HIV Treatment Combos Compared for Safety, Efficacy

Tenofovir alafenamide plus emtricitabine could serve as an alternative treatment option to abacavir plus lamivudine in virologically suppressed individuals with human immunodeficiency virus (HIV), according to a recent phase 3 trial.

During the trial, researchers identified and evaluated 501 HIV-1 positive adults across North American and Europe. All participants included in the trial were virologically suppressed (HIV-1 RNA of less than 50 copies per mL) and were treated with a stable 3-drug regimen containing abacavir plus lamivudine.
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Participants were randomly assigned to either switch to fixed dose tablets of 10 mg or 25 mg tenofovir alafenamide plus 200 emtricitabine or remain on 600 mg abacavir plus 300 mg lamivudine, with matching placebo, while continuing to take the third drug.

Finding showed that tenofovir alafenamide plus emtricitabine was noninferior to abacavir plus lamivudine. At week 48, virological suppression was maintained in 227 (90%) of 253 participants treated with tenofovir alafenamide plus emtricitabine vs 230 (93%) of 248 participants treated with abacavir plus lamivudine.

The researchers noted that 12 (4%) participants treated with tenofovir alafenimide plus emtricitabine discontinued treatment due to adverse events, compared with 9 (3%) in the abacavir plus lamivudine group. No treatment-related deaths occurred.

“Tenofovir alafenamide, in combination with emtricitabine and various third drugs, maintained high efficacy with a renal and bone safety profile similar to that of abacavir,” the researchers concluded. “In virologically suppressed patients, a regimen containing tenofovir alafenamide could be an alternative to those containing abacavir, without concern for new onset of renal or bone toxicities or hyperlipidaemia.”

—Christina Vogt

Reference:

Winston A, Post FA, DeJesus E, et al. Tenofovir alafenamide plus emtricitabine versus abacavir plus lamivudine for treatment of virologically suppressed HIV-1-infected adults: a randomized, double-blind, active-controlled, non-inferiority phase 3 trial. Lancet HIV. 2018;5(4):e162-e171.  https://doi.org/10.1016/S2352-3018(18)30010-9