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Efavirenz versus boosted atazanavir-containing regimens and immunologic, virologic, and clinical outcomesA prospective study of HIV-positive individuals

Type of publication Peer-reviewed
Publikationsform Original article (peer-reviewed)
Author Cain Lauren E., Caniglia Ellen C., Phillips Andrew, Olson Ashley, Muga Roberto, 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, et al. ,
Project Swiss HIV Cohort Study (SHCS)
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Original article (peer-reviewed)

Journal Medicine
Volume (Issue) 95(41)
Page(s) e5133 - e5133
Title of proceedings Medicine
DOI 10.1097/md.0000000000005133

Open Access

URL https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5072966/
Type of Open Access Repository (Green Open Access)

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.
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