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July 2007Hot Topics Presented at 4th International AIDS Society Conference on HIV Pathogenesis, Treatment and PreventionContributed by: Heather Huentelman, PharmD, BCPS Epzicom ® versus Truvada ®: Are they equal? Abacavir/lamivudine (ABC/3TC or Epzicom ®) was compared head-to-head with Truvada tenofovir/emtricitabine (TDF/FTC or Truvada ®) in 333 patients with viral loads less than 200 HIV-1 RNA copies/mL. 1 Both Epzicom ® and Truvada ® are a one pill once a day combination of nucleoside reverse transcriptase inhibitors. Epzicom ® is know for the abacavir-hypersensitivity reaction that requires discontinuation of the medication and can not be rechallenged. Truvada is known for causing potential renal insufficiency. Both combinations are thought to be very effective in treating HIV, and are most different based on their side effect profiles.
Summary I find this to be a very interesting study; it demonstrates to me that Epzicom ® works as well as Truvada ® as long as the patient can tolerate the medication. Screening for abacavir hypersensitivity is a very important factor to continuation of the medication (i.e. determine the absence of the HLA-B*5701 allele prior to starting any abacavir containing regimen). It was also striking that there was an increase of 44 CD4+ cells/mm 3 in the Epzicom ® arm. There may be less mitochondrial toxicity associated with Epzicom ® leading to increased T-cell counts. This may not be a big factor for patients with high CD4+ cells but could mean the difference between requiring prophylaxis and not in patients with low CD4+ cells (near 200 cells/mm 3). It is also interesting to remember that when comparing tenofovir/emtricitabine to zidovudine/lamivudine that was a higher CD4 cell count for the TDF/FTC group. 2,3 This might mean that Epzicom ®>Truvada ®>Combivir ® for increasing overall CD4+ cell counts. It would be interesting to have a study comparing all three combinations with presence of the HLA-B*5701 allele as an exclusion criteria.
TMC278 may be superior to efavirenz with by reducing common side effects including CNS and metabolic effects TMC278 is a new agent in the non-nucleoside reverse transcriptase class by Tibotec. TMC278 has been compared to efavirenz (Sustiva ®) in a phase 2b C204 study with 368 ART-naïve HIV-1 infected patients.
TMC125 is another new agent in the same class with an excellent safety profile. Both agents will have an impact on ARV-treatment naïve patients. With all the new agents in the non-nucleoside class, tolerability, safety and resistance profiles will determine the agents place in treatment. 4th International AIDS Society Conference on HIV Pathogenesis, Treatment, and Prevention: Abstract TUAB105, presented July 24, 2007; abstract WEPEA 105, presented July 25, 2007 Other ARV Corner Articles
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