Atripla as an ART of the first line was ineffective only in 6% of cases

An international group of experts conducted a study that showed for the first time how effective the drug Atripla (tenofovir / emtricitabine / efavirenz), used in high-income countries as first-line ART, is effective over the long term. The results of the evaluation were published in the AIDS journal in January.

Virological failure

The experts collected patient data in 2006–2014. who took the first line of ARVT regimen with any combination of tenofovir / emtricitabine / efavirenz, including Atripla, efavirenz (Sustiva) + Truvada, or monodrugs.

The results of the work were based on data analysis of the largest pan-European "cohort" of patients COHERE.

Most of them (19,527 people, 20 cohorts, 12 countries of the world) were either gay or bisexual (about 60%) or heterosexual (30%), only 2.7% were injecting drug users. The average age of participants was 39 years, the average baseline level of CD4 was 218 cells / cu. mm, viral load (HV) 70 500 copies / ml.

According to the results of the analysis, it was found that 6.3% of people who used the scheme as a starting one did not achieve a sustainable response and undetectable viral load (less than 200 copies / ml) during the first year. This figure fell to 3.5% in the second year and to 1.7% in seven years.

However, as noted by the authors, these figures were obtained when taking into account the transition of PLHIV to other therapy regimens. Under the conditions of taking Atripla, the failure rate was 5.75% (1 out of 17) in the first year, 3% in the second and 1.5% in the sixth.

These indicators compare favorably with those from the UK-CHIC study (2017), obtained earlier on the basis of an analysis of the treatment of people receiving first-line antiretroviral therapy (any combination regimen) in one cohort. Then the level of inefficiency of the schemes was estimated at 8.1% in the first year and 5.8% in the second. The estimate of the proportion of patients who did not reach the HV undeterminable at the eighth year was also 1.5%.

Termination and change of therapy

Within the framework of COHERE, not only the ineffectiveness of ART was considered, but also indicators of the complete cessation of ART and transition to another mode with or without the restoration of viral load. The rate of total rejection of therapy among PLHIV who started receiving Atripla was 3% in the first year, but decreased to 7% by the seventh.

The frequency of discontinuation of drug intake among people who took the combination as a first-line regimen was 2.5% for the first 12 months and decreased to 0.8% by the seventh year.

The percentage of PLWH who changed the scheme for any reason was 13.6% in the first year (one of seven), 8.5% in the second, and 5.5% by the seventh year.