Switching from protease inhibitors to efavirenz: differences in efficacy and tolerance among risk groups: a case-control study from the Swiss HIV Cohort

Détails

ID Serval
serval:BIB_016EC29FEF40
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Switching from protease inhibitors to efavirenz: differences in efficacy and tolerance among risk groups: a case-control study from the Swiss HIV Cohort
Périodique
AIDS
Auteur(s)
Hirschel  B., Flepp  M., Bucher  H. C., Zellweger  C., Telenti  A., Wagels  T., Bernasconi  E., Ledergerber  B.
ISSN
0269-9370 (Print)
Statut éditorial
Publié
Date de publication
02/2002
Volume
16
Numéro
3
Pages
381-5
Notes
Journal Article
Research Support, Non-U.S. Gov't --- Old month value: Feb 15
Résumé
OBJECTIVES: Many patients have simplified their therapy by replacing protease inhibitors (PI) with efavirenz. In a large cohort study representative of clinical practice, we compared outcomes in patients who replaced PI with efavirenz (switchers), with patients who continued on PI (non-switchers). We investigated the likelihood of virological failure in switchers and non-switchers, and the tolerance of efavirenz-containing regimens in different transmission risk groups. DESIGN, SETTING, AND METHODS: Using the database of the Swiss HIV Cohort Study, we identified patients who switched from PI-containing to efavirenz-containing highly active antiretroviral therapy for reasons of tolerance, toxicity, or convenience. Switchers were matched to non-switchers on the basis of calendar time, CD4 cell count, and viral load. RESULTS: The probability of virological failure was less in patients who switched to efavirenz values after one year: 9.4% [95% confidence interval (CI) 5.5-15.9] versus 27.2% (95% CI 21.5-34.1), odds ratio (OR) for failure 0.34. The effect was more pronounced when injection drug users (IDU) were omitted from the analysis (OR 0.19, 95% CI 0.09-0.43); it was absent in IDU (OR 0.95, 95% CI 0.44-2.04). IDU stopped efavirenz more frequently during the first 2 months of treatment than non-IDU [22.6% (95% CI 11.5-41.6) versus 6.6% (95% CI 3.6-11.8) at 2 months]. No difference between IDU and non-IDU was evident when the frequency of stopping indinavir or nelfinavir was measured. CONCLUSION: Switchers had less virological failure and less chance of further treatment changes than non-switchers. However, efavirenz was less successful in IDU than in other transmission categories.
Mots-clé
Adult CD4 Lymphocyte Count Case-Control Studies Cohort Studies Drug Tolerance Female HIV Infections/complications/*drug therapy/immunology/virology HIV Protease Inhibitors/adverse effects/*therapeutic use HIV-1/drug effects/isolation & purification Humans Male Oxazines/adverse effects/*therapeutic use RNA, Viral/blood Reverse Transcriptase Inhibitors/adverse effects/*therapeutic use Substance Abuse, Intravenous/complications Switzerland
Pubmed
Web of science
Création de la notice
25/01/2008 15:45
Dernière modification de la notice
03/03/2018 13:14
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