Once‐Daily Quadruple‐Drug Therapy with Adefovir Dipivoxil, Lamivudine, Didanosine, and Efavirenz in Treatment‐Naive Human Immunodeficiency Virus Type 1–Infected Patients

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Abstract
A 48-week open-label study of 11 antiretroviral-naive, human immunodeficiency virus type 1 (HIV-1)–infected adults evaluated once-daily treatment with adefovir dipivoxil, lamivudine, didanosine, and efavirenz. At baseline, the median plasma HIV-1 RNA level was 4.99 log10 copies/mL, and the median CD4 cell count was 471 cells/mm3. At 24 and 48 weeks after initiation of treatment, median HIV-1 RNA levels decreased from baseline by 4.77 and 4.99 log10 copies/mL, respectively, and median CD4 cell counts increased by 135 and 177 cells/mm3, respectively. The regimen was generally well tolerated. No patients withdrew from the study because of adverse events. However, 7 patients developed adefovir-related nephrotoxicity after ⩾20 weeks of treatment; this resolved without sequelae after adefovir was discontinued. Overall adherence was 85%. Once-daily quadruple-drug therapy with adefovir, lamivudine, didanosine, and efavirenz provides pronounced and durable suppression of HIV-1 RNA and elevation of CD4 cell counts over the course of 48 weeks, with generally good tolerability and adherence

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