Journal Article

A Review of the Virological Efficacy of the 4 World Health Organization–Recommended Tenofovir-Containing Regimens for Initial HIV Therapy

Michele W. Tang, Phyllis J. Kanki and Robert W. Shafer

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 54, issue 6, pages 862-875
Published in print March 2012 | ISSN: 1058-4838
Published online March 2012 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1093/cid/cir1034

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(See the Editorial Commentary by Kuritzkes et al, on pages 876–7.)

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.

Journal Article.  6043 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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