title: Treatment outcomes of recommended first-line antiretroviral regimens in resource-limited clinics.
abstract: BACKGROUND
  Although used globally, little data exist on the efficacy of nevirapine (NVP) used in combination with tenofovir (TDF)/emtricitabine or lamivudine (XTC), and no large randomized prospective control trials exists comparing this combination with efavirenz (EFV)/TDF/(XTC).
  
  
  METHODS
  As part of the AIDSRelief program, a retrospective review of patient medical chart information along with a cross-sectional viral load, and adherence measurement was conducted between 2004 and 2009. An on-treatment analysis excluded patients who died, transferred out of care, or were lost to follow-up. A switch of antiretrovirals for any reason was considered a failure in the intent-to-treat analysis. Patients with only clinically relevant reasons for switching such as toxicity, adverse effects, viral failure or clinical/immunological failure, lost to follow-up, and death were considered failures as part of the modified-intent-to-treat analysis. Step-wise multiple regression analysis was used to identify variables that were associated with viral suppression.
  
  
  RESULTS
  A random sample of 3862 patients met criteria and were included in this analysis. In the on-treatment analysis, older age (P < 0.004) and baseline CD4 <100 cells per cubic millimeter (P < 0.021) were the most significant variables impacting viral load. Patients on TDF/XTC/EFV achieved higher rates of viral suppression compared with patients on TDF/XTC/NVP or azidothymidine (AZT)/lamivudine (3TC)/NVP.
  
  
  CONCLUSIONS
  Our data show that patients on TDF/XTC/EFV had better outcomes than patients on TDF/XTC/NVP, AZT/3TC/EFV, or AZT/3TC/NVP. High rates of virologic suppression seen in patients on this regimen are consistent with previous studies and indicate the need to increase use of this regimen in HIV programs to promote sustainable viral suppression over time.
authors.affiliation: Institute of Human Virology, Clinical Division, Baltimore, MD 21201, USA.
authors.forename: Anthony
authors.initials: A
authors.lastname: Amoroso
authors.forename: Martine
authors.initials: M
authors.lastname: Etienne-Mesubi
authors.forename: Anthony
authors.initials: A
authors.lastname: Edozien
authors.forename: Sylvia
authors.initials: S
authors.lastname: Ojoo
authors.forename: Robert
authors.initials: R
authors.lastname: Sheneberger
authors.forename: Michael
authors.initials: M
authors.lastname: Obiefune
authors.forename: Mian Bazle
authors.initials: MB
authors.lastname: Hossain
authors.forename: Kristen
authors.initials: K
authors.lastname: Stafford
authors.forename: Robert R
authors.initials: RR
authors.lastname: Redfield
mesh_terms: D000225:Adenine / Q000008:administration & dosage / Q000031:analogs & derivatives; D000328:Adult; D000367:Age Factors; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000191:economics; D018791:CD4 Lymphocyte Count; D003430:Cross-Sectional Studies; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D003906:Developing Countries; D016527:Drug Costs; D004359:Drug Therapy, Combination; D000068679:Emtricitabine; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000191:economics / Q000276:immunology / Q000821:virology; D006801:Humans; D019259:Lamivudine / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D019829:Nevirapine / Q000008:administration & dosage; D063065:Organophosphonates / Q000008:administration & dosage; D012189:Retrospective Studies; D000068698:Tenofovir; D016896:Treatment Outcome; D019562:Viral Load / Q000187:drug effects; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D063065:Organophosphonates; D003841:Deoxycytidine; D019259:Lamivudine; D019829:Nevirapine; D000068698:Tenofovir; D000068679:Emtricitabine; D000225:Adenine