A review of the virological efficacy of the 4 World Health Organization-recommended tenofovir-containing regimens for initial HIV therapy

Clin Infect Dis. 2012 Mar;54(6):862-75. doi: 10.1093/cid/cir1034.

Abstract

We systematically reviewed studies of the virological efficacy of the 4 new tenofovir (TDF)-containing regimens recommended for initial antiretroviral (ARV) therapy in the 2010 World Health Organization ARV Treatment Guidelines. Thirty-three studies assessed the efficacy of 1 or more TDF-containing regimens: TDF/lamivudine (3TC)/nevirapine (NVP) (n = 3), TDF/ emtricitabine (FTC)/NVP (n = 9), TDF/3TC/efavirenz (EFV) (n = 6), and TDF/FTC/EFV (n = 19). TDF/3TC/NVP was the least well-studied and appeared the least efficacious of the 4 regimens. In 2 comparative studies, TDF/3TC/NVP was associated with significantly more virological failure than AZT/3TC/NVP; a third study was terminated prematurely because of early virological failure. TDF/FTC/NVP was either equivalent or inferior to its comparator arms. TDF/3TC/EFV was equivalent to its comparator arms. TDF/FTC/EFV was equivalent or superior to its comparator arms. Possible explanations for these findings include the greater antiviral activity of EFV versus NVP and longer intracellular half-life of FTC-triphosphate versus 3TC-triphosphate. Further study of TDF/3TC/NVP is required before it is widely deployed for initial ARV therapy.

Publication types

  • Review

MeSH terms

  • Adenine / administration & dosage
  • Adenine / analogs & derivatives*
  • Anti-HIV Agents / administration & dosage*
  • Benzoxazines / administration & dosage
  • CD4 Lymphocyte Count
  • Deoxycytidine / administration & dosage
  • Deoxycytidine / analogs & derivatives
  • Drug Therapy, Combination
  • Emtricitabine
  • HIV Infections / drug therapy*
  • Humans
  • Lamivudine / administration & dosage
  • Nevirapine / administration & dosage
  • Organophosphonates / administration & dosage*
  • Tenofovir
  • Treatment Failure
  • Viral Load
  • World Health Organization

Substances

  • Anti-HIV Agents
  • Benzoxazines
  • Organophosphonates
  • Deoxycytidine
  • Lamivudine
  • Nevirapine
  • Tenofovir
  • Emtricitabine
  • Adenine
  • efavirenz