Genotypic and phenotypic predictors of the magnitude of response to tenofovir disoproxil fumarate treatment in antiretroviral-experienced patients

J Infect Dis. 2004 Mar 1;189(5):837-46. doi: 10.1086/381784. Epub 2004 Feb 10.

Abstract

Results from 2 placebo-controlled intensification trials of tenofovir disoproxil fumarate (DF) in treatment-experienced human immunodeficiency type 1 (HIV-1)-infected patients (n=332) were integrated to determine the effects of resistance at baseline on HIV-1 RNA response. In these trials, there was a high prevalence of HIV-1 resistance mutations, with 94% of patients having nucleoside-associated mutations and 71% having thymidine analogue-associated mutations (TAMs). Statistically significant HIV-1 RNA reductions associated with tenofovir DF treatment, relative to placebo (P<.001), were observed for patients without TAMs (n=97) or for patients with 1-2 (n=88) or >or=3 TAMs (n=147). Response to tenofovir DF was reduced among patients with HIV-1 with >or=3 TAMs inclusive of either the M41L or L210W mutation (n=86) or patients who had a preexisting K65R mutation (n=6). Slightly increased treatment responses were observed when the M184V mutation was present. Phenotypic cutoffs were established at 1.4-fold and 4-fold, respectively, for the beginning of reduced response to tenofovir DF and for a strongly reduced response. The results from these controlled clinical trials provide guidance for the use of tenofovir DF for treatment-experienced patients.

Publication types

  • Clinical Trial
  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Acquired Immunodeficiency Syndrome / drug therapy*
  • Acquired Immunodeficiency Syndrome / genetics
  • Adenine / analogs & derivatives
  • Adenine / therapeutic use*
  • Anti-HIV Agents / therapeutic use*
  • CD4 Lymphocyte Count
  • Double-Blind Method
  • Genotype
  • HIV Infections / drug therapy*
  • HIV Infections / genetics
  • HIV Reverse Transcriptase / genetics
  • HIV-1 / enzymology
  • HIV-1 / genetics*
  • Humans
  • Multivariate Analysis
  • Mutation
  • Organophosphonates*
  • Organophosphorus Compounds / therapeutic use*
  • Phenotype
  • Placebos
  • Predictive Value of Tests
  • RNA, Viral / genetics
  • RNA, Viral / isolation & purification
  • Regression Analysis
  • Tenofovir
  • Thymidine / analogs & derivatives
  • Thymidine / genetics

Substances

  • Anti-HIV Agents
  • Organophosphonates
  • Organophosphorus Compounds
  • Placebos
  • RNA, Viral
  • Tenofovir
  • HIV Reverse Transcriptase
  • Adenine
  • Thymidine