title: First-line antiretroviral therapy with efavirenz or lopinavir/ritonavir plus two nucleoside analogues: the SUSKA study, a non-randomized comparison from the VACH cohort.
abstract: BACKGROUND
  Efavirenz and lopinavir/ritonavir are both recommended antiretroviral agents for combination first-line therapy, although information on direct comparisons between them is scarce. A retrospective longitudinal study from the VACH cohort comparing both regimens was performed.
  
  
  METHODS
  Efficacy was examined comparing time to virological failure, CD4 recovery and clinical progression. Tolerability was examined comparing time to treatment discontinuation for any reason and for toxicity. Survival analysis was conducted using the Kaplan-Meier method, and standard and weighted Cox regression models.
  
  
  RESULTS
  A total of 1550 antiretroviral-naive patients starting a two-nucleoside reverse transcriptase inhibitor regimen plus either efavirenz (n = 1159) or lopinavir/ritonavir (n = 391) were included in the study. At baseline, patients starting lopinavir/ritonavir had higher HIV-1 RNA and lower CD4+ cell counts. There was no difference in the adjusted hazards of virological failure [efavirenz versus lopinavir/ritonavir hazard ratio (HR) = 0.93, 95% confidence interval (CI): 0.77-1.12, P = 0.43], CD4 recovery (HR = 1.11, 95% CI: 0.95-1.30, P = 0.19) and clinical progression (HR = 0.71, 95% CI: 0.39-1.31, P = 0.27). There was an increased risk of discontinuation for any reason or for toxicity for lopinavir/ritonavir (HR = 2.10, 95% CI: 1.40-3.15, P = 0.0003). CD4 recovery with both drugs was also similar in the lowest CD4 strata. A higher risk of early hypertriglyceridaemia was associated with lopinavir/ritonavir-based regimens.
  
  
  CONCLUSIONS
  Our study suggests similar virological efficacy for efavirenz- or lopinavir/ritonavir-based first-line antiretroviral regimens, but an increased risk of discontinuation because of toxicity in case of lopinavir/ritonavir-based therapy. Immunological outcome appeared similar with both regimens.
authors: Hospital de la Santa Creu i Sant Pau, Mas Casanovas 90, 08025 Barcelona, Spain. pdomingo@santpau.es
authors: Pere
authors: P
authors: Domingo
authors: Ignacio
authors: I
authors: Suárez-Lozano
authors: Ferran
authors: F
authors: Torres
authors: Ramón
authors: R
authors: Teira
authors: José
authors: J
authors: Lopez-Aldeguer
authors: Francesc
authors: F
authors: Vidal
authors: Agustín
authors: A
authors: Muñoz
authors: Pompeyo
authors: P
authors: Viciana
authors: Fernando
authors: F
authors: Lozano
authors: Antonio
authors: A
authors: Vergara
authors: Bernadino
authors: B
authors: Roca
authors: Ma Luisa
authors: ML
authors: García Alcalde
authors: Jaime
authors: J
authors: Cosín
authors: Alberto
authors: A
authors: Terrón
authors: Ma José
authors: MJ
authors: Galindo
authors: Paloma
authors: P
authors: Geijo
authors: Esteban
authors: E
authors: Ribera
authors: Juan
authors: J
authors: Gonzalez
authors: Trinitario
authors: T
authors: Sanchez
authors: Juan Ramón
authors: JR
authors: Lacalle
authors: Myriam
authors: M
authors: Garrido
mesh_terms: D000328:Adult; D000480:Alkynes; D019380:Anti-HIV Agents / Q000009:adverse effects / Q000627:therapeutic use*; D048588:Benzoxazines / Q000009:adverse effects / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D003521:Cyclopropanes; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality / Q000821:virology; D015497:HIV-1 / Q000302:isolation & purification; D006801:Humans; D015228:Hypertriglyceridemia / Q000139:chemically induced; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D061466:Lopinavir; D008297:Male; D011744:Pyrimidinones / Q000009:adverse effects / Q000627:therapeutic use*; D012367:RNA, Viral / Q000097:blood; D012189:Retrospective Studies; D019438:Ritonavir / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome; D019562:Viral Load; D028761:Withholding Treatment
chemical_list: D000480:Alkynes; D019380:Anti-HIV Agents; D048588:Benzoxazines; D003521:Cyclopropanes; D011744:Pyrimidinones; D012367:RNA, Viral; D061466:Lopinavir; C098320:efavirenz; D019438:Ritonavir