• Sustiva (Efavirenz) is Highly Effective and Well Tolerated in Combination with the Nucleosides Stavudine and Lamivudine (Study DMP 266-043)
  Poster 538
  Authored by C. Cohen, R. Elion, S. Green, K. Sathasivam, B. Waterhouse, S. Villano, N. M. Rui

After the initial success of AZT/3TC/efavirenz (combivir plus sustiva) as demonstrated in a study known as 006, other studies were launched to further explore the power of sustiva-based combinations. This study provides the 84-week outcome of those who started antiviral treatment with d4T (Zerit) in combination with 3TC and sustiva.

The study followed 68 people -- all of whom were treated with this combination as their first treatment. The average viral load was about 65,000 and about a third had a viral load over 100,000. The average CD4 count was about 370, and about 25% had an initial CD4 count <200. These subsets were analyzed separately to explore how well they did on this combination, as a lower CD4 count and higher viral load at baseline have predicted a decreased response in some other combinations.

Overall, the success rate at week 84 was just about 75%, and was identical in the two viral load subsets, showing no loss of benefit when starting this combination in those with very high viral loads. In fact, the average viral load in the "high" viral load group was about 300,000. Similarly, there was no difference in the success of this combination in the group whose CD4 count was below 200, and in this group, the average CD4 count was about 65 cells. Furthermore, there were only seven people in this study who did not achieve a viral load below 50 copies, and four of them had documented decreased adherence with this combination. Thus, of those actually adherent on this combination, only three (about 5%) were unsuccessful in terms of viral suppression. Only three people stopped this combination due to side effects.

This study supports the very successful outcome of initiating therapy with two nucleosides and sustiva. In particular, it supports that even in those who have been difficult to control in other studies, this combination provides reliable suppression for those with low CD4 counts and high viral loads.