Where does that leave AZT/3TC/ABC + TDF?
All we can conclude from Elion’s study is that it’s not in the “completely unacceptable category.” Whether this 4-nuke regimen is any better (or worse) than AZT/3TC/ABC alone can’t be determined without a controlled trial, a trial that is unlikely to take place in light of ACTG 5095. One also wonders whether the once-daily dosing of this regimen, including once-daily dosing of AZT, might have contributed to the somewhat surprising resistance findings, with more TAMs and K65R than would have been expected. Perhaps once-daily dosing of AZT does not provide adequate protection against resistance, both to TDF and to AZT itself. Clearly, this regimen cannot be recommended based on the available data, but the results of Elion’s study may be reassuring to patients who are already taking it with a good virologic response.
