The effect of efavirenz versus nevirapine-containing regimens on immunologic, virologic and clinical outcomes in a prospective observational study

HIV CAUSAL, collaboration (2012). The effect of efavirenz versus nevirapine-containing regimens on immunologic, virologic and clinical outcomes in a prospective observational study. AIDS, 26(13), pp. 1691-705. Hagerstown, Md.: Lippincott Williams & Wilkins 10.1097/QAD.0b013e328354f497

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OBJECTIVE: To compare regimens consisting of either efavirenz or nevirapine and two or more nucleoside reverse transcriptase inhibitors (NRTIs) among HIV-infected, antiretroviral-naive, and AIDS-free individuals with respect to clinical, immunologic, and virologic outcomes. DESIGN: Prospective studies of HIV-infected individuals in Europe and the US included in the HIV-CAUSAL Collaboration. METHODS: Antiretroviral therapy-naive and AIDS-free individuals were followed from the time they started an NRTI, efavirenz or nevirapine, classified as following one or both types of regimens at baseline, and censored when they started an ineligible drug or at 6 months if their regimen was not yet complete. We estimated the 'intention-to-treat' effect for nevirapine versus efavirenz regimens on clinical, immunologic, and virologic outcomes. Our models included baseline covariates and adjusted for potential bias introduced by censoring via inverse probability weighting. RESULTS: A total of 15 336 individuals initiated an efavirenz regimen (274 deaths, 774 AIDS-defining illnesses) and 8129 individuals initiated a nevirapine regimen (203 deaths, 441 AIDS-defining illnesses). The intention-to-treat hazard ratios [95% confidence interval (CI)] for nevirapine versus efavirenz regimens were 1.59 (1.27, 1.98) for death and 1.28 (1.09, 1.50) for AIDS-defining illness. Individuals on nevirapine regimens experienced a smaller 12-month increase in CD4 cell count by 11.49 cells/mul and were 52% more likely to have virologic failure at 12 months as those on efavirenz regimens. CONCLUSIONS: Our intention-to-treat estimates are consistent with a lower mortality, a lower incidence of AIDS-defining illness, a larger 12-month increase in CD4 cell count, and a smaller risk of virologic failure at 12 months for efavirenz compared with nevirapine.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Gynaecology, Paediatrics and Endocrinology (DFKE) > Clinic of Paediatric Medicine

UniBE Contributor:

Aebi, Christoph

ISSN:

0269-9370

ISBN:

1473-5571 (Electroni

Publisher:

Lippincott Williams & Wilkins

Language:

English

Submitter:

Anette van Dorland

Date Deposited:

04 Oct 2013 14:40

Last Modified:

05 Dec 2022 14:12

Publisher DOI:

10.1097/QAD.0b013e328354f497

Web of Science ID:

000307532100013

Additional Information:

HIV-CAUSAL Collaboration;G0700820/Medical Research Council/United Kingdom;P30 MH062294/MH/NIMH NIH HHS/;P30-MH062294/MH/NIMH NIH HHS/;R01 AI073127/AI/NIAID NIH HHS/;R01 HL090342/HL/NHLBI NIH HHS/;R01 HL095136/HL/NHLBI NIH HHS/;R01-AI073127/AI/NIAID NIH HHS/;R01-HL090342/HL/NHLBI NIH HHS/;R01-HL095136/HL/NHLBI NIH HHS/;R01-HS018372/HS/AHRQ HHS/;RCI-HL100347/HL/NHLBI NIH HHS/;U01 AA020790/AA/NIAAA NIH HHS/;U01-A1069918/PHS HHS/;U01-AA020790/AA/NIAAA NIH HHS/;U10 AA013566/AA/NIAAA NIH HHS/;U10-AA013566/AA/NIAAA NIH HHS/;U24 AA020794/AA/NIAAA NIH HHS/;U24-AA020794/AA/NIAAA NIH HHS/;England;London, England;AIDS. 2012 Aug 24;26(13):1691-705.

URI:

https://boris.unibe.ch/id/eprint/16496 (FactScience: 224146)

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