Home > For Consumers > Co‐formulated...

PubMed Health. A service of the National Library of Medicine, National Institutes of Health.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet]. Chichester, UK: John Wiley & Sons, Ltd; 2003-. doi: 10.1002/14651858.CD005481.pub3

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet].

Co‐formulated abacavir‐lamivudine‐zidovudine for treating HIV infection and AIDS

This version published: 2016; Review content assessed as up-to-date: January 13, 2013.

Link to full article: [Cochrane Library]

Plain language summary

The primary objective of this review was to evaluate the antiviral efficacy of co‐formulated abacavirlamivudinezidovudine for initial treatment of HIV infection. The secondary objectives were to evaluate the safety and tolerability of the triple drug combination. We identified 15 potentially eligible studies, four of which met our inclusion criteria. Our findings indicate that co‐formulated abacavir‐lamivudine‐zidovudine remains a viable option for initiating antiretroviral therapy, especially in HIV‐infected patients with pre‐existing hyperlipidaemia and those who do not tolerate ritonavir.

Abstract

Background: UNAIDS estimates that 34 million people are currently living with the human immunodeficiency virus (HIV) worldwide. Currently recommended regimens for initiating HIV treatment consist of either a non‐nucleoside reverse transcriptase inhibitor (NNRTI) or ritonavir‐boosted protease inhibitor (PI) combined with two nucleoside reverse transcriptase inhibitors (NRTIs). However, there may be some patients for whom NNRTIs and PIs may not be appropriate. This is an update of the review published in the Cochrane Library Issue 3, 2009.

Objectives: To evaluate the effects of any fixed‐dose combination of three NRTIs (co‐formulated abacavirlamivudinezidovudine) for initial treatment of HIV infection.

Search methods: Between December 2010 and July 2011, we used standard Cochrane methods to search electronic databases and conference proceedings with relevant search terms without limits to language or publication status.

Selection criteria: We selected randomised controlled trials (RCTs) with a minimum follow‐up time of six months which compared co‐formulated abacavirlamivudinezidovudine with either PI‐based or NNRTI‐based therapy among antiretroviral‐naive HIV‐infected patients aged at least 13 years.

Data collection and analysis: Three authors independently selected eligible studies, assessed risk of bias, and extracted data; resolving discrepancies by consensus. We calculated the risk ratio (RR) or mean difference (MD), as appropriate, with its 95% confidence interval (CI) and conducted meta‐analysis using the random‐effects method because of significant statistical heterogeneity (P<0.1).

Main results: We identified 15 potentially eligible RCTs, four of which met our inclusion criteria. The four included RCTs were conducted in the United States of America (USA); USA, Puerto Rico, Guatemala, Dominican Republic, and Panama; USA and Mexico; and Botswana, respectively. The RCTs compared co‐formulated abacavirlamivudinezidovudine to treatment based on efavirenz (NNRTI), nelfinavir (PI), atazanavir (PI), and co‐formulated lopinavir‐ritonavir (PI), respectively. Overall, there was no significant difference in virological suppression between co‐formulated abacavir‐lamivudine‐zidovudine and NNRTI‐ or PI‐based therapy (4 trials; 2247 participants: RR 0.73, 95% CI 0.39 to 1.36). However, the results showed significant heterogeneity (I2=79%); with co‐formulated abacavir‐lamivudine‐zidovudine inferior to NNRTI (1 trial, 1147 participants: RR 0.35, 95%CI 0.26 to 0.49) but with a trend towards co‐formulated abacavir‐lamivudine‐zidovudine being superior to PI (3 trials, 1110 participants: RR 1.07, 95%CI 1.00 to 1.16; I2=0%). We found no significant differences between co‐formulated abacavir‐lamivudine‐zidovudine and either PI or NNRTI on CD4+ cell counts (3 trials, 1687 participants: MD ‐0.01, 95%CI ‐0.11 to 0.09; I2=0%), severe adverse events (4 trials: RR 1.22, 95%CI 0.78 to 1.92; I2=62%) and hypersensitivity reactions (4 trials: RR 4.04, 95% CI 0.41 to 40.02; I2=72%). Only two studies involving PIs reported data on the lipid profile. One study found that the mean increase in total cholesterol from baseline to 96 weeks was significantly lower with co‐formulated abacavir‐lamivudine‐zidovudine than with nelfinavir, but there were no differences with triglyceride levels. The second study found the fasting lipid profile to be comparable in both co‐formulated abacavir‐lamivudine‐zidovudine and atazanavir arms at 48 weeks.

The significant heterogeneity of effects for most outcomes evaluated was largely due to differences in the control therapy used in the included trials (i.e. NNRTIs or PIs). Using the GRADE approach, we rated the overall quality of the evidence on the relative effects of co‐formulated abacavirlamivudinezidovudine for initial treatment of HIV infection as moderate. The main reason for downgrading the quality of the evidence was imprecision of the findings. The estimate of the treatment effect for each outcome has wide confidence intervals, which extend from the fixed‐dose NRTI combination regimen being appreciably better to the regimen being appreciably worse than PI‐ or NNRTI‐based regimens.

Authors' conclusions: This review provides evidence that co‐formulated abacavirlamivudinezidovudine remains a viable option for initiating antiretroviral therapy, especially in HIV‐infected patients with pre‐existing hyperlipidaemia. The varied geographical locations of the included trials augment the external validity of these findings. We are moderately confident in our estimate of the treatment effects of the triple NRTI regimen as initial therapy for HIV infection. In the context of the GRADE approach, such moderate quality of evidence implies that the true effects of the regimen are likely to be close to the estimate of effects found in this review; but there is a possibility that they could be substantially different.  Further research should be geared towards defining the subgroup of HIV patients for whom this regimen will be most beneficial.

Editorial Group: Cochrane HIV/AIDS Group.

Publication status: Edited (no change to conclusions).

Citation: Shey MS, Kongnyuy EJ, Alobwede SM, Wiysonge CS. Co‐formulated abacavir‐lamivudine‐zidovudine for initial treatment of HIV infection and AIDS. Cochrane Database of Systematic Reviews 2013, Issue 3. Art. No.: CD005481. DOI: 10.1002/14651858.CD005481.pub3. Link to Cochrane Library. [PubMed: 23543540]

Copyright © 2016 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

PMID: 23543540

Download

PubMed Health Blog...

read all...

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...