Investigation of two commonly-used HIV treatments finds one more safe and effective

Combination treatment with tenofovir-emtricitabine more safe and effective than combination treatment with abacavir-lamivudine.

Online PR News – 12-January-2010 – – Boston, MA – The initial treatment for patients with the human immunodeficiency virus (HIV) consists of the use of fixed-dose combination nucleoside reverse-transcriptase inhibitors (NRTIs) with a nonnucleoside reverse-transcriptase inhibitor or a ritonavir-boosted protease inhibitor. Researchers at Brigham and Women’s Hospital (BWH), working within the NIH-funded AIDS Clinical Trials Group (ACTG), found that the NRTI combination tenofovir-emtricitabine (Truvada, Gilead Sciences) was more safe and effective than abacavir-lamivudine (Epzicom, GlaxoSmithKline). This research is published online and in the December 2 issue of the New England Journal of Medicine.

It was unknown which of these two available NRTI combinations used to treat HIV has greater efficacy and safety. The researchers compared four once-daily antiretroviral regimens as initial therapy for HIV infection; they found a significant difference in virologic efficacy, according to the NRTI combination, in patients with high amounts of HIV RNA in their blood. “For those patients treated with abacavir-lamivudine, the amount of time before virologic failure and the first adverse event occurred were both significantly shorter than in those assigned to tenofovir DF–emtricitabine,” said Paul Sax, MD, clinical director for the Division of Infectious Diseases at BWH.

The researchers assigned participants beginning treatment for HIV to one of the four treatment groups which included: abacavir–lamivudine or tenofovir disoproxil fumarate (DF)–emtricitabine in combination with efavirenz or ritonavir-boosted atazanavir. At a median follow-up of 60 weeks, among the 797 patients with HIV-1 RNA levels of 100,000 copies per milliliter or more, the time to virologic failure was significantly shorter in the abacavir–lamivudine group than in the tenofovir DF–emtricitabine group, with 57 virologic failures in the abacavir–lamivudine group versus 26 in the tenofovir DF–emtricitabine group. The time to the first adverse event was also shorter in the abacavir–lamivudine group. These findings led an independent Data and Safety Monitoring Board to recommend stopping the comparison between NRTIs among those with HIV RNA levels > 100,000 copies.

“These findings have important implications for clinical practice, especially for patients who are beginning HIV therapy with high viral loads,” said Dr. Sax. “While both treatment strategies were highly effective, the results clearly showed that tenofovir DF-emtricitabine was both more effective and better tolerated.”

This research was funded by grants from the National Institute of Allergy and Infectious Diseases, National Institutes of Health, with additional support from the General Clinical Research Center units, funded by the National Center for Research Resources.

About Brigham and Women's Hospital:-
Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery. The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit