Similar 96-week Renal Safety Profile of Tenofovir Disoproxil Fumarate (TDF) versus Stavudine (d4T) when used in Combination with Lamivudine (3TC) and Efavirenz (EFV) in Antiretroviral Naïve Patients JE Gallant1, AL Pozniak2, S Staszewski3, B Lu4, J Sayre4 and A Cheng4 for the Study 903 Team 1Johns Hopkins Univ School of Medicine, Baltimore, MD, USA; 2 Chelsea and Westminster Hosp, London, UK; 3University Hospital, J.W. Goethe-Universität, Frankfurt, Germany; 4Gilead Sciences, Foster City, CA, USA. 43rd Annual Interscience Conference on Antimicrobial Agents and Chemotherapy September 14-17, 2003 Chicago, Illinois Poster No. H- 840 Background
Study 903 is an ongoing 144 week, randomized,double-blind, international multicenter trial whichcompares TDF and d4T when used in combinationwith EFV and 3TC in antiretroviral treatment naïvepatients.
Case reports of renal dysfunction have recentlybeen published1-6
Main Inclusion Criteria
• HIV-1 infected patients naïve to antiretroviral treatment• 18 - 65 years of age• Plasma HIV RNA > 5,000 copies/mL• No significant laboratory or clinical abnormalities• No CD4+ cell count criteria• Serum Creatinine < 1.5 mg/dL• Serum Phosphorus ≥ 2.2 mg/dL• Calculated Creatinine Clearance ≥ 60 mL/min
Study Design: Randomization ART-naive d4T placebo BID patients Stratification by:
• plasma HIV RNA >/< 100,000 c/ml
• CD4 count >/< 200 cells/mm³ randomized TDF placebo QD Baseline Characteristics TDF + 3TC + EFV d4T + 3TC + EFV Serum Creatinine Maximum Toxicity Grade TDF + 3TC + EFV d4T + 3TC + EFV 0-96 Weeks in mg/dL Consecutive Visits with Graded Creatinine TDF+3TC+EFV d4T+3TC+EFV Pat of er b m Consecutive Visits Serum Phosphorus Maximum Toxicity Grade TDF + 3TC + EFV d4T + 3TC + EFV 0-96 Weeks in mg/dL Consecutive Visits with Graded Serum Phosphorus TDF+3TC+EFV d4T+3TC+EFV tien a f P 10 Consecutive Visits Proteinuria Maximum Toxicity Grade TDF + 3TC + EFV d4T + 3TC + EFV 0-96 Weeks in mg/dL Glucosuria Maximum Toxicity Grade TDF + 3TC + EFV d4T + 3TC + EFV 0-96 Weeks in mg/dL Mean Increase from Baseline in Calculated Creatinine Clearance (Calc Cr Cl) TDF + 3TC + EFV d4T + 3TC + EFV Summary of Results: Parameters through 96 weeks Parameters through 96 weeks TDF+3TC+EFV d4T+3TC+EFV
Mean Change from Baseline inCalc Cr Cl* (mL/min)
Conclusions
• The renal safety profile was similar between the patients receiving tenofovir DF or stavudine plus lamivudine and efavirenz through 96 weeks
• No patients discontinued study due to tenofovir DF-related renal abnormalities
• No patient developed Fanconi’s Syndrome through 96 weeks References
1Blick G, et al. 10th CROI, Boston, MA, February 10-14, 2003. Poster 718
2Reynes J, et al. 10th CROI, Boston, MA, February 10-14, 2003. Poster 717
5Murphy MD, et al. CID 2003; 36:1082-1085
6Shere-Wolfe KD, et al. CID 2002; 35:1137
Passage en phase ambulatoire le 23 juillet 2009 En quoi la prise en charge de la grippe A/H1N1 Dois-je déclarer tous les cas suspects de grippe sera-t-elle différente à partir du 23 juillet ? Les patients ne devront plus avoir recours aux Centres 15 et aux Non, uniquement les cas groupés (3 cas en 1 semaine dans une urgences qui seront réservées aux cas compliqués, mais s’adresse-
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