Table 1.
Study strategies and associated virologic efficacy and toxicity profile
| |
Initial regimen |
Virologic failure at 1, 2, and 3 years |
One-year risk of toxicities |
Management following toxicity |
|---|---|---|---|---|
| 1 | TDF + 3TC + EFV | 1 year – 12%[25] | a. Lipoatrophy – 6% (3-9%)[33] | a. Lipoatrophy – no change |
| 2 year – 20%[45] | b. Renal failure – 1% (0-2%)[26] | b. Renal failure – switch to AZT+3TC+EFV | ||
| 3 year – 24%[32] | c. Myocardial infarction (MI) – 0.1% (0%-0.2%)[25, 26, 46] | c. Non-fatal MI – no change | ||
| 2 | TDF + 3TC + NVP | 1 year – 18%[25, 29, 30] | a. Lipoatrophy – 6% (3-9%)[33] | a. Lipoatrophy – no change |
| 2 year – 36%[29, 30, 45] | b. Renal failure – 1% (0-2%)[26] | b. Renal failure – switch to AZT+3TC+EFV | ||
| 3 year – 31%[29, 30, 32] | c. MI – 0% (0%-0.1%)[25, 26, 46, 47] | c. Non-fatal MI – no change | ||
| d. Hepatotoxicity – 6.3% (4-8%)[35] | d. Hepatotoxicity – switch to TDF+3TC+EFV | |||
| 3 | AZT + 3TC + EFV | 1 year – 17%[25] | a. Lipoatrophy – 23% (15-30%)[32, 33] | a. Lipoatrophy - switch to TDF+3TC+EFV |
| 2 year – 26%[45] | b. Anemia – 6% (4-8%)[25] | b. Anemia - switch to TDF+3TC+EFV | ||
| 3 year – 31%[32] | c. MI – 0.2% (0.1%-0.3%)[25, 46] | c. Non-fatal MI - switch to TDF+3TC+EFV | ||
| 4 | AZT + 3TC + NVP | 1 year – 25%[25, 29, 30] | a. Lipoatrophy – 23% (15-30%)[32, 33] | a. Lipoatrophy - switch to TDF+3TC+NVP |
| 2 year – 39%[29, 30, 45] | b. Anemia – 6% (4-8%)[25] | b. Anemia - switch to TDF+3TC+NVP | ||
| 3 year – 46%[29, 30, 32] | c. MI – 0.1% (0%-0.2%)[25, 46, 47] | c. Non-fatal MI - switch to TDF+3TC+NVP | ||
| d.Hepatotoxicity – 6.3% (4-8%)[35] | d. Hepatotoxocity – switch to AZT+3TC+EFV | |||
| 5 | d4T + 3TC + NVP | 1 year – 18%[26, 29, 30] | a. Lipoatrophy - 30% (20-40%)[26, 33, 36] | a. Lipoatrophy - switch to TDF+3TC+NVP |
| 2 year – 36%[26, 29, 30] | b. Non-fatal MI - switch to TDF+3TC+NVP | |||
| 3 year – 31%[26, 29, 30] | b. MI - 0.3% (0.1%-0.5%)[26, 46, 47] | c. Peripheral neuropathy - switch to TDF+3TC+NVP | ||
| c. Peripheral neuropathy - 25% (15-35%)[34, 37] | ||||
| d. Lactic acidosis - switch to TDF+3TC+NVP | ||||
| d. Lactic acidosis - 0.5% (0.1-1.5%)[38, 39] | e. Hepatotoxicity – switch to AZT+3TC+EFV | |||
| e. Hepatotoxicity – 6.3% (4-8%)[35] |