title: A comparison of the long-term durability of nevirapine, efavirenz and lopinavir in routine clinical practice in Europe: a EuroSIDA study.
abstract: OBJECTIVE
  The durability of combination antiretroviral therapy (cART) regimens can be measured as time to discontinuation because of toxicity or treatment failure, development of clinical disease or serious long-term adverse events. The aim of this analysis was to compare the durability of nevirapine, efavirenz and lopinavir regimens based on these measures.
  
  
  METHODS
  Patients starting a nevirapine, efavirenz or lopinavir-based cART regimen for the first time after 1 January 2000 were included in the analysis. Follow-up started ≥ 3 months after initiation of treatment if viral load was <500 HIV-1 RNA copies/mL. Durability was measured as discontinuation rate or development/worsening of clinical markers.
  
  
  RESULTS
  A total of 603 patients (21%) started nevirapine-based cART, 1465 (51%) efavirenz, and 818 (28%) lopinavir. After adjustment there was no significant difference in the risk of discontinuation for any reason between the groups on nevirapine and efavirenz (P=0.43) or lopinavir (P=0.13). Compared with the nevirapine group, those on efavirenz had a 48% (P=0.0002) and those on lopinavir a 63% (P<0.0001) lower risk of discontinuation because of treatment failure and a 31% (P=0.01) and 66% (P<.0001) higher risk, respectively, of discontinuation because of toxicities or patient/physician choice. There were no significant differences in the incidence of non-AIDS-related events, worsening anaemia, severe weight loss, increased aspartate aminotransferase (AST)/alanine aminotransferase (ALT) levels or increased total cholesterol. Compared with patients on nevirapine, those on lopinavir had an 80% higher incidence of high-density lipoprotein (HDL) cholesterol decreasing below 0.9 mmol/L (P=0.003), but there was no significant difference in this variable between those on nevirapine and those on efavirenz (P=0.39).
  
  
  CONCLUSIONS
  The long-term durability of nevirapine-based cART, based on risk of all-cause discontinuation and development of long-term adverse events, was comparable to that of efavirenz or lopinavir, in patients in routine clinical practice across Europe who initially tolerated and virologically responded to their regimen.
authors.affiliation: Research Department of Infection & Population Health, University College London Medical School, Royal Free Campus, London, UK. j.reekie@ucl.ac.uk
authors.forename: J
authors.initials: J
authors.lastname: Reekie
authors.forename: P
authors.initials: P
authors.lastname: Reiss
authors.forename: B
authors.initials: B
authors.lastname: Ledergerber
authors.forename: D
authors.initials: D
authors.lastname: Sedlacek
authors.forename: M
authors.initials: M
authors.lastname: Parczewski
authors.forename: J
authors.initials: J
authors.lastname: Gatell
authors.forename: C
authors.initials: C
authors.lastname: Katlama
authors.forename: G
authors.initials: G
authors.lastname: Fätkenheuer
authors.forename: J D
authors.initials: JD
authors.lastname: Lundgren
authors.forename: A
authors.initials: A
authors.lastname: Mocroft
mesh_terms: D000480:Alkynes; D001118:Argentina / Q000453:epidemiology; D048588:Benzoxazines / Q000009:adverse effects / Q000627:therapeutic use*; D003521:Cyclopropanes; D004334:Drug Administration Schedule; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D005060:Europe / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000821:virology; D017320:HIV Protease Inhibitors / Q000627:therapeutic use*; D015497:HIV-1; D006801:Humans; D007557:Israel / Q000453:epidemiology; D061466:Lopinavir; D008297:Male; D019829:Nevirapine / Q000009:adverse effects / Q000627:therapeutic use*; D011446:Prospective Studies; D011744:Pyrimidinones / Q000009:adverse effects / Q000627:therapeutic use*; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D000480:Alkynes; D048588:Benzoxazines; D003521:Cyclopropanes; D017320:HIV Protease Inhibitors; D011744:Pyrimidinones; D018894:Reverse Transcriptase Inhibitors; D061466:Lopinavir; D019829:Nevirapine; C098320:efavirenz