Treatment News

Compiled by Gus Cairns

Kivexa or Truvada? More evidence

“The most common starting combinations for people new to HIV therapy in the UK are SustivaR (efavirenz) combined with either TruvadaR (tenofovir + FTC) or KivexaR (abacavir + 3TC). With the announcement that AtriplaR, a one-pill, once-a-day treatment combining Truvada and Sustiva, has been licensed in the EU, this combo may become more popular. But is it the best one?”

But is it the best starting combo? The second-most popular is Kivexa® (abacavir + 3TC) plus Sustiva. Does one have the edge over the other?

A study from the English midlands seems to show that if you want a big CD4 boost, take Kivexa; but if you want to minimise your risk of heart problems, take Truvada.

Data on treatment outcomes were analysed for the 110 patients who started on either Truvada or Kivexa, both plus Sustiva, at the HIV clinics in Walsall, Coventry and Northampton during 2006.

Of the 110, 59 started on Kivexa and 51 on Truvada. This was a largely African and heterosexual group of patients; 70% were of African origin and just over half were men.

Pre-treatment average viral loads were slightly lower in the Truvada patients than the Kivexa ones and so were CD4 counts (169 versus 184).

Only two patients had to stop treatment owing to side effects, one on Kivexa and one on Truvada.

When it came to antiviral potency, Kivexa seemed to have some edge over Truvada. Six months after starting, no Kivexa patient still had a viral load over 400, but 12% of the Truvada patients still did, and at this point 80% of Kivexa patients were undetectable (below 40) compared with 73% of Truvada patients. However these differences were not statistically significant and could have been due to chance.
What was significant was that Kivexa patients gained more CD4 cells. The average CD4 rise in the first six months was 169 on Kivexa and 106 on Truvada, and there was a less than one-in-a-hundred probability that this was a chance observation (it has also been seen in other studies).

On the other hand, total cholesterol and ‘bad’ LDL-cholesterol rose in patients on Kivexa but stayed the same on Truvada, even though Sustiva raises cholesterol, and there was a tendency for there to be a better ratio of ‘good’ HDL-cholesterol in the Truvada patients too. There was no evidence of kidney problems in either group.

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