Efavirenz versus boosted atazanavir-containing regimens and immunologic, virologic, and clinical outcomes: A prospective study of HIV-positive individuals.

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/mm 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.

• Authors: Lauren E Cain, Ellen C Caniglia, Andrew Phillips, Ashley Olson, Roberto Muga, Santiago Pérez-Hoyos, Sophie Abgrall, Dominique Costagliola, Rafael Rubio, Inma Jarrín, Heiner Bucher, Jan Fehr, Ard van Sighem, Peter Reiss, François Dabis, Marie-Anne Vandenhende, Roger Logan, James Robins, Jonathan A C Sterne, Amy Justice, Janet Tate, Giota Touloumi, Vasilis Paparizos, Anna Esteve, Jordi Casabona, Rémonie Seng, Laurence Meyer, Sophie Jose, Caroline Sabin, Miguel A Hernán, HIV-CAUSAL Collaboration
• Journal: Medicine (Medicine (Baltimore)) Vol. 95 Issue 41 Pg. e5133 (Oct 2016) ISSN: 1536-5964 [Electronic] United States
• PMID: 27741139 (Publication Type: Journal Article, Multicenter Study, Observational Study)

Chemical References

• Alkynes
• Benzoxazines
• Cyclopropanes
• HIV Protease Inhibitors
• Reverse Transcriptase Inhibitors
• Atazanavir Sulfate
• efavirenz

Topics

• Adult
• Alkynes
• Atazanavir Sulfate (administration & dosage)
• Benzoxazines (administration & dosage)
• Cyclopropanes
• Dose-Response Relationship, Drug
• Europe (epidemiology)
• Female
• Follow-Up Studies
• HIV Protease Inhibitors (administration & dosage)
• HIV Seropositivity (drug therapy, epidemiology, virology)
• HIV-1 (physiology)
• Humans
• Male
• Middle Aged
• Prospective Studies
• Reverse Transcriptase Inhibitors (administration & dosage)
• Treatment Outcome
• United States (epidemiology)
• Viral Load