M A J O R A R T I C L EH I V / A I D S
SWIFT: Prospective 48-Week Study to Evaluate
Efficacy and Safety of Switching to Emtricitabine/
Tenofovir From Lamivudine/Abacavir in
Virologically Suppressed HIV-1 Infected Patients
on a Boosted Protease Inhibitor Containing
R. Campo,1E. DeJesus,2U. F. Bredeek,3K. Henry,4H. Khanlou,5K. Logue,6C. Brinson,7P. Benson,8L. Dau,9H. Wang,10
K. White,11J. Flaherty,12T. Fralich,9B. Guyer,9and D. Piontkowsky9
1Department of Infectious Diseases, University of Miami School of Medicine, Florida;2Department of Infectious Disease, Orlando Immunology Center,
Florida,3Department of Infectious Diseases, Metropolis Medical, San Francisco, California,4Department of Internal Medicine HIV Program, Hennepin
County Medical Center, Minneapolis, Minnesota,5Medical Institute of Immunology and Infectious Diseases, Los Angeles, California;6Department of
Medicine, St. Clair Medical Associates, Toronto, Ontario, Canada;7Central Texas Clinical Research, Austin, Texas,8Be Well Medical Center, Berkley,
Michigan,9Department of Medical Affairs,10Department of Biostatistics,11Department of Clinical Virology, and12Department of Clinical Research,
Gilead Sciences, Inc, Foster City, California
side reverse transcriptase inhibitor (NRTI) backbone with lamivudine/abacavir (3TC/ABC) as a commonly used alter-
native. For patients infected with human immunodeficiency virus (HIV-1) virologically suppressed on a boosted
protease inhibitor (PI)+3TC/ABC regimen, the merits of switching to FTC/TDF as the NRTI backbone are unknown.
Methods.SWIFT was a prospective, randomized, open-label 48-week study to evaluate efficacy and safety of
switching to FTC/TDF. Subjects receiving 3TC/ABC+PI+ritonavir (RTV) with HIV-1 RNA<200 c/mL ≥3 months
were randomized to continue 3TC/ABC or switch to FTC/TDF. The primary endpoint was time to loss of virologic
response (TLOVR) with noninferiority measured by delta of 12%. Virologic failure (VF) was defined as confirmed
rebound or the last HIV-1 RNA measurement on study drug ≥200 c/mL.
Results.In total, 311 subjects were treated in this study (155 to PI+RTV+FTC/TDF, 156 to PI+RTV+3TC/
ABC). Baseline characteristics were similar between the arms: 85% male, 28% black, median age, 46 years; and median
CD4 532 cells/mm3. By TLOVR through week 48, switching to FTC/TDF was noninferior compared to continued
3TC/ABC (86.4% vs 83.3%, treatment difference 3.0% (95% confidence interval, −5.1% to 11.2%). Fewer subjects on
FTC/TDF experienced VF (3 vs 11; P=.034). FTC/TDF showed greater declines in fasting low-density lipoproteins
(LDL), total cholesterol (TC), and triglycerides (TG) with significant declines in LDL and TC beginning at week 12
with no TC/HDL ratio change. Switching to FTC/TDF showed improved NCEP thresholds for TC and TG and im-
proved 10-year Framingham TC calculated scores. Decreased epidermal growth factor receptor (eGFR) was observed
in both arms with a larger decrease in the FTC/TDF arm.
Conclusions.Switching to FTC/TDF from 3TC/ABC maintained virologic suppression, had fewer VFs, improved
lipid parameters and Framingham scores but decreased eGFR.
Keywords.HIV-1; FTC/TDF; 3TC/ABC; virologic failure; switch.
In the United States, emtricitabine/tenofovir disoproxil fumarate (FTC/TDF) is a preferred nucleo-
Received 6 August 2012; accepted 7 December 2012; electronically published
29 January 2013.
Correspondence: Rafael E. Campo, MD, University of Miami School of Medi-
cine, Department of Infectious Diseases, 1120 NW 14th St, Ste 853, Miami,
FL 33136 (email@example.com).
Clinical Infectious Diseases
© The Author 2013. Published by Oxford University Press on behalf of the Infectious
Diseases Society of America. This is an Open Access article distributed under the
terms of the Creative Commons Attribution License (http://creativecommons.org/
licenses/by/3.0/), which permits unrestricted reuse, distribution, and reproduction in
any medium, provided the original work isproperly cited.
HIV/AIDS • CID 2013:56 (1 June) • 1637
Fixed-dose combination (FDC) antiretrovirals such as emtrici-
tabine/tenofovir disoproxil fumarate (FTC/TDF) and lamivu-
dine/abacavir (3TC/ABC) allow simplification of regimens to
potentially improve outcomes by augmenting adherence .
Comparative studies of FTC/TDF to 3TC/ABC-containing
regimens tend to favor the FTC/TDF arm in regards to effica-
cy and/or safety [2, 3].
In a large, prospective, treatment-naive trial, subjects with
baseline HIV-1 RNA >100 000 c/mL had a lower rate of viro-
logic failure on FTC/TDF compared to 3TC/ABC-containing
regimens . Similarly, the BICOMBO study showed that vi-
rologically suppressed subjects on a 3TC-containing regimen
had a lower rate of virologic failure when switched to FTC/
TDF compared to 3TC/ABC-containing regimens . In fact,
the 3TC/ABC arm was not noninferior or comparable to the
FTC/TDF arm . The total cholesterol (TC), low-density li-
poprotein (LDL) cholesterol, and triglycerides (TG) were sig-
nificantly lower for subjects on FTC/TDF compared to 3TC/
ABC . In another study ROCKET 2, virologically sup-
pressed subjects with dyslipidemia on lopinavir/ritonavir
(LPV/r) also showed significant declines in TC, LDL, and TG
levels 12 weeks following switch to FTC/TDF-compared to
3TC/ABC-containing regimens . Other studies support
similar lipid improvement with FTC/TDF [3, 6]. Finally, some
but not all studies have shown an association of 3TC/ABC use
with an increased relative risk rate of myocardial infarction
US treatment Guidelines list FTC/TDF as a preferred and
3TC/ABC as an alternative NRTI backbone [1, 14]. In light of
this, we undertook a prospective, randomized, open-label trial
(SWIFT) to evaluate the virologic efficacy and safety potentials
and risks of a nucleos(t)ide backbone switch from 3TC/ABC
to FTC/TDF in virologically suppressed subjects receiving a
ritonavir-boosted protease inhibitor (PI) based regimen.
The SWIFT study was a 48 week prospective, randomized,
open–label, multicenter study to evaluate the safety and effica-
cy of switching FDCs from 3TC/ABC to FTC/TDF in virolog-
ically suppressed, HIV-1 infected patients maintained on their
boosted PI. Eligible subjects were ≥18 years old, males and
nonpregnant females, receiving 3TC/ABC plus a boosted PI
with HIV-1 RNA < 200 copies/mL for at least 3 months prior
to study entry and < 200 copies/mL at screening by the COBAS
TaqMan version 1.0 assay (TaqMan). Subjects had to have an
estimated glomerular filtration rate (eGFR) ≥ 50 mL/minutes
by the Cockcroft-Gault (CG) method, AST and ALT ≤ 5 times
the upper limit of normal, and, if receiving lipid-lowering
agents, the drug and dose had to be stable for ≥3 months.
Subjects were excluded if they were receiving antiretroviral
agents in addition to 3TC/ABC plus a boosted PI, had known
historical resistance to any of the study agents including resis-
tance mutations to FTC/TDF (including K65R, M184V/I, or
multiple thymidine analogs) or PIs. Subjects were stratified by
LPV/r versus other PIs, and by co-morbidities (diabetes melli-
tus, hyperlipidemia and cardiovascular disease). Antiviral effi-
cacy was assessed by serial measurements of plasma HIV-1
RNA at baseline, and weeks 4, 12, 24, 36, and 48, and at early
study discontinuation, if it occurred. Subjects with HIV-1
RNA >200 copies/mL had the test repeated at the investiga-
The primary objective was to assess non-inferiority of
FTC/TDF relative to 3TC/ABC measured by the proportion
of subjects who maintained HIV-1 RNA < 200 c/mL through
week 48 (intent-to-treat, missing= failure). Secondary objec-
tives included evaluation of safety and tolerability, changes in
CD4 cell count, assessment of eGFR using the CG, and the
abbreviated modified diet in renal disease (MDRD) methods,
and evaluation of change in fasting lipid parameters (TG,
TC, LDL, HDL, TC: HDL). In a subset, certain cardiovascular
biomarkers (high-sensitivity C-reactive protein [hsCRP], inter-
leukin 6 [IL-6], interleukin 10 [IL-10], tumor necrosis factor α
[TNF-α], and fibrinogen) were explored over the 48 weeks.
Changes in the risk of coronary heart disease (CHD) outcomes
were determined by 10-year Framingham risk scores [15,16].
The treated analysis set, used for safety and outcome summa-
ries, includes subjects who were randomized and received at
least 1 dose of study drug. The intent to treat (ITT) analysis
set, used for efficacy analysis, excludes those with major proto-
col violations from the treated analysis set.
The primary endpoint was the proportion of subjects with
HIV-1 RNA< 200 c/mL through week 48 by time to loss of
virologic response (TLOVR) algorithm. TLOVR responders
were those who completed the study and maintained HIV-1
RNA < 200 c/mL through week 48 without intervening VF. VF
was defined as confirmed on-study HIV-1 RNA ≥ 200 c/mL on 2
successive occasions or the last on-study HIV-1 RNA ≥ 200 c/mL.
Subjects were considered failures in the TLOVR analysis if they
experienced VF, discontinued study medication before week
48, or changed to a new antiretroviral (ARV) regimen. A 2-
sided exact 95% confidence interval (CI) for the difference in
treatment group response rate (FTC/TDF minus 3TC/ABC)
was constructed using inverted 2 one-sided tests with the stan-
dardized statistics. The FTC/TDF group was considered non-
inferior to the 3TC/ABC group if the lower confidence bound
of the responder difference was greater than –12%.
1638 • CID 2013:56 (1 June) • HIV/AIDS
Descriptive statistics summarize secondary efficacy end-
points. Confidence intervals (95%) and tests of significance, all
2-sided were also used for measure of interest of secondary
efficacy endpoints. Observed values and changes from baseline
in the risk of CHD outcomes for the 10-year Framingham risk
score were analyzed. The Framingham risk score was calculat-
ed based on using both the fasting TC score and also based on
the fasting LDL score approaches. Framingham risk scores
were summarized using descriptive statistics and differences
between treatment groups and were compared using Wilcoxon
rank sum test.
The HIV-1 RNA threshold for VF was amended in the pro-
tocol 1 year into the study from 50 c/mL to 200 c/mL based
on data regarding discordance between the COBAS Amplicor
and the TaqMan HIV-1 test. The data showed an increased
rate of samples with >50 c/mL in the TaqMan assay that
were<50 c/mL in the COBAS Amplicor assay . This
protocol change was consistent with the ACTG standard of
<200 c/mL . Subjects meeting criteria for VF had geno-
typic resistance testing performed on their last available
plasma sample if HIV-1 RNA >1000 c/mL.
A total of 312 subjects were randomized from 76 North
American centers. One subject randomized to FTC/TDF with-
drew consent before receiving study treatment and was exclud-
ed from the efficacy and safety analysis. Overall, 311 subjects
were randomized and treated (155 started FTC/TDF and 156
continued 3TC/ABC). One subject randomized to FTC/TDF
was excluded from the ITT analysis set for a major protocol
violation (documented prior resistance to study drug). Demo-
graphic and baseline disease characteristics are summarized in
Table 1.Baseline Demographics and Characteristics
CharacteristicFTC/TDF+PI/r (N=155)3TC/ABC+PI/r (N=156)Total (N=311)
Age, median (range), years
Male sex, No. (%)
Race, No. (%)
HIV-1 RNA c/mL, No. (%)
50 to < 200
Time since first ARV therapy, median (IQR), years
CD4 cell count, median (IQR), cells/mm3
Comorbidities, No. (%)
Lipid modifying agent, No. (%)
eGFR Cockcroft-Gault, mL/min (IQR)
46 (22, 66)
46 (22, 75)
46 (22, 75)
4 (2.5, 6.9)
532 (354, 725)
3.7 (2.5, 6.7)
532 (382, 728)
3.8 (2.5, 6.7)
532 (363, 725)
Abbreviations: ARV, antiretroviral; eGFR, epidermal growth factor receptor; FTC/TDF, emtricitabine/tenofovir disoproxil fumarate; HIV-1, human immunodeficiency
virus; IQR, interquartile range; PI, protease inhibitor; 3TC/ABC, lamivudine/abacavir.
HIV/AIDS • CID 2013:56 (1 June) • 1639
At week 48, TLOVR responses were 133 of 155 (86.4%) for
the FTC/TDF arm compared to 130 of 156 (83.3%) with con-
tinued 3TC/ABC, representing a treatment difference of 3.0%
(95% CI, −5.1% to 11.2%), establishing noninferiorty. Addi-
tionally, fewer people had virologic failure in the FTC/TDF
arm vs 3TC/ABC, 3/155 (1.9%) vs 11/156 (7.1%); P= .034
through week 48 (Figure 1). All 3 subjects who experienced
virologic failure in the FTC/TDF arm had low-level viremia
(range, 209–452 copies/mL); low adherence was not reported
in these subjects with low-level viremia. Two were receiving
atazanavir/ritonavir and 1 boosted fosamprenavir. Of the 11
subjects with virologic failure in the 3TC/ABC arm, 3 discon-
tinued study drug early, and 8 subjects experienced viremia
(range, 272–6430 copies/mL) at the week 48 visit. Of these 11
subjects, 5 were receiving atazanavir/ritonavir, 4 lopinavir/
ritonavir, 1 fosamprenavir/ritonavir, and 1 darunavir/ritonavir.
No specific boosted PI regimen was associated with virologic
Four virologic failure subjects had HIV-1 RNA values above
1000 copies/mL and had genotypic and phenotypic analyses: 1
subject in the FTC/TDF arm and 3 subjects in the 3TC/ABC
arm. No genotypic resistance to study drugs was observed in
any subject in either arm through week 48. Note, of the 4 sub-
jects who were suppressed at screening but above the HIV-1
RNA value of 200 copies/mL at baseline, 2 were virologic suc-
cesses due to post-baseline ongoing virologic suppression, 1
was a virologic failure due to detectable but low-level viremia
at week 48 while on FTC/TDF, and 1 subject was excluded
from the ITT analysis set due to a major protocol violation.
Changes in CD4 count at week 48 were similar between
treatment arms with median (IQR) changes of 8 (−49, 80)
and 39 (−41, 125) cells/mm3for the FTC/TDF and the 3TC/
ABC arms, respectively (P=.10).
Subjects who switched to FTC/TDF from 3TC/ABC showed
reductions from baseline at week 48 in fasting TC (median
change of −21 mg/dL vs −3 mg/dL with 3TC/ABC, P< .001),
and LDL (−7 mg/dL vs 2 mg/dL with 3TC/ABC; P=.007).
There were no differences in lipid lowering agent modification
between arms during the study. No differences in HDL
(P=.26), TG (P= .074) or HDL/TC ratio (P=.17) were ob-
served (Supplement 1).
At baseline, there was no difference in the distribution
across National Cholesterol Education Program (NCEP) cate-
gories between the 2 treatment groups; NCEP sets cholesterol
guidelines in the United States . At week 48, a higher per-
centage of subjects who switched to FTC/TDF were in the de-
sirable NCEP categories for TC and TG compared to those
who remained on 3TC/ABC (TC: 62% vs 45% < 200 mg/dL,
P= .005; TG: 60% vs 41% < 150 mg/dL, P=.003) (Figure 2).
Switching to FTC/TDF resulted in improvements in the
predicted risk for CHD outcomes as measured by Framing-
ham Risk Scores. Mean (SD) change from baseline in risk by
the TC formula was −1.0 (4.32) for the FTC/TDF arm at week
12 (P= .008); this reduction was also maintained through
week 48 with a mean (SD) change from baseline of −1.2
(4.39) and P= .006. When the LDL formula was used, mean
(SD) change from baseline in Framingham risk was −0.9
(3.07) for the FTC/TDF arm at week 12 (P<.001) and was
−0.5 (3.93) at week 48 (P=.21). The mean change for all
vir disoproxil fumarate; HIV-1, human immunodeficiency virus type 1; PI, protease inhibitor; 3TC/ABC, lamivudine/abacavir; TLOVR, time to loss of virologic
Virologic response and virologic failure by Kaplan-Meier through week 48.Abbreviations: CI, confidence interval; FTC/TDF,emtricitabine/tenofo-
1640 • CID 2013:56 (1 June) • HIV/AIDS
calculated Framingham Scores in the 3TC/ABC group fluctu-
ated about the baseline level with no statistically significant
changes from baseline observed. The difference between
groups for the predicted risk of CHD (regardless of method of
calculation) only achieved statistical significance at week 24
(P<.05). The FTC/TDF group further demonstrated a shift
from higher risk Framingham categories to lower risk catego-
ries (Figure 3).
The safety and tolerability for both treatment arms in SWIFT
were consistent with the known safety profiles of FTC/TDF
and 3TC/ABC (Table 2). Similar percentages of subjects in
each arm reported any serious adverse event (SAE), any
adverse event (AE), or any Grade 3 or 4 treatment-emergent
AE. Three subjects died during the study: 1 subject in the
FTC/TDF group (suicide) and 2 subjects in the 3TC/ABC
group (homicide, lymphoma). None of the deaths or SAEs
was considered by the investigator to be related to study
(Table 3). There was one pregnancy in the 3TC/ABC arm
with a spontaneous abortion, which was considered unrelated
to the study drug.
The percentage of subjects who discontinued study drug
due to an AE was higher in the FTC/TDF group [4.5% (n=7/
155)], compared to the 3TC/ABC [1.9% (n =3/156)]. Rash,
which was reported in 1.3% (2 subjects) in the FTC/TDF arm,
was the only AE reported in more than 1 subject that resulted
in study drug discontinuation. A higher percentage of treat-
ment-emergent AEs considered related to study drug by the
investigator were reported in the FTC/TDF than in the 3TC/
ABC group, 10.3% (n=16) vs 3.8% (n =6). Adverse events
considered related to the study drug in more than 1 subject
included nausea, headache, and dizziness (1.9%, 3 subjects
each); diarrhea, flatulence, malaise, and rash (1.3%, 2 subjects
each) in the FTC/TDF group; and diarrhea (1.3%, 2 subjects)
in the 3TC/ABC group.
There were no differences observed in renal adverse events
between arms (FTC/TDF 4.5% [n=7]; 3TC/ABC 5.1%
[n= 8]). Three subjects in the FTC/TDF arm had renal AEs
reported as related to study drug by the investigator: renal
nofovir disoproxil fumarate; PI, protease inhibitor; 3TC/ABC, lamivudine/abacavir.
Fasting total cholesterol and triglycerides by National Cholesterol Education Program classification. Abbreviations: FTC/TDF, emtricitabine/te
HIV/AIDS • CID 2013:56 (1 June) • 1641
impairment (baseline serum creatinine [SCr] of 1.0 mg/dL
which subsequently increased to 1.3 mg/dL then decreased to
1.1 mg/dL), abnormal urine odor, and increased SCr with de-
creased eGFR (grade 1 decrease at discontinuation).
Modest decreases from baseline through week 48 in
creatinine clearance by the CG method (GFRCG) using ideal
body weight occurred within both treatment arms, FTC/TDF
(GFRCG−8.3 mL/minutes, P<.001) and 3TC/ABC (GFRCG
−4.5 mL/minutes, P= .002). When compared across arms, a
statistically significant difference was observed between the
groups (P=.012). MDRD GFR estimates gave similar results
Treatment emergent laboratory abnormalities were compa-
rable between the groups. Most laboratory abnormalities were
grade 1 or 2, and most common was elevated bilirubin, pri-
marily in subjects on ATV+RTV. There was no grade 2 or
higher changes in SCr throughout the study. Grade 1 SCr lab-
oratory changes occurred in 3.2% of subjects on FTC/TDF
and 1.9% on 3TC/ABC. No clinically relevant changes in
serum phosphorus and in hypophosphatemia were observed.
There was no difference in development of proteinuria
between the 2 arms when analyzed by change in grade from
baseline (Table 4). No patients had confirmed normoglycemic
glucosuria in either arm.
Given previous reports of increased risks for cardiovascular
events, including myocardial infarction, associated with ARV
regimens containing ABC, we explored changes in commonly
used surrogate cardiovascular biomarkers in a subset of 159 of
bine/tenofovir disoproxil fumarate; PI, protease inhibitor; 3TC/ABC, lamivudine/abacavir.
Categorical shifts by Framingham 10-year risk scores from baseline to week 48. Abbreviations: CHD, coronary heart disease; FTC/TDF, emtricita-
Table 2. Summary of Adverse Events (Treated Analysis Set)
Category, No. (%)a
Grade 3 or 4 adverse
Adverse event related
to study drug
Grade 3 or 4 adverse
event related to
Serious adverse event
Serious adverse event
related to study drug
Adverse event leading
to study drug
Death during study
120 (76.9%) 232 (74.6%)
16 (10.3%)29 (9.3%)
16 (10.3%)6 (3.8%) 22 (7.1%)
1 (0.6%)01 (0.3%)
7 (4.5%)3 (1.9%)10 (3.2%)
1 (0.6%) 2 (1.3%)3 (1.0%)
protease inhibitor; 3TC/ABC,lamivudine/abacavir.
1642 • CID 2013:56 (1 June) • HIV/AIDS
312 (51%) patients, 81 randomized to FTC/TDF and 78 to
3TC/ABC. No differences at week 48 compared to baseline
were observed between treatment arms for hsCRP, IL-10, IL-6,
and TNF-α (Table 5), although there was a trend for differenc-
es in fibrinogen (median change, FTC/TDF −10 mg/dL, 3TC/
ABC −1 mg/dL, P=.062) at week 48.
In this large, prospective, randomized trial, the first study spe-
cifically designed to evaluate the efficacy and safety of
switching from 3TC/ABC to FTC/TDF in HIV-1-infected sub-
jects suppressed on a PI +RTV containing regimen, we have
demonstrated that FTC/TDF is noninferior to remaining on
3TC/ABC in maintaining treatment response by TLOVR with
fewer VFs, as well as a lower risk of emergent resistance
through 48 weeks. Efficacy and virologic failure rates in sub-
jects on FTC/TDF compared to 3TC/ABC arm were compara-
ble to results seen with this FDC seen in the BICOMBO and
ASSERT trials [2, 19].
We did observe slightly higher rates of discontinuation due
to AEs and mild AEs considered study drug-related in the
FTC/TDF vs 3TC/ABC arms. This finding is not unexpected
as previous studies demonstrate an increase in certain adverse
events when stable subjects are switched to a new therapy.
Modest declines in eGFR occurred in both arms with the
degree of decline significantly greater in FTC/TDF-treated
subjects; however, values remained in the normal range. Long-
term studies have shown that the use of TDF may be associat-
ed with initial declines in GFR within the first few months of
starting TDF, which then stabilize [20–22]. Importantly, there
were no differences between arms in emergent proteinuria
and or normoglycemic glycosuria (Table 4).
Table 4.Change From Baseline in Urine Protein by Grade
Urine Protein Change in Gradea
−10 +1 +2 +3
Cochran-Mantel-Haenssel statistics (based on table scores).
Abbreviations: FTC/TDF,emtricitabine/tenofovir disoproxil fumarate; 3TC/ABC,
aNonzero correlation value 1.5674, P= .2106; row mean scores diff 1.5674,
Cardiovascular Biomarkers Change From Baseline at
Median (Q1, Q3)FTC/TDF+PI/r3TC/ABC+PI/r
C-reactive protein (mg/dL) N= 69
TNF-α-INF (pg/mL) N=56
P-values for comparison between treatment groups are from Wilcoxon rank-
Abbreviations: 3TC/ABC, lamivudine/abacavir; FTC/TDF, emtricitabine/tenofovir
disoproxil fumarate; IL, interleukin; INF, interferon; PI, protease inhibitor; TNF,
tumor necrosis factor.
aMissing =excluded analysis.
Table 3.Disposition of Subjects
Subjects randomized but not
Completed 48 weeks of studyb138 (89.0)
Discontinued study drug
Primary reason for premature discontinuation of study
Lack of efficacy
Lost to follow-up
Study discontinued by
139 (89.1) 277 (89.1)
17 (11.0)34 (10.9)
protease inhibitor; 3TC/ABC,lamivudine/abacavir.
aAll percentages are based on the No. of subjects in the treated analysis set.
bSubjects completed 48 weeks of the study if the subject completed the
protocol-planned duration of the study based on the study completion form.
HIV/AIDS • CID 2013:56 (1 June) • 1643
Comorbidities (FTC/TDF vs 3TC/ABC) were common in
our study population, including diabetes (10% vs11%), hyper-
lipidemia (52% vs 62%), and hypertension (33% vs 33%). Ad-
ditionally, 3.2% in both arms had a history of MI. As with
previous studies, we demonstrated lipid benefits when switch-
ing to FTC/TDF [3–6]. Significant declines in LDL and
TC were observed by week 12 in the FTC/TDF arm and sig-
nificant reductions in TC, LDL, and TG were seen at week 48.
By NCEP category criteria , higher percentages showed
improvements in TC and LDL, as well as improvement (shift
from a higher risk to a lower risk category) in the predicted
risk for CHD outcomes with FTC/TDF as seen in other com-
parative studies [2, 5]. In an ad hoc analysis, we found that the
predicted Framingham 10-yr Risk Score was more favorable
when switching FTC/TDF; particularly, for those with comor-
bidities, whites, and regimens with a PI other than LPV/r.
Such an improvement in Framingham scores is perhaps one
of the most novel benefits of switching from an 3TC/ABC to
FTC/TDF-containing regimen. It is however, worthwhile to
note that the small number of subjects on LPV/r and other
confounding factors at baseline may make this a weaker corre-
lation and may limit these results from being generalized.
Finally, the changes from baseline in commonly used surro-
gate cardiovascular biomarkers (hsCRP, IL-10, IL-6, TNF-α,
and fibrinogen) between the FTC/TDF and 3TC/ABC arm in a
subset of 159 subjects were not significant except a trend toward
significance with fibrinogen (P=.062) (Table 5), perhaps with a
larger sample size it may have achieved significance.
The SWIFT study showed that high rates of virologic sup-
pression were well maintained through 48 weeks with fewer vi-
rologic failures in subjects who switched to FTC/TDF, and also
this regimen is well tolerated. Decreases in creatinine clearance
did occur with both treatments and were greater in the FTC/
TDF arm. In the FTC/TDF arm, improvements in certain lipid
parameters and in other measures including in NCEP catego-
ries and Framingham predicted risk for CHD outcomes were
noted [15,16]. In summary, switching patients on a boosted PI
regimen to FTC/TDF from 3TC/ABC is associated with im-
portant metabolic benefits without loss of virologic control.
Supplementary materials are available at Clinical Infectious Diseases online
(http://cid.oxfordjournals.org/). Supplementary materials consist of data
provided by the author that are published to benefit the reader. The
posted materials are not copyedited. The contents of all supplementary
data are the sole responsibility of the authors. Questions or messages
regarding errors should be addressed to the author.
F. B. received travel support to his institution from Me-
Medical.R.C. receivedinstitutional grantsupportfor
participation in the study’s clinical trials. E. D. J. received travel support
through his institution from Gilead. K. H. received institutional grand
support from the Minneapolis Medical Research Foundation and also re-
ceived travel support from Gilead.
Potential conflicts of interest.
All authors: No reported conflicts.
All authors have submitted the ICMJE Form for Disclosure of Potential
Conflicts of Interest. Conflicts that the editors consider relevant to the
content of the manuscript have been disclosed.
1. Department of Health and Human Services (DHHS). Guidelines for
the use of antiretroviral agents in HIV-1-infected adults and adoles-
cents, 2012. Available at: http://AIDSinfo.nih.gov.
2. Martinez E, Arranz JA, Podzamczer D, et al. Efficacy and safety of
NRTI’s switch to tenofovir plus emtricitabine (Truvada) vs abacavir
plus lamivudine (Kivexa) in patients with virologic suppression receiv-
ing a lamivudine containing HAART: The BICOMBO study [oral pre-
sentation]. Paper presented at: 4th International AIDS Society
Conference on HIV Pathogenesis, Treatment, and Prevention (IAS).
Sydney, Australia, July 22–26, 2007.
3. Sax PE, Tierney C, Collier AC, et al. Abacavir-lamivudine versus teno-
fovir-emtricitabine for initial HIV-1 therapy. N Engl J Med 2009;
4. Valantin MA, Bittar R, de Truchis P, et al. Switching the nucleoside
reverse transcriptase inhibitor backbone to tenofovir disoproxil
fumarate+ emtricitabine promptly improves triglycerides and low-
density lipoprotein cholesterol in dyslipidaemic patients. J Antimicrob
Chemother 2010; 65:556–61.
5. Behrens G, Maserati R, Rieger A, et al. Switching from kivexa [ABC/
3TC ]+kaletra [LPV/r] to truvada [TDF/FTC]+kaletra [LPV/r]
reduces high hholesterol: results of a 12 week randomized, controlled
study (ROCKET II) [Poster WEPE0110]. Poster presented at: XVIII
International AIDS Conference. Vienna, Austria, July 18–23, 2010.
6. Moyle G, Orkin C, Fisher M, et al. Switching from kivexa (KVX) +
efavirenz (EFV) to atripla (ATR) reduces total cholesterol in hyper-
cholesterolemic subjects: final results of a 24-week, andomised study
[poster P80]. Poster presented at: 10th International Congress on
Drug Therapy in HIV Infection. Glasgow, UK, November 7–11, 2010.
7. Worm SW, Sabin C, Weber R, et al. Risk of myocardial infarction in
patients with HIV infection exposed to specific individual antiretrovi-
ral drugs from the 3 major drug classes: the data collection on adverse
events of anti-HIV drugs (D:A:D) study. J Infect Dis 2010; 201:
8. SMART/INSIGHT and D:A:D Study Groups. Use of nucleoside
reverse transcriptase inhibitors and risk of myocardial infarction in
HIV-infected patients. AIDS 2008; 22:F17–24.
9. Lang S, Mary-Krause M, Cotte L, et al. Impact of individual antiretro-
viral drugs on the risk of myocardial infarction in human immunode-
ficiency virus-infected patients: a case-control study nested within the
French Hospital Database on HIV ANRS cohort CO4. Arch Intern
Med 2010; 170:1228–38.
10. Durand M, Sheehy O, Baril JG, Lelorier J, Tremblay CL. Relation
between use of nucleosidic reverse transcriptase inhibitors (NRTI) and
risk of acute myocardial infarction (AMI): a nested case control study
using Quebec’s public health insurance database (RAMQ)[poster].
Paper presented at: 5th IAS Conference on HIV Pathogenesis, Treat-
ment, and Prevention. Cape Town, South Africa, July 19–22, 2009.
11. Bedimo R, Westfall A, Drechsler H, Vidiella G, Tebas P. Abacaviruse
and risk of acute myocardial infarction and cerebrovascular disease in
the HAART era [oral presentation]. Paper presented at: 5th IAS Con-
ference on HIV Pathogenesis, Treatment and Prevention. Cape Town,
South Africa, July 19–22, 2009.
12. Triant VA, Regan S, Lee H, Sax PE, Meigs JB, Grinspoon SK. Associa-
tion of immunologic and virologic factors with myocardial infarction
1644 • CID 2013:56 (1 June) • HIV/AIDS
rates in a US healthcare system. J Acquir Immune Defic Syndr 2010; Download full-text
13. Ding X, Andraca-Carrera E, Cooper C, et al. No association of abaca-
vir use with myocardial infarction: findings of an FDA meta-analysis.
J Acquir Immune Defic Syndr 2012; 61:441–7.
14. Thompson MA, Mugavero MJ, Amico KR, et al. Guidelines for im-
proving entry into and retention in care and antiretroviral adherence
for persons with HIV: evidence-based recommendations from an in-
ternational association of physicians in AIDS care panel. Ann Intern
Med 2012; 156:817–33.
15. Framingham Heart Study. A Project of the National heart, lung, and
blood institute and Boston University. Available at: http://www.
framinghamheartstudy.org. Accessed 3 January 2012.
16. National Cholesterol Education Program (NCEP). Third report of the
National Cholesterol Education Program (NCEP) expert panel on de-
tection, evaluation, and treatment of high blood cholesterol in adults
(Adult Treatment Panel III) Executive Summary. 2001.
17. Lima V, Harrigan R, Montaner JS. Increased reporting of detectable
plasma HIV-1 RNA levels at the critical threshold of 50 copies per
milliliter with the TaqMan assay in comparison to the Amplicor
assay. J Acquir Immune Defic Syndr 2009; 51:3–6.
18. Damond F, Roquebert B, Benard A, et al. Human immunodeficiency
virus type 1 (HIV-1) plasma load discrepancies between the Roche
COBAS AMPLICOR HIV-1 MONITOR Version 1.5 and the Roche
COBAS AmpliPrep/COBAS TaqMan HIV-1 assays. J Clin Microbiol
19. Post FA, Moyle GJ, Stellbrink HJ, et al. Randomized comparison of
renal effects, efficacy, and safety with once-daily abacavir/lamivudine
antiretroviral-naive, HIV-1-infected adults: 48-week results from the
ASSERT study. J Acquir Immune Defic Syndr 2010; 55:49–57.
20. Gallant JE, Winston JA, DeJesus E, et al. The 3-year renal safety of a
tenofovir disoproxil fumarate vs a thymidine analogue-containing
regimen in antiretroviral-naive patients. AIDS 2008; 22:2155–63.
21. Madruga JV, Cassetti I, Etzel A, et al. The 10-year safety and efficacy of
tenofovir DF (TDF)-containing HAART in antiretroviral naive patients
[poster P086]. Poster presented at: 10th International Congress on
Drug Therapy in HIV Infection. Glasgow, UK, November 7–11, 2010.
22. Laprise C, Baril JG, Dufresne S, Trottier H. Association between
tenofovir exposure and reduced kidney function in a cohort of HIV-
positive patients: results from 10 years of follow-up. Clin Infect Dis
HIV/AIDS • CID 2013:56 (1 June) • 1645