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  • Open Access

Substitution of tenofovir for nucleoside analogues in virologically controlled HIV-infected patients co-infected with hepatitis C virus: TEN-SWITCH

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Journal of the International AIDS Society200811 (Suppl 1) :P277

https://doi.org/10.1186/1758-2652-11-S1-P277

  • Published:

Keywords

  • Tenofovir
  • Nucleoside Analogue
  • Potential Drug Interaction
  • Virologic Suppression
  • Simultaneous Management

Background

Treatment of hepatitis C virus (HCV) in HCV/HIV co-infected patients requires the simultaneous management of two complex regimens, including addressing potential drug interactions between HCV and HIV medications.

Methods

TEN-SWITCH is a prospective, observational study to evaluate the impact of substituting tenofovir (TDF) for other nucleoside analogues in virologically controlled HIV-infected patients (HIV RNA <400 copies/mL) on maintenance of virologic suppression and immune status in HCV/HIV co-infected subjects. Adverse events and HCV treatment uptake following a switch to TDF were also evaluated.

Summary of results

Among 23 subjects enrolled (mean age 45 years, 83% male), 44% were HCV genotype 3, 65% were receiving methadone and 87% reported a history of illicit and injection drug use. The median number of previous NRTIs, NNRTIs and PIs were 2 (range: 0–4), 1 (range: 0–2) and 0 (range: 0–4), respectively. Prior to switch, subjects received PI- (n = 18, LPV/RTV = 9, IDV/RTV = 1, SQV/RTV = 1, ATV/RTV = 2, ATV = 4) or NNRTI-based (n = 5, EFV = 2, NVP = 3, DLV = 1) HAART in combination with either 3TC/DDI (n = 14), ABC/DDI (n = 2), FTC/DDI (n = 1), 3TC/d4T (n = 4), 3TC/AZT (n = 1) or ABC/AZT (n = 1). Median baseline CD4+ count and HIV RNA were 350 (range: 40–999) cells/mm3 and <50 (range: 0–75) copies/mL. Overall, 100% and 91% had HIV-RNA <400 copies/mL and <50 copies/mL, respectively. Among the 18 subjects having completed 12 months of follow-up, two subjects (11%) discontinued TDF following a switch (one due to adverse events, nausea and vomiting likely associated with addition of RTV to unboosted ATV regimen; one due to non-adherence). Two other adverse events that did not require therapy discontinuation were observed (one – vertigo, one – nausea with the addition of RTV). At 12 months of follow-up, the median CD4+ count and HIV-RNA were 530 (range: 180–999) cells/mm3 and <50 (range: 0–82) copies/mL. At 12 months (intent to treat), 89% and 83% had HIV-RNA <400 copies/mL and <50 copies/mL, respectively. Of 18 subjects, three (17%) initiated treatment for HCV infection.

Conclusion

Switching nucleosides in an effective HAART regimen to TDF in preparation for HCV treatment to address potential ribavirin/nucleoside interactions is a safe intervention not associated with loss of virologic or immunologic efficacy of the regimen.

Authors’ Affiliations

(1)
National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Darlinghurst, Australia
(2)
Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, Canada
(3)
Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
(4)
Cool Aid Community Health Centre, Victoria, British Columbia, Canada
(5)
Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada
(6)
Pender Community Health Centre, Vancouver Coastal Health, Vancouver, British Columbia, Canada

Copyright

© Grebely et al; licensee BioMed Central Ltd. 2008

This article is published under license to BioMed Central Ltd.

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