title: Comparative effectiveness of continuing a virologically effective first-line boosted protease inhibitor combination or of switching to a three-drug regimen containing either efavirenz, nevirapine or abacavir.
abstract: OBJECTIVE
  To compare virological effectiveness in patients who continued on a virologically successful first-line boosted protease inhibitor (PI)-containing combination antiretroviral therapy (cART) regimen or who switched to a PI-free cART including efavirenz, nevirapine or abacavir.
  
  
  METHODS
  From the French Hospital Database on HIV, we selected 439 patients with undetectable viral load (VL) on a first-line boosted PI-containing cART regimen who switched to a PI-free combination including efavirenz, nevirapine or abacavir. Each of these patients was matched with three patients who continued to take their first-line cART regimen, on the basis of gender, age, CD4 cell count, VL, date of cART initiation and the duration of VL undetectability. Time to virological failure (VF) was analysed with Kaplan-Meier curves and Cox models.
  
  
  RESULTS
  The 12 month probabilities of VF were 3.7% and 5.7% in non-switch and switch patients, respectively, and 3.9%, 7.2% and 9.0% in patients switching to efavirenz-, nevirapine- and abacavir-containing cART, respectively. After adjustment, only patients switching to abacavir-containing cART had a higher risk of VF than non-switch patients (adjusted hazard ratio, 1.99; 95% confidence interval, 1.05-3.79).
  
  
  CONCLUSIONS
  Switching from a virologically successful first-line boosted PI-containing cART regimen to a non-nucleoside reverse transcriptase inhibitor-containing cART regimen containing either efavirenz or nevirapine is virologically safe, while switching to abacavir-containing cART should be avoided.
authors.affiliation: INSERM U943, Paris F-75013, France.
authors.forename: T
authors.initials: T
authors.lastname: Bommenel
authors.forename: O
authors.initials: O
authors.lastname: Launay
authors.forename: J L
authors.initials: JL
authors.lastname: Meynard
authors.forename: J
authors.initials: J
authors.lastname: Gilquin
authors.forename: C
authors.initials: C
authors.lastname: Katlama
authors.forename: A S
authors.initials: AS
authors.lastname: Lascaux
authors.forename: A
authors.initials: A
authors.lastname: Mahamat
authors.forename: V
authors.initials: V
authors.lastname: Martinez
authors.forename: C
authors.initials: C
authors.lastname: Pradier
authors.forename: E
authors.initials: E
authors.lastname: Rouveix
authors.forename: A
authors.initials: A
authors.lastname: Simon
authors.forename: D
authors.initials: D
authors.lastname: Costagliola
authors.forename: S
authors.initials: S
authors.lastname: Abgrall
mesh_terms: D000328:Adult; D000480:Alkynes; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D048588:Benzoxazines / Q000008:administration & dosage; D015331:Cohort Studies; D003521:Cyclopropanes; D015224:Dideoxynucleosides / Q000008:administration & dosage; D005260:Female; D006678:HIV / Q000302:isolation & purification*; D015658:HIV Infections / Q000188:drug therapy*; D017320:HIV Protease Inhibitors / Q000008:administration & dosage; D006801:Humans; D008297:Male; D019829:Nevirapine / Q000008:administration & dosage; D011446:Prospective Studies; D016896:Treatment Outcome; D019562:Viral Load; D000099227:Abacavir
chemical_list: D000480:Alkynes; D019380:Anti-HIV Agents; D048588:Benzoxazines; D003521:Cyclopropanes; D015224:Dideoxynucleosides; D017320:HIV Protease Inhibitors; D019829:Nevirapine; D000099227:Abacavir; C098320:efavirenz