Efavirenz versus boosted atazanavir-containing regimens and immunologic, virologic, and clinical outcomes : A prospective study of HIV-positive individuals
Cain, Lauren E. (Harvard T.H. Chan School of Public Health (Boston, Estats Units d'Amèrica))
Caniglia, Ellen C. (Harvard T.H. Chan School of Public Health (Boston, Estats Units d'Amèrica))
Phillips, Andrew (University College London)
Olson, Ashley
Muga, Roberto (Institut Germans Trias i Pujol)
Pérez Hoyos, Santiago
Abgrall, Sophie
Costagliola, Dominique
Rubio, Rafael
Jarrín, Inma
Bucher, Heiner
Fehr, Jan
van Sighem, Ard
Reiss, Peter
Dabis, François
Vandenhende, Marie-Anne
Logan, Roger
Robins, James
Sterne, Jonathan A C
Justice, Amy
Tate, Janet
Touloumi, Giota
Paparizos, Vasilis
Esteve, Anna
Casabona-Barbarà, Jordi
Seng, Rémonie
Meyer, Laurence
Jose, Sophie
Sabin, Caroline A
Hernán, Miguel A
HIV CAUSAL Collaboration
Universitat Autònoma de Barcelona. Departament de Medicina

Date:	2016
Description:	11 pàg.
Abstract:	Objective: To compare regimens consisting of either ritonavir-boosted atazanavir or efavirenz and a nucleoside reverse transcriptase inhibitor (NRTI) backbone with respect to clinical, immunologic, and virologic outcomes. Design: Prospective studies of human immunodeficiency virus (HIV)-infected individuals in Europe and the United States included in the HIV-CAUSAL Collaboration. Methods: HIV-positive, antiretroviral therapy-naive, and acquired immune deficiency syndrome (AIDS)-free individuals were followed from the time they started an atazanavir or efavirenz regimen. We estimated an analog of the "intention-to-treat" effect for efavirenz versus atazanavir regimens on clinical, immunologic, and virologic outcomes with adjustment via inverse probability weighting for time-varying covariates. Results: A total of 4301 individuals started an atazanavir regimen (83 deaths, 157 AIDS-defining illnesses or deaths) and 18,786 individuals started an efavirenz regimen (389 deaths, 825 AIDS-defining illnesses or deaths). During a median follow-up of 31 months, the hazard ratios (95% confidence intervals) were 0. 98 (0. 77, 1. 24) for death and 1. 09 (0. 91, 1. 30) for AIDS-defining illness or death comparing efavirenz with atazanavir regimens. The 5-year survival difference was 0. 1% (95% confidence interval: −0. 7%, 0. 8%) and the AIDS-free survival difference was −0. 3% (−1. 2%, 0. 6%). After 12 months, the mean change in CD4 cell count was 20. 8 (95% confidence interval: 13. 9, 27. 8) cells/mm3 lower and the risk of virologic failure was 20% (14%, 26%) lower in the efavirenz regimens. Conclusion: Our estimates are consistent with a smaller 12-month increase in CD4 cell count, and a smaller risk of virologic failure at 12 months for efavirenz compared with atazanavir regimens. No overall differences could be detected with respect to 5-year survival or AIDS-free survival.
Note:	Altres ajuts: NIH R01-AI073127, U10-AA013566; MRC G0700820
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Atazanavir ; Efavirenz ; HIV ; Mortality ; Observational studies ; SDG 3 - Good Health and Well-being
Published in:	Medicine, Vol. 95 Núm. 41 (2016) , art. e5133, ISSN 1536-5964

DOI: 10.1097/MD.0000000000005133
PMID: 27741139

11 p, 299.2 KB

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Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Institut d'Investigació en Ciencies de la Salut Germans Trias i Pujol (IGTP)
Articles > Research articles
Articles > Published articles