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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Efavirenz versus boosted atazanavir-containing regimens and immunologic, virologic, and clinical outcomes: A prospective study of HIV-positive individuals
Medicine (United States), Volume 95, No. 41, Article e5133, Year 2016
Notification
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Description
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. © 2016 the Author(s). Published by Wolters Kluwer Health, Inc. All rights reserved.
Authors & Co-Authors
Cain, Lauren E.
United States, Boston
Harvard T.h. Chan School of Public Health
Caniglia, Ellen C.
United States, Boston
Harvard T.h. Chan School of Public Health
Phillips, Andrew N.
United States, Boston
Harvard T.h. Chan School of Public Health
Olson, Ashley D.
United States, Boston
Harvard T.h. Chan School of Public Health
Muga, Roberto
United States, Boston
Harvard T.h. Chan School of Public Health
Pérez-Hoyos, Santiago
United States, Boston
Harvard T.h. Chan School of Public Health
Abgrall, Sophie
United States, Boston
Harvard T.h. Chan School of Public Health
Jarrín, Inma
United States, Boston
Harvard T.h. Chan School of Public Health
Bucher, Heíner C.C.
United States, Boston
Harvard T.h. Chan School of Public Health
Fehr, Jan Sven
United States, Boston
Harvard T.h. Chan School of Public Health
van Sighem, Ard I.
United States, Boston
Harvard T.h. Chan School of Public Health
Reiss, Peter
United States, Boston
Harvard T.h. Chan School of Public Health
Dabis, Franćois Ç.Ois
United States, Boston
Harvard T.h. Chan School of Public Health
Vandenhende, Marianne
United States, Boston
Harvard T.h. Chan School of Public Health
Logan, Roger W.
United States, Boston
Harvard T.h. Chan School of Public Health
Robins, James M.
United States, Boston
Harvard T.h. Chan School of Public Health
Sterne, Jonathan A.C.
United States, Boston
Harvard T.h. Chan School of Public Health
Justice, Amy C.
United States, Boston
Harvard T.h. Chan School of Public Health
Tate, Janet P.
United States, Boston
Harvard T.h. Chan School of Public Health
Touloumi, Giota
United States, Boston
Harvard T.h. Chan School of Public Health
Casabona, Jordi
United States, Boston
Harvard T.h. Chan School of Public Health
Seng, Rémonie
United States, Boston
Harvard T.h. Chan School of Public Health
Meyer, Laurence J.
United States, Boston
Harvard T.h. Chan School of Public Health
Sabin, Caroline Anne
United States, Boston
Harvard T.h. Chan School of Public Health
Hernán, Miguel A.
United States, Boston
Harvard T.h. Chan School of Public Health
Ainsworth, Jonathan
Unknown Affiliation
Anderson, Jane
Unknown Affiliation
Babiker, Abdel G.A.G.
Unknown Affiliation
Delpech, Valerie
Unknown Affiliation
Dunn, David T.
Unknown Affiliation
Fisher, Martin
Unknown Affiliation
Gazzard, Brian G.
Unknown Affiliation
Gilson, Richard John Cary
Unknown Affiliation
Gompels, Mark
Unknown Affiliation
Hill, Teresa
Unknown Affiliation
Johnson, Margaret A.
Unknown Affiliation
Leen, Clifford L.S.
United Kingdom, Edinburgh
Nhs Lothian
Morris, Lynn G.
Unknown Affiliation
Sachikonye, Memory
Unknown Affiliation
Schwenk, Achim
Unknown Affiliation
Walsh, John Frank
Unknown Affiliation
Hill, Teresa
United Kingdom, London
University College London
Huntington, Susie E.
United Kingdom, London
University College London
Jose, Sophie
United Kingdom, London
University College London
Phillips, Andrew N.
United Kingdom, London
University College London
Sabin, Caroline A.
United Kingdom, London
University College London
Thornton, Alicia Claire
United Kingdom, London
University College London
Dunn, David D.
United Kingdom, London
Medical Research Council
Glabay, Adam J.
United Kingdom, London
Medical Research Council
Orkin, Chloë M.
United Kingdom, London
Barts Health Nhs Trust
Lynch, Janet
United Kingdom, London
Barts Health Nhs Trust
Hand, James
United Kingdom, London
Barts Health Nhs Trust
de Souza, Carl B.S.S.
United Kingdom, London
Barts Health Nhs Trust
Fisher, Martin J.
United Kingdom, Worthing
University Hospitals Sussex Nhs Foundation Trust
Perry, Nicky
United Kingdom, Worthing
University Hospitals Sussex Nhs Foundation Trust
Tilbury, Stuart
United Kingdom, Worthing
University Hospitals Sussex Nhs Foundation Trust
Churchill, Duncan R.
United Kingdom, Worthing
University Hospitals Sussex Nhs Foundation Trust
Gazzard, Bg S.
United Kingdom, London
Chelsea and Westminster Hospital Nhs Foundation Trust
Nelson, Mark Richard
United Kingdom, London
Chelsea and Westminster Hospital Nhs Foundation Trust
Waxman, Matthew
United Kingdom, London
Chelsea and Westminster Hospital Nhs Foundation Trust
Asboe, David
United Kingdom, London
Chelsea and Westminster Hospital Nhs Foundation Trust
Mandalia, Sundhiya
United Kingdom, London
Chelsea and Westminster Hospital Nhs Foundation Trust
Delpech, Valerie C.
United Kingdom, London
Public Health England
Anderson, Jane S.C.
United Kingdom, London
Homerton University Hospital Nhs Foundation Trust
Munshi, Sajid
United Kingdom, London
Homerton University Hospital Nhs Foundation Trust
Awosika, Damilola D.
United Kingdom, London
Homerton University Hospital Nhs Foundation Trust
Post, Frank A.
United Kingdom, London
King's College Hospital
Korat, Hardik
United Kingdom, London
King's College Hospital
Taylor, Christopher B.
United Kingdom, London
King's College Hospital
Gleisner, Zachary
United Kingdom, London
King's College Hospital
Ibrahim, Fowzia A.
United Kingdom, London
King's College Hospital
Campbell, Lucy J.
United Kingdom, London
King's College Hospital
Brima, Nataliya
United Kingdom, London
University College London
Williams, Ian G.
United Kingdom, London
University College London
Gompels, Mark M.
United Kingdom, Bristol
North Bristol Nhs Trust
Allen, Sam H.
United Kingdom, Bristol
North Bristol Nhs Trust
Schwenk, Achim
United Kingdom, London
North Middlesex University Hospital Nhs Trust
Ainsworth, Jonathan G.
United Kingdom, London
North Middlesex University Hospital Nhs Trust
Wood, Christopher W.
United Kingdom, London
North Middlesex University Hospital Nhs Trust
Miller, Sheila
United Kingdom, London
North Middlesex University Hospital Nhs Trust
Johnson, Margaret A.
United Kingdom, London
Royal Free London Nhs Foundation Trust
Youle, Mike S.
United Kingdom, London
Royal Free London Nhs Foundation Trust
Lampe, Fiona C.
United Kingdom, London
Royal Free London Nhs Foundation Trust
Smith, Colette Joanne
United Kingdom, London
Royal Free London Nhs Foundation Trust
Grabowska, Helen
United Kingdom, London
Royal Free London Nhs Foundation Trust
Chaloner, Clinton
United Kingdom, London
Royal Free London Nhs Foundation Trust
Puradiredja, Dewi Ismajani
United Kingdom, London
Royal Free London Nhs Foundation Trust
Walsh, John Christopher
United Kingdom, London
Imperial College Healthcare Nhs Trust
MacKie, Nicola E.
United Kingdom, London
Imperial College Healthcare Nhs Trust
Winston, Alan
United Kingdom, London
Imperial College Healthcare Nhs Trust
Weber, Jonathan N.
United Kingdom, London
Imperial College Healthcare Nhs Trust
Ramzan, Farhan
United Kingdom, London
Imperial College Healthcare Nhs Trust
Wilson, Alan C.
United Kingdom, Edinburgh
Nhs Lothian
Palfreeman, Adrian J.
United Kingdom, Leicester
University Hospitals of Leicester Nhs Trust
Fox, Lynn
United Kingdom, Leicester
University Hospitals of Leicester Nhs Trust
Chadwick, David Robert
United Kingdom, Middlesbrough
South Tees Hospitals Nhs Foundation Trust
Baillie, Kirsty
United Kingdom, Middlesbrough
South Tees Hospitals Nhs Foundation Trust
Kegg, Stephen
United Kingdom
Woolwich Nhs Trust
Main, Paul
United Kingdom
Woolwich Nhs Trust
Allan, Sue
Unknown Affiliation
Hay, Phillip E.
United Kingdom
St George’s Nhs Trust
Dhillon, Mandip
United Kingdom
St George’s Nhs Trust
Martin, Fabiola
Unknown Affiliation
Statistics
Citations: 3
Authors: 103
Affiliations: 18
Identifiers
Doi:
10.1097/MD.0000000000005133
ISSN:
00257974
Research Areas
Environmental
Infectious Diseases
Study Design
Cohort Study