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Emtricitabine yielded better virologic outcomes than lamivudine in first-line ART
The use of emtricitabine as part of combination ART in treatment-naive patients with HIV was associated with better virological responses than lamivudine, according to recent findings.
Researchers from Erasmus University Medical Center conducted an observational study using data of 4,740 patients enrolled in the AIDS Therapy Evaluation in the Netherlands nationwide HIV cohort (ATHENA).
They identified patients with HIV who underwent treatment with lamivudine or emtricitabine (Emtriva, Gilead Sciences) in combination with either efavirenz (Sustiva, Bristol-Myers Squibb) and tenofovir (Viread, Gilead Sciences) or nevirapine and tenofovir from January 2002 through January 2012. The investigators compared the virologic response between lamivudine and emtricitabine.
In an on-treatment analysis, the researchers found that at week 48, there was more virological failure with lamivudine vs. emtricitabine with efavirenz/tenofovir (10.8% vs. 3.6%; adjusted OR=1.78; 95% CI, 1.11-2.84) and with nevirapine/tenofovir (27% vs. 11%; aOR=2.09; 95% CI, 1.25-3.52). Similar results were found in propensity score adjusted models and intent-to-treat sensitivity analyses. At week 240, the adjusted HR of virological failure with lamivudine vs. emtricitabine was 2.35 (95% CI, 1.61-3.42) with efavirenz/tenofovir and 2.01 (95% CI, 1.36-2.98) with nevirapine/tenofovir. Neither the time to virological suppression within 48 weeks nor the likelihood of virological rebound after successful suppression was affected by the inclusion of lamivudine or emtricitabine.
“Our study could have important implications,” the researchers wrote. “The presumed clinical equivalence of lamivudine and emtricitabine in treatment guidelines could have a significant impact on HIV care as generic lamivudine has become available. The observed increased virological failure rate on recommended ART that includes generic lamivudine instead of emtricitabine could result in additional morbidity and costs. Whether these additional costs will exceed initial savings by using generic lamivudine is unknown.”
Disclosure: The researchers report no relevant financial disclosures.