Tolerance and acceptability of an efavirenz-based regimen in 740 adults (predominantly women) in West Africa.
In sub-Saharan Africa, the position of efavirenz as a first-line nonnucleoside reverse transcriptase inhibitor remains to be discussed. We report here the 6-month efficacy and tolerance of an efavirenz-containing highly active antiretroviral therapy in a large cohort of HIV-1-infected adults. Seven hundred forty highly active antiretroviral therapy-naive adults (74% women; 14% with positive serum HBs antigen and 21% with abnormal baseline transaminase value) started zidovudine + lamivudine + efavirenz. At month 6, 1.2% of them were dead, 87% had undetectable viral load, and 7% had abnormal transaminase value. From months 1 to 6, the percentage of women who were actually using a contraceptive method increased from 58% to 80% (65% intramuscular progesterone and 35% oral estrogen/progesterone combination). The incidence of pregnancy was 2.6/100 woman-years (95% confidence interval, 0.67-4.51), and 86% of pregnant women voluntarily interrupted the pregnancy with no intervention on our part. Before month 6, only 0.8% of patients permanently discontinued efavirenz for severe adverse effects (neurologic, 0.6%; cutaneous, 0.1%; and hepatic, 0.1%). The leading cause of severe morbidity was tuberculosis. Considering the very high hepatic and cutaneous tolerance, efavirenz could be considered as a valuable first-line drug for women of childbearing age who agree to use contraception in sub-Saharan Africa, provided that the risk of teratogenicity should be closely monitored.
Danel
Christine
C
Programme PAC-CI, Abidjan, Côte d'Ivoire, France. christine.danel@pacci.ci
Moh
Raoul
R
Anzian
Amani
A
Abo
Yao
Y
Chenal
Henri
H
Guehi
Calixte
C
Gabillard
Delphine
D
Sorho
Souleymane
S
Rouet
François
F
Eholié
Serge
S
Anglaret
Xavier
X
D000328:Adult; D000480:Alkynes; D019380:Anti-HIV Agents / Q000009:adverse effects / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D048588:Benzoxazines; D015331:Cohort Studies; D003267:Contraception; D007560:Cote d'Ivoire; D003521:Cyclopropanes; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D015497:HIV-1; D015498:HIV-2; D006509:Hepatitis B / Q000097:blood / Q000150:complications; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006801:Humans; D008297:Male; D009422:Nervous System Diseases / Q000139:chemically induced; D010078:Oxazines / Q000009:adverse effects / Q000627:therapeutic use*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000139:chemically induced / Q000517:prevention & control; D000637:Transaminases / Q000097:blood; D016896:Treatment Outcome
D000480:Alkynes; D019380:Anti-HIV Agents; D048588:Benzoxazines; D003521:Cyclopropanes; D006514:Hepatitis B Surface Antigens; D010078:Oxazines; D000637:Transaminases; C098320:efavirenz