To print: Select File and then Print from your browser's menu --------------------------------------------------------------------------------------- Title: Efavirenz-Based Therapies Associated With Better Outcomes in HIV Patients in Developing Countries URL: http://www.pslgroup.com/dg/22ECB6.htm Doctor's Guide October 14, 2008
NEW YORK -- October 14, 2008 -- HIV-infected patients in sub-Saharan Africa taking efavirenz are more likely to adhere to treatment and less likely to experience virologic failure and death compared with patients taking nevirapine, according to a study published in the October 18 issue of the journal AIDS. "Our findings add to existing limited evidence that efavirenz-based therapies produce a more favourable virological and clinical outcome than nevirapine," said lead author Jean Nachega, MD, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. "Patients started on nevirapine had an increased risk of virologic failure and death, and were significantly less likely than those started on efavirenz to achieve high treatment adherence." Dr. Nachega and Gary Maartens, MD, University of Cape Town, Cape Town, South Africa, and colleagues examined the records of 2,817 patients with HIV who were enrolled in the Aid for AIDS program in Africa. Program participants were from 9 countries in Africa with the majority in South Africa. Participants were highly active antiretroviral therapy (HAART)-naïve adults who began nevirapine-based or efavirenz-based therapies between January 1998 and September 2004. Researchers determined how often patients requested reimbursement for their purchases of nevirapine- or efavirenz-based HAART to estimate adherence to their treatment regimens. They also evaluated CD4 counts, viral load changes, and mortality. The median follow-up period was 2 years. Results showed that patients started on nevirapine were significantly less likely than those started on efavirenz to achieve high adherence, whether defined as 100% (30.2% vs 38.1%, P < .002) or more than 90% (44.8% vs 49.4%, P < .02) pharmacy-claim adherence. In a multivariate analysis, patients on nevirapine had greater risk of virologic failure (hazard ratio [HR] = 1.52; 95% confidence interval [CI], 1.24-1.86)], death (HR = 2.17; CI, 1.31-3.60), and regimen discontinuation (HR = 1.67; CI, 1.32-2.11). Switching from nevirapine to efavirenz had no significant virologic effect, whereas switching from efavirenz to nevirapine resulted in significantly slower time to suppression (HR = 0.58; 95% CI, 0.35-0.93) and faster time to failure (HR = 3.92; 95% CI, 1.61-9.55) than remaining on efavirenz. "Given the rapid roll-out of antiretroviral programs in Africa and the frequent use of first-line nevirapine-based HAART in such programs the assumption that efavirenz and nevirapine are equally effective needs to be reassessed," said Dr. Nachega. "Based on our results, there is a critical need for a large randomised clinical trial to definitively compare the outcomes of efavirenz and nevirapine and for acceleration of efforts to develop lower cost formulations of efavirenz, including generic, fixed-dose combinations in Africa." SOURCE: Johns Hopkins Bloomberg School of Public Health --------------------------------------------------------------------------------------------- Copyright © 1999 P\S\L Consulting Group Inc. All rights reserved. Republication or redistribution of P\S\L content is expressly prohibited without the prior written consent of P\S\L. P\S\L shall not be liable for any errors, omissions or delays in this content or any other content on its sites, newsletters or other publications, nor for any decisions or actions taken in reliance on such content. --------------------------------------------------------------------------------------------- This news story was printed from *Doctor's Guide to the Internet* located at http://www.docguide.com --------------------------------------------------------------------------------------- Return to News Story Page This site is maintained by webmaster@pslgroup.com Please contact us with any comments, problems or bugs. All contents Copyright (c) 1998 P\S\L Consulting Group Inc. All rights reserved.