title: Comparison of the effectiveness of initial combined antiretroviral therapy with nelfinavir or efavirenz at a university-based outpatient service in Brazil.
abstract: Since there are some concerns about the effectiveness of highly active antiretroviral therapy in developing countries, we compared the initial combination antiretroviral therapy with zidovudine and lamivudine plus either nelfinavir or efavirenz at a university-based outpatient service in Brazil. This was a retrospective comparative cohort study carried out in a tertiary level hospital. A total of 194 patients receiving either nelfinavir or efavirenz were identified through our electronic database search, but only 126 patients met the inclusion criteria. Patients were included if they were older than 18 years old, naive for antiretroviral therapy, and had at least 1 follow-up visit after starting the antiretroviral regimen. Fifty-one of the included patients were receiving a nelfinavir-based regimen and 75 an efavirenz-based regimen as outpatients. Antiretroviral therapy was prescribed to all patients according to current guidelines. By intention-to-treat (missing/switch = failure), after a 12-month period, 65% of the patients in the efavirenz group reached a viral load <400 copies/mL compared to 41% of the patients in the nelfinavir group (P = 0.01). The mean CD4 cell count increase after a 12-month period was also greater in the efavirenz group (195 x 10(6) cells/L) than in the nelfinavir group (119 x 10(6) cells/L; P = 0.002). The efavirenz-based regimen was superior compared to the nelfinavir-based regimen. The low response rate in the nelfinavir group might be partially explained by the difficulty of using a regimen requiring a higher patient compliance (12 vs 3 pills a day) in a developing country.
authors.affiliation: Departamento de Clínica Médica, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil.
authors.forename: T
authors.initials: T
authors.lastname: Vanni
authors.forename: K M
authors.initials: KM
authors.lastname: Morejón
authors.forename: R C
authors.initials: RC
authors.lastname: Santana
authors.forename: L de
authors.initials: Ld
authors.lastname: Melo
authors.forename: S B R L
authors.initials: SB
authors.lastname: Ferrão
authors.forename: A P
authors.initials: AP
authors.lastname: Amorim
authors.forename: G G
authors.initials: GG
authors.lastname: Gaspar
authors.forename: C C
authors.initials: CC
authors.lastname: Ponzi
authors.forename: N A
authors.initials: NA
authors.lastname: Golin
authors.forename: F L
authors.initials: FL
authors.lastname: Custódio
authors.forename: A T D
authors.initials: AT
authors.lastname: Marangoni
authors.forename: C P
authors.initials: CP
authors.lastname: Campos
authors.forename: B A L
authors.initials: BA
authors.lastname: Fonseca
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000480:Alkynes; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D023241:Antiretroviral Therapy, Highly Active; D048588:Benzoxazines / Q000008:administration & dosage; D018791:CD4 Lymphocyte Count; D002985:Clinical Protocols; D015331:Cohort Studies; D003521:Cyclopropanes; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D006801:Humans; D019259:Lamivudine / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D019888:Nelfinavir / Q000008:administration & dosage; D012367:RNA, Viral / Q000097:blood; D012189:Retrospective Studies; D016896:Treatment Outcome; D019562:Viral Load; D015215:Zidovudine / Q000008:administration & dosage
chemical_list: D000480:Alkynes; D019380:Anti-HIV Agents; D048588:Benzoxazines; D003521:Cyclopropanes; D012367:RNA, Viral; D019259:Lamivudine; D015215:Zidovudine; D019888:Nelfinavir; C098320:efavirenz