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Medicine (Baltimore). 2016 Sep;95(37):e4890. doi: 10.1097/MD.0000000000004890.

Long-term efficacy and toxicity of abacavir/lamivudine/nevirapine compared to the most prescribed ARV regimens before 2013 in a French Nationwide Cohort Study.

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aDepartment of Research and Innovation, Reims Teaching Hospitals, Robert Debré Hospital bFaculty of Medicine, University of Reims Champagne-Ardenne, Reims cDepartment of Infectious Diseases, University Hospital, Nantes dDepartment of Infectious and Tropical Diseases, Martinique Teaching Hospitals, Fort-De-France Hospital, Fort-De-France, Martinique eAix-Marseille University, APHM Hôpital Sainte-Marguerite, Immuno-Hematology Clinic, Marseille, France fInserm U912 (SESSTIM), Marseille, France gHospices Civils de Lyon, Service des Maladies Infectieuses et Tropicales, INSERM U1052, Lyon hLaboratoire de pharmacologie, Université de Nice-Sophia-Antipolis, Hôpital Pasteur, CHU de Nice, Nice Cedex 1 iCHU de Toulouse, Service des Maladies Infectieuses et Tropicales, INSERM UMR1043, Université Toulouse III Paul Sabatier, Toulouse jCentre Hospitalier Tourcoing, Service Universitaire de Maladies Infectieuses et du Voyageur, Tourcoing kLe Trait d'Union, Centre de Soins de l'Infection par le VIH, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg lDepartment of Internal Medicine, Infectious Diseases, and Clinical Immunology, Reims Teaching Hospitals, Robert Debré Hospital mFaculté de médecine, EA-4684/SFR CAP-SANTE, Université de Reims Champagne-Ardenne, Reims, France.


Data on the long-term efficacy and safety of abacavir/lamivudine (ABC/3TC) and nevirapine (NVP) are scarce. This combination has the advantage of simplifying treatment and improving long-term tolerance. The aim of this study was to compare the rate of any discontinuation of antiretroviral (ARV) regimen because of virologic failure (VF), and/or adverse drug reaction (ADR) among patients receiving stable ARV regimens for at least 6 months.ABC/3TC/NVP was compared to ABC/3TC with either ritonavir-boosted darunavir (DRV/r) or ritonavir-boosted atazanavir (ATV/r), unboosted ATV, or tenofovir/emtricitabine (TDF/FTC) with either one of the following: ATV/r, unboosted ATV, DRV/r, efavirenz (EFV), or NVP, in the French prospective multicenter Dat'AIDS cohort.The study enrolled 16,511 patients treated with following ARV regimens: ABC/3TC/NVP (n = 1089), TDF/FTC/NVP (n = 1542), ABC/3TC/DRV/r (n = 1065), ABC/3TC/ATV/r (n = 1847), ABC/3TC/ATV (n = 563), TDF/FTC/ATV/r (n = 3519), TDF/FTC/DRV/r (n = 2767), TDF/FTC/ATV (n = 419), and TDF/FTC/EFV (n = 3700). Mean follow-up was 36 ± 24 months. Patients treated with ABC/3TC/NVP received this regimen as a switch regimen in 97% of cases. By multivariable analysis, the risk of treatment discontinuation due to VF was similar between ABC/3TC/NVP and other ARV regimens, except for TDF/FTC/ATV and ABC/3TC/ATV, which were associated with a higher risk of treatment interruption due to VF (hazard ratio [HR] 1.99; 95% confidence interval [CI] 1.29-3.06 and HR 2.19; 95% CI 1.51-3.18, respectively). Treatment discontinuation due to ADR was lowest with the ABC/3TC/NVP regimen. Other ARV regimens were associated with a 1.80- to 3.19-fold increase in the risk of treatment discontinuation due to ADR (P < 0.0001 for all comparisons).ABC/3TC/NVP as a simplification regimen is a long-term effective regimen with lower discontinuation due to long-term toxicity compared with other standard ARV regimens.

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