Virological and immunological responses to efavirenz or boosted lopinavir as first-line therapy for patients with HIV.

Details

Serval ID
serval:BIB_E2651DBEF695
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Virological and immunological responses to efavirenz or boosted lopinavir as first-line therapy for patients with HIV.
Journal
Antiviral Therapy
Author(s)
Young J., Bucher H.C., Guenthard H.F., Rickenbach M., Fux C.A., Hirschel B., Cavassini M., Vernazza P., Bernasconi E., Battegay M.
Working group(s)
Swiss HIV Cohort Study
ISSN
1359-6535 (Print)
ISSN-L
1359-6535
Publication state
Published
Issued date
2009
Volume
14
Number
6
Pages
771-779
Language
english
Notes
Publication types: Clinical Trial ; Journal Article ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Abstract
BACKGROUND: Efavirenz and lopinavir boosted with ritonavir are both recommended as first-line therapies for patients with HIV when combined with two nucleoside reverse transcriptase inhibitors. It is uncertain which therapy is more effective for patients starting therapy with an advanced infection.
METHODS: We estimated the relative effect of these two therapies on rates of virological and immunological failure within the Swiss HIV Cohort Study and considered whether estimates depended on the CD4(+) T-cell count when starting therapy. We defined virological failure as either an incomplete virological response or viral rebound after viral suppression and immunological failure as failure to achieve an expected CD4(+) T-cell increase calculated from EuroSIDA statistics.
RESULTS: Patients starting efavirenz (n=660) and lopinavir (n=541) were followed for a median of 4.5 and 3.1 years, respectively. Virological failure was less likely for patients on efavirenz, with the adjusted hazard ratio (95% confidence interval) of 0.63 (0.50-0.78) then multiplied by a factor of 1.00 (0.90-1.12) for each 100 cells/mm(3) decrease in CD4(+) T-cell count below the mean when starting therapy. Immunological failure was also less likely for patients on efavirenz, with the adjusted hazard ratio of 0.68 (0.51-0.91) then multiplied by a factor of 1.29 (1.14-1.46) for each 100 cells/mm(3) decrease in CD4(+) T-cell count below the mean when starting therapy.
CONCLUSIONS: Virological failure is less likely with efavirenz regardless of the CD4(+) T-cell count when starting therapy. Immunological failure is also less likely with efavirenz; however, this advantage disappears if patients start therapy with a low CD4(+) T-cell count.
Keywords
Adult, Anti-HIV Agents/administration & dosage, Anti-HIV Agents/adverse effects, Benzoxazines/administration & dosage, Benzoxazines/adverse effects, Cohort Studies, Female, HIV Infections/drug therapy, Humans, Lopinavir, Male, Prospective Studies, Pyrimidinones/administration & dosage, Pyrimidinones/adverse effects
Pubmed
Web of science
Create date
04/11/2009 15:26
Last modification date
20/08/2019 17:06
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