TY - JOUR
T1 - The effect of efavirenz versus nevirapine-containing regimens on immunologic, virologic and clinical outcomes in a prospective observational study
AU - AUTHOR GROUP
AU - Cain, Lauren E.
AU - Phillips, Andrew
AU - Lodi, Sara
AU - Sabin, Caroline
AU - Bansi, Loveleen
AU - Justice, Amy
AU - Tate, Janet
AU - Logan, Roger
AU - Robins, James M.
AU - Sterne, Jonathan A. C.
AU - van Sighem, Ard
AU - de Wolf, Frank
AU - Bucher, Heiner C.
AU - Elzi, Luigia
AU - Touloumi, Giota
AU - Vourli, Georgia
AU - Esteve, Anna
AU - Casabona, Jordi
AU - del Amo, Julia
AU - Moreno, Santiago
AU - Seng, Rémonie
AU - Meyer, Laurence
AU - Pérez-Hoyos, Santiago
AU - Muga, Roberto
AU - Abgrall, Sophie
AU - Costagliola, Dominique
AU - Hernán, Miguel A.
AU - Ainsworth, J.
AU - Anderson, J.
AU - Babiker, A.
AU - Chadwick, D.
AU - Delpech, V.
AU - Dunn, D.
AU - Gras, L. A. J.
AU - Prins, J. M.
AU - Boer, K.
AU - Bos, J. C.
AU - Geerlings, S. E.
AU - Godfried, M. H.
AU - Kuijpers, T. W.
AU - Lange, J. M. A.
AU - van der Meer, J. T. M.
AU - Nellen, F. J. B.
AU - Pajkrt, D.
AU - van der Poll, T.
AU - Reiss, P.
AU - Scherpbier, H. J.
AU - van der Valk, M.
AU - van Vugt, M.
AU - Wit, F. W. M. N.
PY - 2012
Y1 - 2012
N2 - 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. Prospective studies of HIV-infected individuals in Europe and the US included in the HIV-CAUSAL Collaboration. 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. 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/μl and were 52% more likely to have virologic failure at 12 months as those on efavirenz regimens. 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
AB - 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. Prospective studies of HIV-infected individuals in Europe and the US included in the HIV-CAUSAL Collaboration. 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. 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/μl and were 52% more likely to have virologic failure at 12 months as those on efavirenz regimens. 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
U2 - https://doi.org/10.1097/QAD.0b013e328354f497
DO - https://doi.org/10.1097/QAD.0b013e328354f497
M3 - Article
C2 - 22546987
SN - 0269-9370
VL - 26
SP - 1691
EP - 1705
JO - AIDS (London, England)
JF - AIDS (London, England)
IS - 13
ER -