywords: CNS toxicity; atripla; HIV
Author(s): J. Zheng - Medical Student1, A. Scourfield, MD (Doctor of Medicine) - Clinical Research Fellow 1, L. Waters - Clinical Research Fellow 1, M. Cevik - Clinical Research Fellow 1, S. Mandalia - Statistician 2, M. Nelson - Consultant 1;
1Chelsea and Westminster Hosp., London, United Kingdom, 2Imperial Coll., London, United Kingdom.
Financial Disclosures:  J. Zheng, None..
A. Scourfield, None..
L. Waters, None..
M. Cevik, None..
S. Mandalia, None..
M. Nelson, None.
Abstract: Background: Atripla® is a fixed dose combination of tenofovir, emtricitabine and efavirenz. Transient central nervous system (CNS) adverse effects are common with initiation of efavirenz but may be persistent leading to discontinuation. We aimed to describe the outcomes of individuals commencing Atripla®. Methods: A case notes review was performed of all individuals within our HIV cohort who had received Atripla® as their first antiretroviral combination at baseline, 6 and 12 months. In those who discontinued, data was collected on duration of therapy and reasons for switching. Results: 472 individuals started Atripla® as first line therapy. 442 (94%) males with a median age of 37 years (IQR 31-43). 354 (75%) were white Caucasian, 246 (52%) were MSM, 24 (5%) heterosexual, the rest were unknown. Baseline median HIV-1 RNA was 16,000 copies/ml.
Median valuesBaselineMonth 6Month 12
Number472463383
CD4 count cells/mm3 (IQR)285 (208-362)387 (297-492)449 (327-536)
% HIV-1 RNA <50
(on treatment analysis)
092%98%
Total cholesterol mmol/l (IQR)4.3 (3.8-5)4.7 (4.2-5.3)4.8 (4.2-5.5)
Triglycerides mmol/l (IQR)1.6 (1.1-2.2)1.5 (1.1-2.2)1.5 (1.1-2.2)
89 (19%) people discontinued Atripla® after a median duration of 294 days (IQR 108-495 days). CNS toxicity was the commonest reason for switching therapy in 63 (71%) cases, other causes included hepatotoxicity 7 (8%), rash 6 (7%), virological failure and/or resistance 6 (7%). The commonest CNS toxicities were insomnia, nightmares, depression and dizziness.
Time to switch for CNS toxicity0-4 weeks4-12 weeks12-52 weeks52-96 weeks
Number (%)6 (10%)4 (6%)30 (48%)23 (36%)
Conclusion: Individuals on Atripla® are often required to switch antiretroviral therapy for adverse events. The commonest reason in our cohort was for CNS toxicity with the majority of cases occurring after more than 3 months.




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