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| |  Women With HIV Demonstrate Higher CD4 Cell Gains Than Men Following Treatment With Stavudine/Lamivudine/Efavirenz: Presented at AIDS 2010 By Jenny Powers VIENNA -- July 26, 2010 -- HIV-infected patients treated with stavudine plus lamivudine in conjunction with efavirenz demonstrated an increase in CD4 cell counts higher than increases achieved by other treatment combinations of paired nucleoside reverse transcriptase inhibitors (NRTIs) and a non-nucleotide reverse transcriptase inhibitor (NNRTI), according to study results presented here at the 18th International AIDS Conference. Female patients had the highest gain, according to results of model predictions. Richard Marlink MD, Harvard School of Public Health, Boston, Massachusetts, presented results here on July 22 of a study carried out by colleagues at the Harvard School of Health that evaluated the long-term term efficacy and tolerability of several protease-inhibitor-sparing antiretroviral therapy (ART) regimens that have become available to HIV-infected individuals in sub-Saharan Africa. The randomised, controlled 3-year trial was carried out in Botswana in 433 ART-naïve patients, and compared the outcomes of treatment with pairs of NRTIs (zidovudine plus lamivudine [ZDV/3TC] versus stavudine plus lamivudine [d4T/3TC]), when added to an NNRTI (efavirenz [EFV] or nelfinavir [NVP]). CD4 counts were measured at baseline and every 2 months following treatment initiation and were entered into a longitudinal model to predict the rate of CD4 increase with the different treatment modalities. The authors fit a stochastic mixed model with a knot at 3 months to account for the acute and long-term effect of treatment on CD4 count increase. A total of 293 females (68%) and 140 males with a median baseline CD4 count of 200 (interquartile range [IQR] 135-250], and a median follow-up 2.99 years (IQR 2.76-3.00 years) received either NRTI or NNRTI therapy. The model demonstrated that CD4 counts rose by an average of 125 cells during the first 3 months of ART regardless of treatment or gender. After 3 months, however, both of these variables were significant predictors of the rate of CD4 cell count increase. In women, CD4 cell increase was 137 cells for ZDV/3TC/NVP, 189 cells for ZDV/3TC/EFV, 181 cells for d4T/3TC/NVP, and 235 cells for d4T/3TC/EFV during the time period of 3 months to 3 years. During the same time period, the increase in CD4 cell counts in men was 103 cells for ZDV/3TC/NVP, 152 cells for ZDV/3TC/EFV, 144 cells for d4T/3TC/NVP, and 197 cells for d4T/3TC/EFV. The authors concluded that, based upon the model's predictions, treatment with d4T/3TC/EFV was the optimal first-line regimen for achieving increase in CD4 cell count. It was of special interest that women, who are most affected by HIV infection, demonstrated superior gains in CD4 cell increase with this treatment. [Presentation title: A Randomized Clinical Trial of Protease-Inhibitor-Sparing ART Among HIV-1C Infected Adults Receiving First-Line Combination Antiretroviral Therapy in Botswana: Longitudinal Modeling of Three-Year Gains. Abstract THPE0072]
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