TY - JOUR
T1 - The relation between efavirenz versus nevirapine and virologic failure in Johannesburg, South Africa
AU - Shearer, Kate
AU - Brennan, Alana T.
AU - Maskew, Mhairi
AU - Long, Lawrence
AU - Berhanu, Rebecca
AU - Sanne, Ian
AU - Fox, Matthew P.
N1 - Publisher Copyright:
©2014 Shearer K et al.
PY - 2014/10/22
Y1 - 2014/10/22
N2 - Introduction: Previous research has raised concerns that patients given nevirapine (NVP)-based regimens experience more virologic failure than patients given efavirenz (EFV)-based regimens. We investigated this hypothesis in a cohort of HIV-positive patients at a large HIV treatment clinic in South Africa.Methods: All antiretroviral therapy (ART)-naïve non-pregnant patients,≥18 years old, without tuberculosis, who initiated treatment with either NVP or EFV from April 2004 to August 2011 at the Themba Lethu Clinic in Johannesburg, South Africa, were included. Log-binomial regression and modified Poisson regression were used to estimate risk ratios (RR) with 95% confidence intervals (CI) for predictors of virologic failure, virologic suppression, and loss to follow-up (LTF), whereas a Cox proportional hazards model was used to estimate the risk of death, all within one year.Results: Of 12,840 included patients, 62.0% were female and the median baseline CD4 count was 98 cells/mm3 (36-169). Of these patients, 93.2% initiated an EFV-based regimen. After adjusting for baseline characteristics, no difference in death (adjusted Hazards Ratio (aHR): 0.92; 95% CI: 0.68-1.25), LTF (adjusted Risk Ratio (aRR): 1.00; 95% CI: 0.79-1.25), nor suppression (aRR: 0.98; 95% CI: 0.95-1.00) at one year was found between regimens. Among patients with ≥1 viral load ≥4 months after ART initiation, 4% (n-350) experienced virologic failure within 12 months of initiation. Patients initiating NVP-based regimens were 60% more likely to fail than patients initiating EFV-based regimens (aRR: 1.58; 95% CI: 1.13-2.22).Conclusions: In this cohort, patients initiating NVP-based regimens experienced more virologic failure than patients initiating EFV-based regimens. Future guidelines should consider the implications of different efficacy profiles when making recommendations for which drugs to prioritize.
AB - Introduction: Previous research has raised concerns that patients given nevirapine (NVP)-based regimens experience more virologic failure than patients given efavirenz (EFV)-based regimens. We investigated this hypothesis in a cohort of HIV-positive patients at a large HIV treatment clinic in South Africa.Methods: All antiretroviral therapy (ART)-naïve non-pregnant patients,≥18 years old, without tuberculosis, who initiated treatment with either NVP or EFV from April 2004 to August 2011 at the Themba Lethu Clinic in Johannesburg, South Africa, were included. Log-binomial regression and modified Poisson regression were used to estimate risk ratios (RR) with 95% confidence intervals (CI) for predictors of virologic failure, virologic suppression, and loss to follow-up (LTF), whereas a Cox proportional hazards model was used to estimate the risk of death, all within one year.Results: Of 12,840 included patients, 62.0% were female and the median baseline CD4 count was 98 cells/mm3 (36-169). Of these patients, 93.2% initiated an EFV-based regimen. After adjusting for baseline characteristics, no difference in death (adjusted Hazards Ratio (aHR): 0.92; 95% CI: 0.68-1.25), LTF (adjusted Risk Ratio (aRR): 1.00; 95% CI: 0.79-1.25), nor suppression (aRR: 0.98; 95% CI: 0.95-1.00) at one year was found between regimens. Among patients with ≥1 viral load ≥4 months after ART initiation, 4% (n-350) experienced virologic failure within 12 months of initiation. Patients initiating NVP-based regimens were 60% more likely to fail than patients initiating EFV-based regimens (aRR: 1.58; 95% CI: 1.13-2.22).Conclusions: In this cohort, patients initiating NVP-based regimens experienced more virologic failure than patients initiating EFV-based regimens. Future guidelines should consider the implications of different efficacy profiles when making recommendations for which drugs to prioritize.
KW - Efavirenz
KW - Loss to follow-up
KW - Mortality
KW - Nevirapine
KW - Resource-limited settings
KW - Viral suppression
KW - Virologic failure
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U2 - 10.7448/IAS.17.1.19065
DO - 10.7448/IAS.17.1.19065
M3 - Article
C2 - 25361827
AN - SCOPUS:84908252052
SN - 1758-2652
VL - 17
JO - Journal of the International AIDS Society
JF - Journal of the International AIDS Society
M1 - 19065
ER -