Lamivudine monotherapy in HIV-1-infected patients harbouring a lamivudine-resistant virus: a randomized pilot study (E-184V study)

被引:124
作者
Castagna, A
Danise, A
Menzo, S
Galli, L
Gianotti, N
Carini, E
Boeri, E
Galli, A
机构
[1] Vita Salute San Raffaele Univ, Clin Malattie Infett, I-20127 Milan, Italy
[2] Vita Salute San Raffaele Univ, Microbiol Lab, Milan, Italy
[3] Politecn Marche Univ, Virol Lab, Ancona, Italy
关键词
HIV; lamivudine monotherapy; M184V mutation; replication capacity; salvage therapy; treatment interruption;
D O I
10.1097/01.aids.0000218542.08845.b2
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Objective: We compared the immunological and clinical outcomes of lamivudine monotherapy and complete therapy interruption in the treatment of HIV-1-infected patients harbouring lamivudine-resistant virus. Methods: This 48-week, open-label pilot study randomly assigned HIV-infected patients receiving lamivudine-containing HAART and harbouring the M184V mutation to monotherapy with lamivudine 300 mg once daily (lamivudine group) or the discontinuation of all antiretroviral drugs (TI group). The primary endpoint was the occurrence of immunological or clinical failure; immunological failure was defined as the first report of a CD4 T-cell count less than 350 cells/mu l, and clinical failure as the occurrence of a Centers for Disease Control and Prevention grade B or C event. The data were analysed on the basis of the intention-to-treat principle. Results: By week 48,20 of 29 patients in the TI group (69%; 95% CI 51-83%) and 12 of 29 in the lamivudine group (41%; 95% CI 26-59%) had discontinued the study because of immunological or clinical failure, which was significantly delayed in the lamivudine group (P=0.018). Only patients in the TI group (6/29, 20.7%) experienced grade 3-4 clinical adverse events at least possibly related to HIV-1 (P=0.02). The mean decline in CD4 cell percentage, viral rebound and recovery of HIV-1 replication capacity were significantly lower in the lamivudine group. The 24-week virological and immunological response after therapy resumption in patients who prematurely discontinued the study was similar in the two groups. Conclusion: In HIV-1-infected patients harbouring a lamivudine-resistant virus, lamivudine monotherapy may lead to a better immunological and clinical outcome than complete therapy interruption. (C) 2006 Lippincott Williams & Wilkins.
引用
收藏
页码:795 / 803
页数:9
相关论文
共 24 条
  • [21] Role of structured treatment interruption before a 5-drug salvage Antiretroviral regimen:: The Retrogene study
    Ruiz, L
    Ribera, E
    Bonjoch, A
    Romeu, J
    Martinez-Picado, J
    Paredes, R
    Díaz, M
    Marfil, S
    Negredo, E
    García-Prado, JG
    Tural, C
    Sirera, G
    Clotet, B
    [J]. JOURNAL OF INFECTIOUS DISEASES, 2003, 188 (07) : 977 - 985
  • [22] RAPID CHANGES IN HUMAN-IMMUNODEFICIENCY-VIRUS TYPE-1 RNA LOAD AND APPEARANCE OF DRUG-RESISTANT VIRUS POPULATIONS IN PERSONS TREATED WITH LAMIVUDINE (3TC)
    SCHUURMAN, R
    NIJHUIS, M
    VANLEEUWEN, R
    SCHIPPER, P
    DEJONG, D
    COLLIS, P
    DANNER, SA
    MULDER, J
    LOVEDAY, C
    CHRISTOPHERSON, C
    KWOK, S
    SNINSKY, J
    BOUCHER, CAB
    [J]. JOURNAL OF INFECTIOUS DISEASES, 1995, 171 (06): : 1411 - 1419
  • [23] Enhanced fidelity of 3TC-selected mutant HIV-1 reverse transcriptase
    Wainberg, MA
    Drosopoulos, WC
    Salomon, H
    Hsu, M
    Borkow, G
    Parniak, MA
    Gu, ZX
    Song, QB
    Manne, J
    Islam, S
    Castriota, G
    Prasad, VR
    [J]. SCIENCE, 1996, 271 (5253) : 1282 - 1285
  • [24] The M184V mutation in HIV-1 reverse transcriptase reduces the restoration of wild-type replication by attenuated viruses
    Wei, X
    Liang, C
    Götte, M
    Wainberg, MA
    [J]. AIDS, 2002, 16 (18) : 2391 - 2398